I see the confusion. I was talking about a similar case that happened (again with anesthesia) last month. Patient coded that time after she received 0.4 mg of narcan while everyone was waiting for her to wake up; cardiologist showed up and yelled at everyone and gave 2 mg once with almost immediate response.
What do you mean? If you are referring that the cardiologist case; I was told patient had a PEA.
Why did I think you were an anesthesiologist??
I am sorry. You sound like you work with a bunch of incompetent anesthesiologists. This is weird as hell and bread and butter. Are there always anesthesiologists around? Do people not know how to assess for Narcotic OD and treat??
And they don’t know how to fix their screw ups. They just sit there and watch while not being aggressive enough.
I must be stupid here but how does one end up in PEA arrest while still breathing? And Maintaining sats?? This makes no sense here. This isn’t PEA arrest.
ESRD, Narcotic use history.
When I got there I saw they were trying to place an a-line and they told me they already pushed narcan and some phenylephrine (mind you SPB was still in the 60s).
I went back to read their notes. Even before they gave him anesthesia, he was already obtruded from what I can see because they had to call his wife to get consent. He did present to the ED AOx3 from the ED doc note.
Yup. They are incompetent. Are they a bunch of new grads? Did they train at HCA? These are actual physicians here we are talking about no? Has to be if you are talking of CAAs involvement.
Aha. So trying to place an art line in a BP that’s barely palpable…. I am sure that’s easy. Was there any fluid being given?? If they are pushing Phenyephrine why is the BP still low?? Dude, you work with idiots.
He received ~800 cc by the time I got there. I did not even look at the pupil because reading the last discharge summary about 2-3 wks ago clearly indicated I was dealing with a drug overdose.
We are just trained differently is all. You did the right thing in that moment.
Which is essentially what happened.
I left the hospital around 1 hour later after given the 1-time dose; did not have to repeat it. I talked to the hospitalist who was assigned to the patient the next day and he told me patient was doing ok and will likely get discharged the following day.
I don't recall seeing any papers showing that naloxone doesn't work for sepsis (this is sarcasm).
SCAPE?
HCA?
Never heard of this either.
I see it with some regulatory in the unit from hypertensive emergencies. The ED or hospitalist will see the flash edema, think HF exacerbation, and try to aggressively diurese and either ignore the BP, or try to throw a ton of labetalol at that, as well. Unfortunately, diuresis can be counterproductive or ineffectual, as once you lower the afterload, improving forward flow, they can then become hypotensive from any volume loss. Instead, staring nicardipine and bridging with BIPAP for a few hours fixes everything.
I had also never heard the acronym, so I googled it.
Why the damn fancy name? This is simply Hypertensive Induced Pulmonary edema. Or Edema from severe Hypertension.
Hospital Corporation of America.
Deep South. Do they churn out crappy residents?
They are all over the South. And yes, their residency is known to be crappy. It’s a corporation. Money driven not education driven.
You answered your own question. Academics make up new terms for uncommon conditions every few years to feel important that they 'clarified' the condition by giving it a new name.
