Tamingthesru
Grand Rounds Recap 12/9/15
Glucose Emergencies
Remember the "I's" when looking for cause of DKA/HHS: Infection, Insulin lack, Infarction (MI, CVA, Ischemic gut), Indiscretion (EtOH, cocaine), Infant (pregnancy).
After 2L NS fluid bolus in the hemodynamically stable patient, the corrected sodium should guide fluid choice for further therapy.
Venous pH, HCO3 and base excess have sufficient agreement to be interchangeable with ABG in the ED.
Grand Rounds Recap 12/2/15
Air Care Ground Rounds
Dr. Hinckley - Air Medical Resource Management
Familiarity and complacency can lead to mistakes. Stay uncomfortable. A policy for preflight walk-a-rounds will be released shortly.
E-poc blood gas analyzer is now on AirCare. Think about using it for all patients, but particularly those who are intubated or may be in a state of shock.
Dr. Powell - Minnesota Tube is coming to AirCare
Everything you need will be in the Critical Care bag. You can bring all the gear with you into the hospital without having to gather supplies there. No football helmet required.
CSF Evaluation in Subarachnoid Hemorrhage
So, what constitutes a “positive” tap when evaluating for subarachnoid hemorrhage?
Traditional teaching is that a positive tap is Xanthochromia or blood in the CSF
What exactly is Xanthochromia?
The word xanthochromia is simply Greek for “yellow color.” It refers to the yellow color that CSF can take in certain situations. Some of these situations are listed below:
- Elevated CSF protein
- Jaundice
- Hypervitaminosis A
- Rifampin Therapy
- Elevated Bilirubin
- Oxyhemoglobin
What we are especially interested in when evaluating for subarachnoid hemorrhage is bilirubin and oxyhemoglobin.