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Pediatric SHOCK Index - emdocs

emDocs post containing very useful emergency medicine information  
emdocs.net
over 6 years ago
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Cognitive approach to shock diagnosis using ultrasonography

0 Recently I coauthored an article about the bedside evaluation of shock using ultrasonography.  It's a reasonable article, albeit conventional.  Below is  
pulmcrit.org
over 6 years ago
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Bulbocavernosus Reflex, Spinal shock - Everything You Need To Know - Dr. Nabil Ebraheim

Educational video describing the Bulbocavernosus Reflex for spinal cord injuries. Become a friend on facebook: http://www.facebook.com/drebraheim Follow me o...  
youtube.com
over 6 years ago
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Going to work in a different country? Different culture? Different language? Avoid getting tripped up as I did!

I grew up in Belgium and went to medical school in Louvain, Belgium. I came to the USA for my internship and selected a small hospital in upstate New York. What an initial culture shock that was! The first problem was the language. I knew enough "school" English to get by, or so I thought. Talking on the phone was the hardest. Initially, the nurses in the hospital thought that I was the most conscientious intern they had ever worked with. When I was on duty and the nurses called me on the phone at night, I would always go to the ward, look over the chart, see the patient and then write a note and orders, rather than just handle things over the phone like all the other interns did when called for rather minor matters. Little did the nurses realize that the reason I would get up in the middle of the night and physically go to the ward was due to the fact that I had no idea what they were talking about. I did not understand a word of what the nurses were telling or asking me on the telephone, especially not when they were using even common American abbreviations, like PRN, QID, LMP etc. [PRN (Latin) means as needed; QID (Latin) means four times a day and LMP means last menstrual period]. That problem rapidly resolved as I began to understand more and more of the English medical terms. However, there is a major difference between understanding day-to-day common English and grasping all the idioms and sayings. A rather amusing anecdote will illustrate that. About two months into my internship, I was on call at night when one of the nurses telephoned me in the early evening. A patient (Mrs X) was having a bad headache and wanted something for it. I was proud that I had understood the problem over the phone and was even more proud that I managed to order something for her headache without having to walk over to the ward. An hour or so later, the same nurse called me for the same patient because she had been constipated and wanted something for it. Again I understood and again I was able to prescribe a laxative over the phone without having to go to see the patient. A while later the same nurse called to let me know that Mrs X was agitated and wanted something for sleep. I understood again and prescribed a sleeping pill. Close to the 11pm shift change the same nurse called me once more: "Dr. LeMaire, I am so sorry to keep bothering you about Mrs X, but she is really a pain in the neck…" Immediately some horrible thought occurred to me. Here is a patient who has a bad headache, is constipated and agitated and now has a pain in her neck. These could all be symptoms of meningitis and here I have been ordering medications over the phone for a potentially serious condition. I broke out in a cold sweat and I told the nurse "I am coming." I ran over to the ward where that patient was hospitalized, went to her room and after introducing myself said "Mrs. X, the nurse tells me that you have a pain in your neck." The rest is history. The patient lodged a complaint about the nurse and me, but we both got off with a minor reprimand and in fact somewhat of a chuckle by the administrator handling the complaint. Such tripping up by the idioms and sayings can of course happen in any language. Be aware! Dr. William LeMaire  
DR William LeMaire
over 6 years ago
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Podcast Time! Upper Gastrointestinal Bleeds

PEM Currents, the Pediatric Emergency Medicine podcast returns today with an episode focusing on upper GI bleeds. Serious UGI bleeds – you know, the ones with shock, massive transfusions and more – are fortunately rare in the Pediatric Emergency Department. However, there is a growing population of patients with chronic diseases that can lead to portal hypertension, varies and other causes of bleeding from the upper GI tract.  
pemcincinnati.com
over 6 years ago
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Primer in Blunt Thoracic Trauma | EMBlog Mayo Clinic

Authors: Moriah Thompson, M.D., Rachel Lindor, M.D. and Meghana Helder, M.D. Jobe et al. J Emerg Trauma Shock. 2013 Oct;6(4):296-7. [f…  
emblog.mayo.edu
over 6 years ago
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Cardiogenic Shock - R.E.B.E.L. EM - Emergency Medicine Blog

Cariogenic Shock is defined as tissue hypoperfusion that is primarily attributable to damage to the heart.  
rebelem.com
over 6 years ago
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Critical Care

Fluid administration is a first-line therapy for acute kidney injury associated with circulatory failure. Although aimed at increasing renal perfusion in these patients, this intervention may improve systemic hemodynamics without necessarily ameliorating intrarenal flow distribution or urine output. We used Doppler techniques to investigate the effects of fluid administration on intrarenal hemodynamics and the relationship between changes in renal hemodynamics and urine output. We hypothesized that, compared to systemic hemodynamic variables, changes in renal hemodynamics would better predict increase in urine output after fluid therapy.  
ccforum.com
over 6 years ago
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WHAT THE HELL I AM DOING? I AM ENGORGING A VEIN IS WHAT I AM DOING!

I’m not sure where this fits in, in this age of ultrasounding everything, but there is an interesting short report in EMJ. It describes a simple technique to achieve IV access in patients where the periphery is shut down.  A typical scenario could be a patient in shock were all you can get in is a pathetic 22-24G cannula on the hand, when what you really want to do is a rapid infusion through a 14-16G in the cubital vein.  
scancrit.com
over 6 years ago
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Critical Care

In severe respiratory and/or circulatory failure, extracorporeal membrane oxygenation (ECMO) may be a lifesaving procedure. Specialized departments provide ECMO, and these patients often have to be transferred for treatment. Conventional transportation is hazardous, and deaths have been described. Only a few centers have performed more than 100 ECMO transports. To date, our mobile ECMO teams have performed more than 700 transports with patients on ECMO since 1996. We describe 4 consecutive years (2010–2013) of 322 national and international ECMO transports and report adverse events.  
ccforum.com
over 6 years ago
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Accelerated Goal Directed Therapy for Septic Shock

. . Introduction . The Surviving Sepsis Campaign has raised awareness that septic shock is a medical emergency.  However, these guidelines recommend a step  
pulmcrit.org
over 6 years ago