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PV Card: Electrolytes and ECG changes

ECG anatomy segments

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.

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By |2021-10-08T09:38:57-07:00Sep 21, 2012|ALiEM Cards, ECG, Endocrine-Metabolic|
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Tricks of the Trade: Calcium gel for hydrofluoric acid burns

HydrofluoricAcidA 41 y/o m presents to your ED after an occupational exposure to 30% hydrofluoric acid (HF). The thumb and index finger of his right hand were affected. Upon visual examination, the site of exposure looks relatively benign but the patient is complaining of extreme pain. Beyond giving opioids, what can you do?

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By |2020-01-28T04:04:14-08:00Sep 11, 2012|Tox & Medications, Trauma, Tricks of the Trade|
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Paucis Verbis: Delayed sequence intubation

Bipap

A 40-year-old man presents with significant agitation and severe respiratory distress from a COPD exacerbation. His oxygen saturation is 75% on room air, and he has diffuse, tight wheezes on exam. You prepare to intubate the patient using a rapid sequence induction protocol: etomidate, succinylcholine, 8-0 endotracheal tube.

Or do you?

This pocket card discusses the delayed sequence intubation (DSI) protocol made famous by Dr. Scott Weingart and Dr. Rich Levitan.1 Thanks to Dr. Michelle Reina (EM resident at Univ of Utah) and Dr. Rob (Intermountain Medical Center in Utah) for designing this helpful card. Rob has even implemented a DSI protocol in his ED.

The card breaks down the reasoning and steps behind DSI. Anecdotally, ketamine has often calmed patients down enough during the preoxygenation phase to enhance oxygenation/ventilation so much so that intubation is not required.

PV Card: Delayed Sequence Intubation (DSI)


Go to ALiEM (PV) Cards for more resources.

Reference

  1. Weingart S, Levitan R. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med. 2012;59(3):165-75.e1. [PubMed]
By |2022-04-05T15:07:58-07:00Aug 31, 2012|ALiEM Cards, Critical Care/ Resus|
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Paucis Verbis: CHF likelihood ratios

senior with oxygen maskA 50 y/o man with a history of CHF and COPD is brought in by ambulance in severe respiratory distress. He is sitting upright with a RR 30 and O2 saturation of 79% on room air. Is this a CHF or COPD exacerbation? This is a common dilemma faced in the ED. Fortunately there are likelihood ratios to help you risk stratify using a Fagan nomogram.

Note that there are 3 tables:

  1. All-comer Emergency Department (ED) patients1
  2. ED patients WITH a known history of asthma or COPD2
  3. Summative LRs for BNP are provided in ED patients with or without a history of asthma/COPD1

See the blue font for the likelihood ratios ≥ 3.0.

PV Card: Does Your Dyspneic Patient Have CHF?


Adapted from [1, 2]
Go to ALiEM (PV) Cards for more resources.

 

References

  1. Wang C, FitzGerald J, Schulzer M, Mak E, Ayas N. Does this dyspneic patient in the emergency department have congestive heart failure? JAMA. 2005;294(15):1944-1956. [PubMed]
  2. McCullough P, Hollander J, Nowak R, et al. Uncovering heart failure in patients with a history of pulmonary disease: rationale for the early use of B-type natriuretic peptide in the emergency department. Acad Emerg Med. 2003;10(3):198-204. [PubMed]
By |2021-10-10T08:40:49-07:00Aug 24, 2012|ALiEM Cards, Cardiovascular|
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