Grand Rounds Recap - 6/8/16

Air Care Grand Rounds/Cadaver lab

We took the opportunity to get down to the University of Cincinnati cadaver lab to review and practice common and uncommon procedures performed on Air Care.

See the following links for instructional posts and videos for these procedures:

Plain Radiography of the Knee with Dr. Shaw

See Dr. Shaw's post titled Clinical Approach to Knee Radiographs.

Taming the SRU Case Follow up - Approach to the Poisoned Patient with Dr. Riddle

Treating poisoned patients begins with the ABC's.

Get an accurate drug history, either from EMS, family, or patient. Encourage EMS to bring bottles, etc. from scene.

Treating TCA overdose: 

  • Sodium bicarb is most important treatment for symptomatic patients: give a bolus and then start a drip
  • Give benzos for agitation or seizures
  • Use norepinephrine for hypotension

Pharmacology ≠ toxicology. In overdose, drugs lose their receptor specificity and you should treat your clinical picture.

Pharmacokinetics ≠ toxicokinetics. At overdose levels, drugs can take much longer than expected to clear.

Baclofen overdose can mimic brain death. In overdose, baclofen can have a profoundly extended half-life with reports of patients taking a week to return to baseline.

UC EM/ CCHMC PEM Combined Simulation

15 day old M infant presents via EMS with concerns for lethargy and altered mental status. Parents called 911 after noticing that their child was less responsive this morning. He did not feed well yesterday and has been vomiting. He would not wake up to feed this morning and they were concerned...

In the simulation, the child is lethargic (altered), hypotensive and tachycardic with the following lab abnormalities:

pH 7.09/pCO2 32/BD-12; Na 119, K 7.5, iCa 1.0, Hct 45, glucose 26

The diagnosis is CAH (Congenital Adrenal Hyperplasia)

  • Congenital Adrenal Hyperplasia classically presents from 2-5 weeks of life and has the classic findings of adrenal insufficiency on metabolic panel (hyponatremia, hyperkalemia, and hypoglycemia)
  • Patients with CAH often tolerate hyperkalemia better than adults because of chronicity of the rise in potassium
  • Try to draw metabolic labs before treating the metabolic abnormalities (i.e. glucose and steroids) in CAH