Wednesday Lectures, 5/27/2015

TTHM 12.4 (5/27) PDR

 

10a ~ PDR (Paolo)

*#FOAM Apneic Oxygenation, Levittan & Weingard podcasts, nasal cannula during apnea

Worst case scenario, probably does nothing… RCT facemask plus/minus apneic O2 during RSI

No statistical significant difference.  Be skeptical of podcasts too…

*Abx for CAP, Ceftri/Azith… or Levaquin/Moxi… Quinolones seem to develop resistance quick.   Cef v Cef/Azith v Levo… all did similar.  Noninferior.

*Antibiotics for fingertip amputations, zero infections across groups, no benefit?

*Lactate… corresponds to hemorrhagic shock, but also increased c EtOH consumption.

*CT in SAH pretty darn good for NPV (despite bias with low prevalence), LP may not be necessary for this context…

 

11a ~ PSQ (Goldberger/Adcock/Shaw)

 

1p ~ Journal Club (Kolb)

*Therapeutic Hypothermia in Peds Cardiac Arrest OOH

NO STATISTICALLY SIGNIFICANT DIFFERENCE (MILD TREND TOWARD BENEFIT)

*Antibiotics for CAP

NO STATISTICALLY SIGNIFICANT DIFFERENCE Cef v Cef/Azith v FQ…

 

2p ~ Cardiovascular Toxins (Stork)

*Digoxin NaK~ATPase inhibition increases intracellular Calcium… 20mg can be fatal! Visual “Halos” toxic effect… Potassium >5 poor prognostic! All K >5.5 died in toxicity study!  Most common arrhythmia is freq PVCs… bidirectional VTach (bigeminy) pathognomonic… prolonged PR & “Salvadore Dali Mustache”.  Maximum Therapeutic Digitalis level up to 2, but dangerous Dig level >20… or K > 5.  Digibind give 10 vials for unknown qty (both adults & kids). Do NOT give Calcium dt “Stone Heart” potential phenomenon?…

*Verapamil OD: Bradycardia Hypotension (c BB CCB aBlock Dig)…

CCB OD tend to stay awake & have high glucose (insulin release inhibited)…

Sustained release forms may have delayed onset… Give Calcium for CCB OD, consider charcoal, consider whole bowel irrigation (early only), consider lipid emulsion last resort! (fat emulsion ~ TPN… One of the most common Tox bad outcomes.

*BB OD ~ remember High Dose Insulin Euglycemia!

*Clonidine & alpha blockers try naloxone high dose, & supportive care!

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