ohiovolffemtp Posted February 13, 2018 Share Posted February 13, 2018 Emed, Is TXA part of your massive transfusion protocol? Quote Link to comment Share on other sites More sharing options...
sk732 Posted February 20, 2018 Share Posted February 20, 2018 Nurse came and grabbed me the other night, thinking her new patient had a perfed viscous and was septic...well, they were septic, but with Reynaud's pentad. It was right at the end of my shift and had to hand them over...I ran into them at the urban MICU when I did a transfer yesterday - they were still alive, had a pile of gallstones and oogy stuff evacuated from their GB, liver and belly. Oddly enough, when I got back, in the very same room that person occupied before being fired out the door, was a person with abrupt onset of belly pain POD#2 from a colonoscopy with laser ablation of telangiactasiae...who did have a perfed viscous AND had the most free sub-diaphragmatic air almost any of us had seen EVER. Surgeon didn't even want to bother with CT - sent to surgery, did not pass go or collect $200. SK 2 Quote Link to comment Share on other sites More sharing options...
sk732 Posted February 23, 2018 Share Posted February 23, 2018 I had two back to back "WTF??!!" moments yesterday - older dude gets sent in by spouse due to 2/12 Hx swollen, non-weight bearing ankle that has a horrible fracture through the distal tibia and another dude that dislocated a finger 3/52 prior...of course it was so contractured it wouldn't reduce. You'd have thought I was going to kill both their first born children when I said they needed specialist care - the ortho on call, normally a pretty cool guy, was giving me a four headed alien look on the phone when I told him about the leg, and the other one was trying to find any excuse possible to not see plastics...for a bad injury to the dominant hand. All this while day 3 of a roll out of a new EMR that is way too bulky for ER use that we've had foisted upon us. Glass half full - had a few good head shakes and laughs, lol. SK 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 23, 2018 Author Moderator Share Posted February 23, 2018 On 2/13/2018 at 0:24 PM, ohiovolffemtp said: Emed, Is TXA part of your massive transfusion protocol? no, but I ordered it anyway(and do frequently) based on my experience with seeing it really help in the past (trauma in Iraq). Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 23, 2018 Author Moderator Share Posted February 23, 2018 8 minutes ago, sk732 said: I had two back to back "WTF??!!" moments yesterday - older dude gets sent in by spouse due to 2/12 Hx swollen, non-weight bearing ankle that has a horrible fracture through the distal tibia and another dude that dislocated a finger 3/52 prior...of course it was so contractured it wouldn't reduce. You'd have thought I was going to kill both their first born children when I said they needed specialist care - the ortho on call, normally a pretty cool guy, was giving me a four headed alien look on the phone when I told him about the leg, and the other one was trying to find any excuse possible to not see plastics...for a bad injury to the dominant hand. All this while day 3 of a roll out of a new EMR that is way too bulky for ER use that we've had foisted upon us. Glass half full - had a few good head shakes and laughs, lol. SK what is the new emr? Quote Link to comment Share on other sites More sharing options...
sk732 Posted February 23, 2018 Share Posted February 23, 2018 what is the new emr?Clin DocSent from my iPhone using Tapatalk Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 23, 2018 Author Moderator Share Posted February 23, 2018 2 minutes ago, sk732 said: Clin Doc Sent from my iPhone using Tapatalk never heard of it. using cerner now and like it much better than epic or meditech. Quote Link to comment Share on other sites More sharing options...
sk732 Posted February 23, 2018 Share Posted February 23, 2018 never heard of it. using cerner now and like it much better than epic or meditech.Set up for out ED Information System program...Sent from my iPhone using Tapatalk Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 23, 2018 Author Moderator Share Posted February 23, 2018 2 minutes ago, sk732 said: Set up for out ED Information System program... Sent from my iPhone using Tapatalk when my last group went to epic they used the outpt module . it sucked for em. Quote Link to comment Share on other sites More sharing options...
sk732 Posted February 23, 2018 Share Posted February 23, 2018 never heard of it. using cerner now and like it much better than epic or meditech.Set up for out ED Information System program...Sent from my iPhone using Tapatalk Quote Link to comment Share on other sites More sharing options...
sk732 Posted February 23, 2018 Share Posted February 23, 2018 never heard of it. using cerner now and like it much better than epic or meditech.Set up for out ED Information System program...Sent from my iPhone using Tapatalk Quote Link to comment Share on other sites More sharing options...
Boatswain2PA Posted March 3, 2018 Share Posted March 3, 2018 And on the flip side, sometimes rural/low volume/long shift EM sucks...like when you see 12 patients in the last 24 hours of your shift, but they all come in about 2 hours apart. Really torques ya off when only one of the 12 are actually sick. 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 3, 2018 Author Moderator Share Posted March 3, 2018 1 hour ago, Boatswain2PA said: And on the flip side, sometimes rural/low volume/long shift EM sucks...like when you see 12 patients in the last 24 hours of your shift, but they all come in about 2 hours apart. Really torques ya off when only one of the 12 are actually sick. yup, it happens, but much less commonly than in a big place. saw 14 in 4 hrs a few days ago. only 1 sick out of the bunch. this was at the place I am transitioning out of next month....:) Quote Link to comment Share on other sites More sharing options...
Boatswain2PA Posted March 3, 2018 Share Posted March 3, 2018 2 hours ago, EMEDPA said: yup, it happens, but much less commonly than in a big place. saw 14 in 4 hrs a few days ago. only 1 sick out of the bunch. this was at the place I am transitioning out of next month....:) I don't think I explained it well enough through my whineing...I had 12 patients in last 24 hrs (no big deal) but each of them checked in right as I was discharging the last guy. I had three 45 minute naps in 23 hours. Was certainly a "suck-it-up-buttercup" kinda day! 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 4, 2018 Author Moderator Share Posted March 4, 2018 intranasal fentanyl is the bomb. just had a small kid with a significant burn from boiling water who was pain free after 25 mcg of IN fentanyl. Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted March 4, 2018 Share Posted March 4, 2018 Love IN versed to calm younger kids (e.g <7) before procedures. Calmer kids = calmer parents. Also, great moments as the kid continues to stumble & mumble at d/c. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 4, 2018 Author Moderator Share Posted March 4, 2018 Or IN ketamine... Quote Link to comment Share on other sites More sharing options...
lkth487 Posted March 5, 2018 Share Posted March 5, 2018 18 hours ago, ohiovolffemtp said: Love IN versed to calm younger kids (e.g <7) before procedures. Calmer kids = calmer parents. Also, great moments as the kid continues to stumble & mumble at d/c. Yeah IN Versed is my favorite, though it's not fun when a kid has a paradoxical reaction. Quote Link to comment Share on other sites More sharing options...
lkth487 Posted March 5, 2018 Share Posted March 5, 2018 2 hours ago, EMEDPA said: Or IN ketamine... I don't have much experience in using IN Ketamin - do you have use that in kids EMEDPA? I have used ketamine infusion for kiddos with sickle cell, and I use it in the PICU for asthma to prevent intubation, but I don't use it much for sedation. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 5, 2018 Author Moderator Share Posted March 5, 2018 41 minutes ago, lkth487 said: I don't have much experience in using IN Ketamin - do you have use that in kids EMEDPA? I have used ketamine infusion for kiddos with sickle cell, and I use it in the PICU for asthma to prevent intubation, but I don't use it much for sedation. yup, just for short procedures like a quick reduction or I+D. remember you also need to still use local for a painful procedure because although they are sedated, they are aware of what is going on sometimes...I use it (IV)as well for resp issues, like asthma and/or not tolerating bipap well, starting at a dose of 0.1 mg/kg IV. Quote Link to comment Share on other sites More sharing options...
lkth487 Posted March 5, 2018 Share Posted March 5, 2018 Cool! I'll have to read up a bit on that and see if we have that available next time I'm in the PED. Quote Link to comment Share on other sites More sharing options...
sk732 Posted March 19, 2018 Share Posted March 19, 2018 Nothing like have to do a quiet Code White on a 10 yo... SK Quote Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted March 19, 2018 Share Posted March 19, 2018 We (ED director primarily) used it for sedation for child lac closures (pre-Dermabond). Quote Link to comment Share on other sites More sharing options...
sk732 Posted March 20, 2018 Share Posted March 20, 2018 No seriously, I had a pediatric code white on Sunday is what I meant to say SK Quote Link to comment Share on other sites More sharing options...
CAdamsPAC Posted March 21, 2018 Share Posted March 21, 2018 So a "very sick" 58 yo male with "hepatitis" per one of the Health Aides in the village was seen by me and I just couldn't make sense out of his HPI or PMHx. Took him into our "ER" HR 108 B/P 98/54 deteriorating mental status w/ exam nonfocal with worsening MS. Two large bore lines were started with serial boluses totaling 2 ltrs w/o any improvement in VS or MS. Random FS glucose 146 and Hgb 2.8. BTW we can't do much more labs except a UA out in the village. Pt became combative requiring 3 mg IV Ativan to sedated him which allowed for DRE revealing charcoal gray grossly heme positive stool!Case was D/W referral ED 80 miles away by air requested air ambulance........Well 45 minutes & 4 liters of IVF later pt was loaded onto the a/c for transfer. No we don't not have B/P support meds stocked!!! Upon arrival @ the ED his Hct was 8.5% Hgb 2.8 !!! He spent 3 days in the hospital and was transfused up to a Hct of 26% and per the physician"wanted to go home" and was d/c'ed back to the village on day #3. No he wasn't scoped from above or below!!!! Of course he was the last patient of the day and had been "sick" for 5 days before his wife who couldn't contribute to the H&P efforts decided he should be seen! Grrrrrrrrrrrrrrrrrrrrr Quote Link to comment Share on other sites More sharing options...
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