Predicting over 5,000 evacuees, UTSW Emergency Services and Disaster Division have rallied their resources. Click HERE for a brief interview with attending, Dr. Raymond Fowler.
1) Cervical myelopathy - indications for surgical repair: neurologic deficit, compression of cervical nerve root or cord, and intractable pain.
2) Myasthenic crisis - consider intubation when forced vital capacity (FVC) is < 10-15 mL/kg or when negative inspiratory force (NIF) is under -20 cmH2O.
3) Vertebral artery dissection - headaches are not present in all patients. Most heal spontaneously. no difference in efficacy of anticoagulants vs antiplatelet agents from death or subsequent stroke
4) Hyperkalemia on ECG - the ECG changes for hyperkalemia are neither necessarily sequential nor present for all potassium levels. Consider giving Calcium.
5) Recurrent CBD stones after cholecystectomy - This can happen in approximately 10% of patients!
Journal club for the academic year began this week. Thank you to our host and sponsor, EMC! It was a great turn out and discussion featuring neuro topics. Thanks to our neuro residents who attended and weighed in on the conversation.
1) Obstruction - slope of the plateau phase = consider obstruction
2) ACEP Level B recommendation to use capnography
3) ETCO2: <10 during CPR, improve chest compressions.
1) Acute pulmonary edema - Goals: preload reduction (nitrates, additional preload with BiPAP)
2) STEMI complications/frequency - LV free-wall rupture (1-2 weeks out) > VSD (3 days - 1 week out) > papillary muscle rupture (3 days - 1 week out)
3) Medicare Part B eligibility -
65yo & U.S. citizen/resident who has been here five years
1) Volume resuscitation in HF - Sepsis still need some volume resuscitation - don't jump directly to pressors!
2) The blood pressure number doesn't lead to improved outcomes without end-organ damage
3) DKA - don't always assume non-compliance. Consider infection (find. the. source.), new onset DM, or any other physiologic stressor (infarction, adrenalitis, etc.)
1) ECMO - consider for cardiogenic shock from cardiotoxic drugs (beta blockers, calcium channel blockers) when refractory to medical therapy.
2) HINTS - outperforms MR with DWI within the first 48 hours. Not ideal for the ED