Tamingthesru
The Agitated Patient
I don’t know if this has happened to you yet. It happened to me on my first shift as an intern. I hadn’t laid hand on a stethoscope in months. I had just unloaded the cardboard boxes from my rental truck into my new place. As I was settling in to my first few patient encounters one of our nurses approached me to say that a patient had been brought into our area that was extremely agitated. I looked up to see a man being held down by multiple police officers, thrashing and swearing.
“What can I give him?” She said.
“How about a hug?” I replied.
Ventilator Management Simulation Debriefing
Case 1 - "Bucking the Vent"
You have inherited a patient in the VA MICU at signout. The patient presented with spontaneous bacterial peritonitis and altered mental status and was intubated for airway protection and hypoxic/hypercarbic respiratory failure. The patient’s altered mental status has resolved but the patient remains intubated waiting for a second large-volume paracentesis that can’t be done over the long weekend at the VA. The RT calls you asking for a one time dose of 5mg Versed, but on a quick glance at the chart, the patient has been getting these Q2 hours for the last several days. You go to the bedside and find an agitated patient motioning to take out the tube. “He’s bucking the vent doc!”
Vent settings: AC-VC: TV500 RR12 PEEP8 FiO2 30%
Grand Rounds Recap 9/30/2015
September Morbidity and Mortality Conference - Dr. Toth
Cases reviewed were from the month of August. We saw greater volume in 2015 than 2014 with longer ED hold times. We reviewed multiple cases including:
Acute Inflamatory Demyelinating Polyneuropathy
- Pain is a common presentation, and cranial nerve palsies are not infrequent, but they usually follow weakness and numbness of the extremeties.
- The diagnosis is in large part clinical, with progressive areflexia and sensory loss being the hallmarks. CSF studies showing albuminocytologic dissociation is confirmatory.