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maryfran123

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  1. Passing on information for free live critical care CME here at St Luke's approved for 2hr Category I CME Saturday June 21 9-11:30 with refreshments 2 topics will be Update on treatment of ARDS including rescue modalities-is ECMO the answer? Massive Transfusions. There will be more of the CME over the year. We are hoping quarterly so will post as they come up. Register at link below. http://www.slhn.org/Classes-Events/Advances-Critical-Care
  2. Our post gradate residency program has looked into the ARC accredidation and I say "ditto" to what ventana posted. The process is cumbersome and quite expensive considering the hospital has nothing to really gain but putting out this $$. The cost is between $10-11K and then an additional $1800 every 3hrs to keep the ARC accredidation. This is why there are many fellowships/residencies not ARC verified.
  3. wow, it costs the APPLICANT $3500 to do this course!!!!
  4. hey, welcome aboard!

  5. Hey, you've done the same for me in the past, just paying it forward, happily!!!

  6. Next time I see this lady (and I hope it isn't too long), I wish to give her a big hug! I am overdue-

  7. Aj-- Good list!! Lets expand it to include: anosmia(loss of sense of smell), vertigo, congitive deficits including short term memory loss, decreased attention span, word finding difficulty, anger/rage, difficulty processing new information, easy mental and/or physical fatigue, decreased libido, apathy, new difficulty completing work or school assignments, easy distractability, sensitivity to light/noise, feelings of being in a "fog", impaired balance/coordination, any sleep disturbance, and numbness/paresthesias not in a specific dermatome. This is essentially the list I run with our concussion/TBI patients when we see them in clinic. It is also a good idea to talk to a spouse/partner/family member/parent because with changes in personality, pts can have a lack of insight regarding these sxs.
  8. We use the RTS as part of our trauma registry and PI process It is not part of our initial evaluation.
  9. Great job on the GCS, including the Peds verbal. LA--actually, we do say "GCS 11" or whatever it is and then do the breakdown but that is just us. Remember to use the pt's BEST response is all 3 categories, not the most consistent response. A pt that is intubated highest score is usually "11T" --T standing for tube/intubated and infers that you are unable to assess verbal. Motor score on the GCS is typical the portion used for prognosis after TBI. The higher the motor score on presentation the more likely it is the pt will have a good outcome. Anyone want to try and make a list of post concussive sxs?
  10. AJ-- I'm not familiar with a class 1-5. The major societies of Trauma, AAN(neurology), Neurosurgery and the CDC use grades 1-3. Sean, good initial list of PCS sxs. Anyone know any others? thanks for not cheating on the GCS sean:D :p BTW, how is the GCS scored differently in Peds? Actually, we tell pt's that sustain sequlae of traumatic brain injury that it can take a year to recover. However, a majority of pts will have their PCS resolve in the first 2 wks and up to 95% within 6wks. It helps reassure pts ALOT to know that their sxs will likely get better on their own in this time frame. Anyone else with answers to the other parts of the question? You're doing great!!!
  11. Jennie--Great job!! We have many ER 1st and 2nd year residents that don't know this!!! I'm not sure I agree that all pt's with post concussive syndrome(PCS) need to be seen by a neurologist but that is MY personal bias. Actually, we(trauma) follow all of our own PCS pt's and only refer out those who have sxs that last longer than 6wks. At our facility, for just post concussive HA they may get referred to neurologist, however, our PMR docs have a much greater interest in following these pts. So, that is where they are sent. Also, we tend to use 2 wks restricted activity for any Grade 3 concussion. Truth is, it is very rare you get an accurate duration or LOC and we err on being safe. Also just to clarify, for a dx of concussion, any grade, to be made the CT head must be normal. Therefore, if they have a (+) finding on CT scan, it is no longer called a concussion. Grade 3 concussions can be dc'd home with a reliable person if asymptomatic. However, we admit many of our for neurochecks. We never get MRI for concussions. Can anyone tell me what some common post concussive sxs are, typical duration of PCS and possible treatment options. As long as we are discussing traumatic brain injury: what is the GCS, how is it scored, of the 3 parts of the GCS scoring what score is the most sensitive prognostically for recovery from TBI. What GCS levels constitute mild, moderate and severe TBI?
  12. Ok, lets do a new question that almost everyone will see that works in FP, Emed, Urgent Care, Occupation Health, Trauma. How different grades of concussion and give a brief description of each grade. How does the grade of concussion affect DC instructions/activity restrictions?
  13. V-- Actually, the mechanism of injury is hyperextension. Pt's that get central cord typically have spinal stenosis w/ increase signal in the spinal cord on MRI. Many require decompressive surgery at a later date. Regarding the steroids, your dosing is correct, however, in my scenario the pt presented 4 hours after injury. For pt's that present 0-3hrs after injury, they receive steroids for a total of 24hrs. For those that present 3+hours-8hrs after injury, they get 48hrs of steroids. After 8hrs, no steroids. Also, don't forget the H2 blocker or PPI while the pt is on the protocol BTW, as an aside, there is no role for steroids in penetrating trauma. I anticipate in the next few years, steroids for SCI will no longer be the standard of care. Good job everyone!!
  14. andersen, NIF is a good idea, however, we typically use vital capacity testing. Below T4, vital capacity is NL. Above Between C5-T4, a decreasing in vital capacity may be an early sign that the pt requires intubation. SCI from C1-C4 are typically intubated. MRI cspine--good test. Wow do expect to see and what intervention will likely be required?? Any takers on the mechanism for this injury and what about the steroids--dose/duration?
  15. LA-- Bingo on your dx. Regarding intubation, probably not. It's been 4 hours since his injury by the time you see him and ABC's/VS are stable. Remember he has some muscle strength in the C5-7 distribution so it is very unlikely he'd develop oxygenation/ventilation issues at this level. If you wanted to be sure, what bedside test could you have respiratory therapist do every few hours to be sure? Would you want any additional studies besides the 3 view Cspine? hint: it could influence your treatment plan. Other than NPO, anything else, for example-would you like to consult anyone, what about other precautions? Not every trauma center has gotten rid of the high dose steroid protocol. We are pretty selective in who gets steroids and who doesn't. Let say for the sake of arguement, we decide to gve this guy steroids. How much and for what duration?
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