Do you have citations on that last point by chance? It's been a few years since I looked into it, but I recall some studies that showed a decent link between pediatric CT scans and elevated ~10-15 year cancer risk, after controlling for a lot of potential confounds.
Not.
For the three trimesters, the third trimester is the least susceptible to radiation damage to the fetus. The first trimester is the one where ionizing radiation is bad stuff; when, already, 33-40% of pregnancies will be lost due to gross genetic abnormalities, throwing the extra rads on there is bad juju.
That’s all I’m saying. The well-validated ones can be very good learning tools but all have pitfalls and cannot replace clinical judgment. If they could, you could put non-physicians in charge of all head traumas, PEs, and chest pains. If you haven’t seen a positive that was (or would have been) missed by a decision rule, you haven’t been practicing long enough.
Don't ventilate them. Attach the mask and form as tight a seal as possible. Relatively easy to do with the setup in the OR, not sure how well it would work with BVM. Idea is to create enough pressure to break spasm.
I don't understand what you're saying re: don't ventilate but yes create pressure to break the spasm. I agree with creating pressure, that's the whole point of the peep valve I mentioned. Not sure how I would do that with a bvm and peep valve without, you know, squeezing the bag.
A CMP diluted with normal saline will have super low potassium, calcium, bicarbonate and a very high chloride.
A CMP diluted with normal saline will have super low potassium, calcium, bicarbonate and a very high chloride.
A person with a calcium of 4 or 5 should be super symptomatic. A K of 2 should have EKG changes.
Also, when you tell a nurse to redraw labs because you think there was IVF in it, usually they are careful not to have IVF in there. Rarely is this an issue upstairs because the nurses are not allowed to draw from IV’s, which the ED’s routinely.
And I always go with the answer that I like.
Oh, honestly, if I was in the ED, I’d either scan then or not based on my gastalt. Spending time waiting for another lab test to result to do a CT scan sounds like a waste of time you don’t have in the ED. I was saying if you gave me this patient to admit who had a negative dimer and a positive CT scan, I’d repeat the dimer for the heck of it.
I don't know that you can do it. The circuits we have in the OR allow you to dial in the amount of pressure that you want. Kids are the most likely to spasm when emerging from anesthesia. Mistake that I have seen before is CRNA trying to ventilate to break spasm. Instead the solution is to apply an airtight mask seal to the patient and dial the pressure in to about 20. If the circuit is leakproof our version of the ambu bag will tense up and create pressure in the system akin to peep. Gently squeezing the bag and holding it increases the pressure. When the spasm breaks you can see and feel the bag deflate as the child takes a breath at which point the pressure valve should be dialed back down to a low level. Madly squeezing the bag against a closed glottis isn't likely to help much.
Interesting. My understanding of our peep valves is that you squeeze the bag and as long as you have a good seal you will eventually build up pressure to whatever you've set the valve to. I suppose you could get a good seal and then pump once or twice in order to get the pressure up and then simply stop bagging. The problem is that I don't think there's a way to see how much pressure is actually being delivered at any given moment. If you have a leak, you wouldn't know it and wouldn't be creating new pressure without squeezing the bag. I suppose some pressure likely comes from the O2 line as well, but I have no idea how much that is or if it's clinically significant.
The one that doesn't fit the contextual puzzle.
That makes much more sense now, thanks!
Yeah the key here is that anesthesia machines and bags / circuits are markedly different that the self-inflating BMV in the ED hooked to 15L wall oxygen with a one-way pop-off valve and no PEEP control.
There are all sorts of Mapleson circuits that can possibly be configured. Excruciatingly mind-numbing minutiae that anesthesia residents are forced to memorize. They all have a fresh gas flow and the most common ones have a valve to dial in the peep.
I think that's the bag. You know, the anesthesia black ridged one? That one.
Bingo. Note only one exit to that bag, no pop-off or 1-way exit valve etc
Corrugated tubing
Yes. Our toys are not like your toys.
God.
I've actually never had a problem with it, but I know people who have encountered the issue.
Right or wrong, I usually pulled decision rules out of MD calc, filled them out, and pasted them directly into the chart to try and objectify something I ruled out without testing. I guess if I missed something, pointing out that I thought about it and went through an objective process to rule it out would be better than just saying "Well, I didn't think they had it" in a deposition. I sort of became a decision rule addict in the pursuit of defensive medicine that way.
