Tamingthesru
Grand Rounds Recap - 12/3/2014
EMS Protocol Updates for 2015 with Dr. Leblanc
Use of EMS units as transport units
- If pt is transported to a facility that is not capable of taking care of the pt, you may be able to use the same squad to transport the pt to another facility
- Need to have an accepting doc
- May need to send additional personnel with the squad
Hypotension/Shock protocol
- Push dose Epi regardless of type of shock - 1 ml of cardiac Epi into 9 mls of NS flush
- 1 ml q1-2 min
- For more info - EMCrit Podcast on Push Dose Pressors
- No more Dopamine!
Procedural Sedation Cage Match
It's a typical busy post-Thanksgiving shift in the ED. It seems like patients with acute decompensated heart failure, sepsis, NSTEMI's and a whole host of other ailments are tucked in every corner and crevice of the ED. Just as you finish putting in orders on the last patient you saw, your next patient rolls by on an EMS stretcher. You see from your computer that the patient is on a backboard and in a c-collar after what clearly was some form of traumatic event. He's screaming in pain and holding his left leg flexed at the hip and internally rotated. "Jeez, I bet that hip is dislocated," you say to yourself.
You know you're going to need to reduce this dislocation, to not do so would risk avascular necrosis. Tammy, one of the nurses you are working with that day is already 2 steps ahead of you. "Doc, we're getting everything set up for the sedation, you're going to need for that hip that's out. What drugs do you want us to pull up?"
Grand Rounds Recap - 11/19/2014
Mortality and Morbidity Conference with Dr. Gozman
Thrombocytopenia
Always consider medications as a key cause of throbocytopenia
Recommendations for platelet transfusion currently include:
- Patients on chemotherapy with <10K
- Patients requiring central venous access with <20K
- Patients requiring an LP with <50K
- Patients requiring non-neurologic surgical interventions with <50K
- Patients requiring CNS surgical intervention with <80K
There is not data to support platelet transfusion in patients with intracerebral hemorrhage on an antiplatetlet agent