You have a patient with an anion gap of 30 and bicarbonate of 10 mEq/L. You also determine on VBG that the patient’s pCO2 is 25 mmHg. What trick of the trade can you use to quickly determine whether this low pCO2 is an appropriate compensation of the primary metabolic acidosis? Dr. Jeremy Faust and Dr. Corey Slovis explains the quick “Rule of 15”.
The prevalence of hyperthyroidism in the general population is about 1-2%, and is ten times more likely in women than men. The spectrum of hyperthyroidism ranges from asymptomatic or subclinical disease to thyroid storm. So how do we diagnose various presentations of hyperthyroidism in the Emergency Department? Below are answers to 7 common questions that commonly arise.
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Sometimes a question is posed on Twitter that generates a great discussion from colleagues ’round the globe. Such was the case for dexmedetomidine. Although benzodiazepines remain the standard of treatment for ethanol withdrawal, particularly seizures and delirium tremens, what’s all the hype about dexmedetomidine?
You obtain a venous blood gas (VBG) on a patient with a COPD exacerbation because you are concerned about hypercarbia. You get a value of 55 mmHg. How correlative is that compared to an arterial blood gas (ABG). There has been a lot of literature on how well the pH correlates between the ABG and VBG but what about pCO2?
A small study (n=89) from 20121 found that with a cutoff of pCO2 < 45 mmHg, the venous pCO2 is 100% sensitive in ruling out arterial hypercarbia. When the pCO2 was ≥ 45 mmHg, the VBG was less correlative.
Below is a review by Dr. Michelle Reina (EM resident at Univ of Utah) and Dr. Rob Bryant (Intermountain Medical Center in Utah) of the VBG vs ABG correlative data, along with a proposed algorithm on what to do with patients with COPD exacerbation.
Adapted from [1–5]
Go to ALiEM (PV) Cards for more resources.
Updated 1/31/13 at 2 pm PST:
The electrocardiogram can pick up all sorts of electrolyte abnormalities. The most common abnormalities revolve around high and low levels of potassium and calcium. Magnesium derangements typically have nonspecific findings. How do you keep things straight? To make things more complicated, multiple electrolyte derangements can occur at the same time, making ECG interpretation challenging.
I have yet to find a better arterial blood gas interpretation review article than the 1991 Western Journal of Medicine summary by Dr. Rick Haber.
This installment of the Paucis Verbis (In a Few Words) e-card series reviews ABG Interpretation. The recent addition of an ABG machine in our ED has made a tremendous difference in our ability to care for undifferentiated patients. This is a refresher in making heads and tails of mixed acid-base disorders.
Adapted from [1]
Go to ALiEM (PV) Cards for more resources.
Hyperkalemia is a common presentation in the Emergency Department, especially in the setting of acute renal failure. In one shift, I had 4 patients with hyperkalemia! All had from some form of renal failure.
This installment of the Paucis Verbis (In a Few Words) e-card series reviews the treatment options for hyperkalemia.
Adapted from [1]
Go to ALiEM (PV) Cards for more resources.