ohiovolffemtp Posted October 10, 2018 Share Posted October 10, 2018 Speaking of the grey hairs who know how to calculate dopamine drips in their heads: I used to teach medics that on a 60 gtts drip, each droplet contained ~ 25 micrograms (actually it's a bit more but close enough & makes the math easier). Get the pt's weight - which is going to be a best guess anyway and calculate as needed. Truth in advertising: I do have grey hair - though I'm getting less grey each year..... 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 10, 2018 Author Moderator Share Posted October 10, 2018 19 minutes ago, ohiovolffemtp said: Speaking of the grey hairs who know how to calculate dopamine drips in their heads: I used to teach medics that on a 60 gtts drip, each droplet contained ~ 25 micrograms (actually it's a bit more but close enough & makes the math easier). Get the pt's weight - which is going to be a best guess anyway and calculate as needed. Truth in advertising: I do have grey hair - though I'm getting less grey each year..... yup. ( (wt in kg) x (desired dose)) /25= drip rate example: 100 kg x 5 mcg/kg/min = 500. 500 / 25= 20 drips/minute with micro drip 60 drops/ml set. I've done it that way since 1991. Some white hair, but less than most folks my age. and yes, a bit less of it every year. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 18, 2018 Author Moderator Share Posted October 18, 2018 What does this show? Quantify what you see. What does this patient need? Yet another installment of why alcohol, anticoagulation, and gravity don't mix. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 18, 2018 Author Moderator Share Posted October 18, 2018 Bonus pic from a busy weekend. Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted October 20, 2018 Share Posted October 20, 2018 Sure looks like the chest needs a 36 or bigger chest tube connected to a pleurovac. Probably reversal of his anti-coagulation, type and screen, possibly crossmatch and transfuse. Depending on what facility might also need a diesel or JP-2 bolus to get to a trauma center. Definitely a right sided hemothorax. As best as I can tell from the pics, I don't see a pneumo. I think I see right sided rib fx. The head CT shows multiple fractures. Can't really tell from the pics as they come up on my computer, but there must be a big bleed - looks like a large midline shift. Probably airway protection, careful management of BP & temp, rapid transfer to somewhere with neurosurgery. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 28, 2018 Author Moderator Share Posted October 28, 2018 Yup, big hemothorax. Blunting of a costophrenic angle implies at least 250 cc . chest tube placed, volume resuscitated, etc. Skull fx was a different pt. also drunk. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 5, 2018 Author Moderator Share Posted November 5, 2018 What is shown here? What is the name of the second xray view? Treatment? Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 5, 2018 Author Moderator Share Posted November 5, 2018 what is this rhythm? Hint : your first guess is wrong. Quote Link to comment Share on other sites More sharing options...
jmj11 Posted November 6, 2018 Share Posted November 6, 2018 On 10/17/2018 at 8:52 PM, EMEDPA said: Bonus pic from a busy weekend. How did this happen? I can see the extracranial hematoma but, from this view, I cannot tell if there is SDH. Did this guy live? I notice the title of the photo is "dude lived." Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted November 6, 2018 Share Posted November 6, 2018 Are there pacer spikes? Quote Link to comment Share on other sites More sharing options...
NYSPA2B Posted November 6, 2018 Share Posted November 6, 2018 Shoulder - AC seperation Special view - Strykers? V pace Quote Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted November 6, 2018 Share Posted November 6, 2018 Regarding the noggin, where was the primary blow most likely based on the film? What type of more specific sx would one wish to consider beside the obvious HI? Maybe later E could share the mechanism of injury which might help with the latter question. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 6, 2018 Author Moderator Share Posted November 6, 2018 18 hours ago, jmj11 said: How did this happen? I can see the extracranial hematoma but, from this view, I cannot tell if there is SDH. Did this guy live? I notice the title of the photo is "dude lived." fell backwards, hit occipital. big subdural. lived. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 6, 2018 Author Moderator Share Posted November 6, 2018 15 hours ago, ohiovolffemtp said: Are there pacer spikes? yup. Ventricular pacer firing at the top of its range, not Vtach. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 6, 2018 Author Moderator Share Posted November 6, 2018 6 hours ago, NYSPA2B said: Shoulder - AC seperation Special view - Strykers? V pace posterior shoulder dislocation axillary view closed reduction Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 6, 2018 Author Moderator Share Posted November 6, 2018 4 hours ago, GetMeOuttaThisMess said: Maybe later E could share the mechanism of injury which might help with the latter question. drunk. fell backwards. Quote Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted November 6, 2018 Share Posted November 6, 2018 Okie dokie, so as expected the Hx matches the film. Pt. has a slightly depressed occipital skull fx. So what else regarding the noggin do we need to think about? Students? Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 10, 2019 Author Moderator Share Posted January 10, 2019 Dx and tx? Ekg on arrival, strip 10 min later. Quote Link to comment Share on other sites More sharing options...
PAtoMD Posted January 10, 2019 Share Posted January 10, 2019 10 minutes ago, EMEDPA said: Dx and tx? Ekg on arrival, strip 10 min later. Preceptor and I couldn’t figure it out. obviously our attention was to the disappearing QRS on the rhythm strip Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 10, 2019 Author Moderator Share Posted January 10, 2019 how many P waves per qrs? is there a fixed relationship between p-waves and qrs? this is actually a textbook perfect example of this. Quote Link to comment Share on other sites More sharing options...
PAtoMD Posted January 10, 2019 Share Posted January 10, 2019 43 minutes ago, EMEDPA said: how many P waves per qrs? is there a fixed relationship between p-waves and qrs? this is actually a textbook perfect example of this. 3rd degree heart block? Quote Link to comment Share on other sites More sharing options...
Jackofallmasterofnone Posted January 10, 2019 Share Posted January 10, 2019 2nd degree block with 2:1 conduction? What's the story on the patient? So we can start throwing some differentials. 1 Quote Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted January 10, 2019 Share Posted January 10, 2019 (edited) A set of calipers might be your friend. Do folks still use calipers? 10 hours ago, PAsPreMed said: Preceptor and I couldn’t figure it out. obviously our attention was to the disappearing QRS on the rhythm strip What field is your preceptor in? This question is not meant to be tacky toward the preceptor in case anyone was perceiving same. I've sat many a time next to an electrophysiologist (when field was new) who would be using calipers himself to try to figure out what the rhythm was. If THEY have problems then we're all in trouble. Addendum: This man 30 years ago made a one sentence statement that I carry with me to this day and recite to patients still from time to time; "Healthy hearts don't have unhealthy rhythms." Edited January 10, 2019 by GetMeOuttaThisMess Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 10, 2019 Author Moderator Share Posted January 10, 2019 6 hours ago, Jackofallmasterofnone said: 2nd degree block with 2:1 conduction? What's the story on the patient? So we can start throwing some differentials. yup. 2nd degree type 2(remember there are 2 types of 2nd degree hb) with 2:1 block with frequent episodes of ventricular standstill (see rhythm strip). presented via ems with syncope. incidental mag of 1.6, which I repleted. required versed/ketamine push and a ketamine drip at 10 mcg/kg/min for pacing. took a lot of juice to capture. 85 Ma to maintain a rate of 70. transferred for pacemaker. Quote Link to comment Share on other sites More sharing options...
PAtoMD Posted January 10, 2019 Share Posted January 10, 2019 3 hours ago, GetMeOuttaThisMess said: A set of calipers might be your friend. Do folks still use calipers? What field is your preceptor in? This question is not meant to be tacky toward the preceptor in case anyone was perceiving same. I've sat many a time next to an electrophysiologist (when field was new) who would be using calipers himself to try to figure out what the rhythm was. If THEY have problems then we're all in trouble. Addendum: This man 30 years ago made a one sentence statement that I carry with me to this day and recite to patients still from time to time; "Healthy hearts don't have unhealthy rhythms." ER. Quote Link to comment Share on other sites More sharing options...
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