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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.....

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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 +

It will be fascinating, while tragic, some day to know exactly why the diverse outcomes of this strange disease. It is beyond comorbidities, while they contribute.

What we are seeing is this: Asymptomatic screen + from large workplace screenings. sent home to quarantine one week later looks like death warmed over and crashing. generally arrives by priv

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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. ?

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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.

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On 10/17/2018 at 8:52 PM, EMEDPA said:

Bonus pic from a busy weekend.

DudeLived.jpg

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."

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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. 

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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."  

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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. 

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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. 

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