Moderator EMEDPA Posted March 31, 2016 Author Moderator Share Posted March 31, 2016 pt below stepped into a large pot of boiling soup at work that was left on the floor by the stove by a coworker. burn ctr f/u arranged. Quote Link to comment Share on other sites More sharing options...
ajnelson Posted March 31, 2016 Share Posted March 31, 2016 I'm in pain just looking at that [emoji17] Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 31, 2016 Author Moderator Share Posted March 31, 2016 I'm in pain just looking at that [emoji17] a few mg of diludid and she was chilling.... 1 Quote Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted March 31, 2016 Share Posted March 31, 2016 More importantly it didn't mess up the nice paint job on the nails! 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 31, 2016 Author Moderator Share Posted March 31, 2016 More importantly it didn't mess up the nice paint job on the nails! the real question is whether or not the restaurant still served the soup to patrons... 1 Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted March 31, 2016 Administrator Share Posted March 31, 2016 burn ctr f/u arranged. Given the extent of the deep partial thickness extremity burns, what would have made you evac her to Emmanuel directly vs. scheduling outpatient f/u? Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 31, 2016 Author Moderator Share Posted March 31, 2016 Given the extent of the deep partial thickness extremity burns, what would have made you evac her to Emmanuel directly vs. scheduling outpatient f/u? any 3rd degree burn or more involvement of plantar surface/circumferential burns. she was seen 12 hrs later at the burn clinic. did fine. I saw her at around 8 pm, called them and made a next day f/u appt. last pt I sent straight there had extensive painless 3rd degree burn to back from molten aluminum. didn't even want to be there. came in because "boss made me" 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 28, 2017 Author Moderator Share Posted May 28, 2017 recent rural trauma. thoughts? Quote Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted May 28, 2017 Share Posted May 28, 2017 Injuries that are associated from the energy of Scott Dixon's crash into the SAFER barrier and catch fence in the Indy 500 (walked away from a heck of a crash). If not, fell off a tractor. Takes a lot of energy to cause pic #1. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 29, 2017 Author Moderator Share Posted May 29, 2017 #1 is falling off motorcycle at 60 mph. #2 and #3 go together and have a special name. my ortho colleagues were very excited to show their residents. mechanism was arm into steering wheel in mva. name that fx... Quote Link to comment Share on other sites More sharing options...
DogLovingPA Posted May 29, 2017 Share Posted May 29, 2017 #2/3 - monteggia fx #1 - ouch Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 29, 2017 Author Moderator Share Posted May 29, 2017 #2/3 - monteggia fx #1 - ouch correct...and because ortho was 3 hrs away I got to reduce it. just like a nursemaids....with propofol.... 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 7, 2018 Author Moderator Share Posted October 7, 2018 students- why is this 70 year old man short of breath? looking for 3 answers. what are we going to do about it? Quote Link to comment Share on other sites More sharing options...
fishbum Posted October 8, 2018 Share Posted October 8, 2018 3rd degree AV block. Pace it. 1 Quote Link to comment Share on other sites More sharing options...
karebear12892 Posted October 8, 2018 Share Posted October 8, 2018 Agree w/ above. Consider Atropine or Dobutamine as an adjunct to pacing. Reverse beta-blockers w/ Glucagon if applicable. T-waves in the precordial waves look hyperacute - concern for hyperkalemia vs. impending MI. Check electrolytes and troponin. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 8, 2018 Author Moderator Share Posted October 8, 2018 8 minutes ago, karebear12892 said: Agree w/ above. Consider Atropine or Dobutamine as an adjunct to pacing. Reverse beta-blockers w/ Glucagon if applicable. T-waves in the precordial waves look hyperacute - concern for hyperkalemia vs. impending MI. Check electrolytes and troponin. atropine x 2 with no effect. good pick up on the t-waves. stable bp. no beta blockers or calcium channel blocker. likely 2 to evolving mi. K nl. trop #1 nl, transferred before trop #2. mg 1.4. interesting, but unk if causative. not paced because relatively stable. pacer pads at bedside in case became hypotensive or more symptomatic. remember pacing is not benign. you typically need some sedation and analgesics. it feels like getting punched 60 times/minute. 2 Quote Link to comment Share on other sites More sharing options...
fishbum Posted October 8, 2018 Share Posted October 8, 2018 I've always understood high level heart blocks to be almost universally refractory to atropine...rate would probably respond to dopamine (over dobutamine which is mostly inotropic, right?) but that's nothing we'd want to do to a guy with what we're guessing is myocardial ischemia. Cool case, thanks for sharing. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 8, 2018 Author Moderator Share Posted October 8, 2018 I asked cardiology if they wanted me to pace or otherwise influence this pts rate while they were on a 90 min ride to them and they said no. I told the medics to pace if became hypotensive or developed chest pain. I was pretty sure it was 3rd degree block and no response to atropine clinched it. the machine's interpretation was actually "electronic atrial paced rhythm" in this pt who does not have an implanted pacer. the tiny Ps march out independent of the QRS, making the dx, best seen on the long lead 2 strip at the bottom. 1 Quote Link to comment Share on other sites More sharing options...
lkth487 Posted October 8, 2018 Share Posted October 8, 2018 (edited) Why didn't they want to pace? That's a long ride.... Edited October 8, 2018 by lkth487 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 8, 2018 Author Moderator Share Posted October 8, 2018 8 hours ago, lkth487 said: Why didn't they want to pace? That's a long ride.... no hypotension. no chest pain. sob resolved with o2. basically asymptomatic aside from HR. would you want to be paced for 90 min if you didn't have to be? it's like getting punched 60 times/min...and the medics had pacing capability if they became symptomatic during the ride. 2 Quote Link to comment Share on other sites More sharing options...
karebear12892 Posted October 8, 2018 Share Posted October 8, 2018 22 hours ago, fishbum said: rate would probably respond to dopamine (over dobutamine which is mostly inotropic, right?) You're right, my mistake. Dopamine is recommended if hypotensive, unless they also have CHF, in which case you'd use Dobutamine instead. Source: UpToDate algorithm 1 Quote Link to comment Share on other sites More sharing options...
lkth487 Posted October 9, 2018 Share Posted October 9, 2018 (edited) 16 hours ago, EMEDPA said: no hypotension. no chest pain. sob resolved with o2. basically asymptomatic aside from HR. would you want to be paced for 90 min if you didn't have to be? it's like getting punched 60 times/min...and the medics had pacing capability if they became symptomatic during the ride. Fair enough! That makes sense. Edited October 9, 2018 by lkth487 Quote Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted October 9, 2018 Moderator Share Posted October 9, 2018 On 10/7/2018 at 7:23 PM, karebear12892 said: Agree w/ above. Consider Atropine or Dobutamine as an adjunct to pacing. Reverse beta-blockers w/ Glucagon if applicable. T-waves in the precordial waves look hyperacute - concern for hyperkalemia vs. impending MI. Check electrolytes and troponin. Good work! If I were really concerned with hypotension and symptomatic bradycardia, I might go with a dirty epi drip. Take one cc of cardiac epi and inject into liter bag, then titrate to life. This will give you 1mcg/mL. All IV tubing has the gtt rate on the packaging, though you might to find someone with grey hair to remember how to calculate a gtt rate We are using high dose insulin more than glucagon these days. 1 Quote Link to comment Share on other sites More sharing options...
MediMike Posted October 9, 2018 Share Posted October 9, 2018 17 hours ago, karebear12892 said: You're right, my mistake. Dopamine is recommended if hypotensive, unless they also have CHF, in which case you'd use Dobutamine instead. Source: UpToDate algorithm Many the time I've seen the fellows throw dopamine onto a non-hypotensive patient with rates that they "just aren't comfortable with" with a resultant BP in the 180s+. Dobutamine is a fantastic +ino and +chrono agent, but as has been mentioned above, agree with doing nothing if no symptoms. 1 2 Quote Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted October 9, 2018 Moderator Share Posted October 9, 2018 1 hour ago, MediMike said: Many the time I've seen the fellows throw dopamine onto a non-hypotensive patient with rates that they "just aren't comfortable with" with a resultant BP in the 180s+. Dobutamine is a fantastic +ino and +chrono agent, but as has been mentioned above, agree with doing nothing if no symptoms. The old adage still holds true, treat the patient, not the monitor. 2 Quote Link to comment Share on other sites More sharing options...
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