CHEST PAIN PROTOCOLS PART II

Chest pain pathway PROTOCOLS Ok here we are the main show, the reason for reading, the Trump of testing…well you get the idea. The whole goal of a protocol is to identify a low risk group of patients and then do something to make them even lower risk (<1%) to send them home without admitting […]

CHEST PAIN PROTOCOLS PART I

INTRODUCTION Why have protocols? Well, so we don’t miss anything. Right?! But how many Myocardial infarctions (Heart attacks or “MI’s”) ARE we missing from the ED. Well any medical student knows that answer… anyone, anyone, Bueller?! Umm yes 2% (see note C), correct! That being said if we “do miss 2%” what should be an […]

Pediatric Hemodynamic monitoring

Source: American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock. Crit Care Med 2017; 45:1061–1093 Monitoring Goals: Capillary refill <2 or equal to 2 seconds Normal pulses with no differential between the peripheral and central pulses, Warm extremities, Urine output greater than 1mL/kg/hr, Normal mental status, Normal […]

Reversal Agents for Anti-coagulation

For Reversal of Major Bleeding Definition: Major Bleed(s) are all bleeds associated with hemodynamic compromise, occurring in an anatomically critical site (e.g., intracranial), or associated with a decrease of hemoglobin >2 g/dL (when baseline is known) or requiring transfusion of >2 U of packed RBCs. Bleeding due to Vitamin K antagonists (VKA): Vitamin K: 10 […]

Pediatric ETT Depth

Lee. New decision formulas for predicting ETT depth in children. Emergency Med J. 2018: Retrospective review of 1111 tube depth from CT images: <1 yo 5.5+0.5xWt[kg] >1 yo 3 + 0.1xHt[cm] Difference from formula: -.5 cm, -2 cm, `1.5 for Formula, Broselow, APLS 1 x ETT = (age/4) + 4 (formula for uncuffed tubes) 2 x ETT […]