Tamingthesru
Grand Rounds Recap - 4/29/15
Morbidity and Mortality Conference with Dr. Stull
1. Pericardiocentesis tips and tricks
- Your needle should be at a 45 degree angle when entering the chest at the xyphoid process, aim to the L shoulder/scapula
- Use a spinal needle and keep the stylet in while entering the skin in order to prevent needle clogging
- Keep head of bed at 30 degrees to encourage the fluid to drain inferiorly
- Can attach an EKG lead to the needle by an alligator clip. You will get an ST elevation in that lead if you hit the myocardium
- Can use an A.line kit to place a catheter into the pericardium for continuous drainage
- US probe position: subxyphoid
- How to Video on TamingtheSRU - http://www.tamingthesru.com/blog/acmc/pericardiocentesis
Grand Rounds Recap - 4/22/15
Oral Boards Practice Cases
Case 1 - 22 yo F in a "coma" with normal vital signs. Not responding to Narcan and Dextrose. Found in a garage. On exam, she has sluggish and dilated pupils. pH 6.98, pCO2 29, bicarb 2
High concern for toxic alcohol ingestion: consult DPIC and nephrology for dialysis
- Fomepizole is the antidote for ethylene glycol only
- Can use ethanol drip to treat both ethylene glycol and methanol
- Replace folate aggressively and early
- Methanol is metabolized to formic acid, if you give folate you can prevent methanol from going down the formic acid pathway
Grand Rounds Recap - 4/15/15
Ocular Emergencies with Dr. Titone
Blood supply to the eye is from the Internal Carotid and drainage is through cavernous sinus. Bony eye septum is an improtant structure that separates the superficial structures from the deeper structures that have direct communications with the brain.
Key historical factors: recent eye procedures, eye drop use, contact lens use, occupational history, UV ligh exposure