New-onset bradycardia?
5 Pathological categories to think about:
- Cardiac: MI (inferior), AV block, SSS
- Neuro: ↑ICP, stroke
- Metabolic: Hypothyroid, hyperkalemia, hypothermia
- Meds: Beta-blocker, digoxin, opioid
- Infectious: myocarditis/endocarditis
Consider subdissociative dose of ketamine (0.3-0.5 mg/kg) for patients in status asthmaticus - may help with air hunger, provide anxiolysis, and facilitate other treatments such as NIPPV and delivery of inhaled/systemic bronchodilators
#medsky #emergencymedicine #criticalcare
⚙️🫀LVAD Initial Assessment (ABCs)
- A: Auscultate hum & vitals (MAP)
- B: Battery check
- C: Controller variables (flow, power)
- D: Driveline - check skin & connection
- E: Echo (LV, RV, pericardial space)
#medsky #criticalcare #fomed #emergencymedicine #resuscitation
Adrenal Crisis
- Chronic Adrenal Insufficiency + Trigger (infection, hypovolemia, trauma)
- Acute (adrenal/pituitary hemorrhage)-uncommon
Clinical Features
- Hypotension
- Hypo/Hyperthermia
- GI symptoms
- Delirium
- Hyponatremia, Hyperkalemia
- Hypoglycemia, NAGMA
#medsky #foamed #criticalcare
Post Cardiac Arrest Priorities:
- Avoid fever
- Adequate sedation & analgesia
- Hemodynamics (MAP >65)
- Lung protective vent settings
- Normoxia & normocapnia
- Identify/treat reversible causes
- Update family/next of kin
#medsky #criticalcare #emergencymedicine #foamed #resuscitation
Underdosing benzodiazepines is a common pitfall in the management of status epilepticus. For adult patients:
- Lorazepam: 4 mg IV per dose
- Midazolam: 10 mg IM if no line
- Diazepam: 10 mg IV per dose
#medsky #criticalcare #emergencymedicine #foamed #resuscitation
EKG on arrival👇🏼. CT angiography of the chest negative for pulmonary embolism. What is the diagnosis?
35 yo male presenting with palpitations and near syncopal event. Bedside echo - apical 4 chamber view 👇🏼
Turn them back! The free radicals are running rampant 🤣
If a patient is hypokalemic assume they are also hypomagnesemic. Check and replenish magnesium! Hypomagnesemia induces renal potassium wasting, making it hard to correct K+. Reminder: serum Mg ≠ total body Mg—most is intracellular 🧫
#medsky #electrolytes #meded #foamed
Lactate is just but piece of the puzzle
Agree. A single lactate level may not be as useful. However, if you are attempting to maximize perfusion with vasoactive agents, IV fluids etc.. but the lactate level is rising, this may be a sign that something is not being addressed - infection, tamponade, blood loss etc.
🫀Emergency Department Post-Cardiac Arrest Cardiovascular checklist ✅
#medsky #emergencymedicine #criticalcare #meded #foamed #resuscitation
For patients with GIB who are actively bleeding, have a high shock index, and/or LLS, do not base your management on the initial H&H. Drop in hemoglobin can lag and give a false sense of assurance. Resuscitate aggressively #emergencymedicine #resuscitation #FOAMed #blueskymed #medsky
Would also consider DDAVP especially in renal insufficiency to help with platelet dysfunction
