Vasopressors in Shock (Lecture by Dr. Keshava)
This is a GREAT SUMMARY of the updates in the surviving sepsis guidelines of 2012.
-30cc/kg bolus (1A)
-albumin if using high volumes (2B)
-NOT providing steroids if fluids work
- Authors strongly recommend norepinephrine (
Levophed) as the first choice for vasopressor therapy (Grade 1B). Vasopressin 0.03 units / minute is an alternative to norepinephrine, or may be added to it (Grade 2A). - When a second agent is needed, epinephrine is their weakly-recommended vasopressor choice (Grade 2B).
Pediatric LP/Septic Workups (Lecture by Kirsten Malone):
-attached to this email is the uptodate.com summary of the three major infant fever protocols
-there is a lot of controversy regarding continuing to follow these protocols, this is because the protocols were developed in the 90's before true herd effect of H.flu, '88 pneumococcal vaccine, and the updated 2000 pneumococcal vaccine.
-Some people believe prevalance has dramatically decreased, which significantly decreases pre-test (pre-septic workup) probability
CPC: Cases:
Aortic Dissection: Attached to this email is the IRAD study which is retrospective analysis of clinical features of confirmed Ao Dissection.
Also, this study is a validation study of a prediction tool developed by AHA used IRAD data.
Asthmatic:
Continuous Bladder Irrigation:
-funny how the resident was making recommendations for us to NOT perform this in the ED. Thanks to Melville for pointing out that the Uro attendings more often than not are the ones who ask us to perform this.
-not sure if anyone heard me belly laugh when he commented that "if the pt needs CBI, it probably needs a Urologist to urgently evaluate the patient". HAHA. I can count on one hand the times ive seen a uro attending in the ED. We manage their patients, including procedural complications, bleeding, obstruction, etc. I find it funny that the thought is that we should be waiting for them to evaluate these pts.
- Ok enough ranting. Here is some info:
-Foley Irrigation Video (skip to minute 3, this is an old school vid)
FAST
-Check out Sonospot.com and go to the Sono Studies or Sono Tutorial on the right side menu and find E-FAST
Attached is a lecture I gave on the EVIDENCE FOR FAST EXAM
Studies: in blunt trauma
Pediatric Sepsis Management:
-as Dr. Melville pointed out, rule #1 is DO NOT SIT AND INTELLECTUALIZE while the kid is dying.
-aside from that , here are some guidelines.
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