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ED YOGA
22 y/o F 35 weeks gestation being treated with magnesium sulfate for preeclampsia in your ED awaiting transfer to nearby hospital for definitive care. You go to re-evaluate the patient and find her somnolent, decreased respiratory drive and decreased deep tendon reflexes. After managing the airway what is the next step in management:
Back to some more Board-Style questions:
56 y/o F with acute organophosphate overdose, severe bronchorrhea, bradycardia and coma. She is intubated for airway protection and atropine therapy initiated. After 10 mg Atropine her HR is 130, BP 160/90 and secretions are still copious. Which of the following is the most appropriate next step in management?
32 F – presents with AMS. EMS reports neighbors smelled gas and called 911. They found patient unresponsive (? Sleeping) initially in the apt. Patient doesn’t remember these events but does recall that she is staying at a friends and had a few drinks earlier in the night mixed with 1 Xanax. nd isn’t sure how the gas got turned on. Vitals stable. Physical exam aside from being confused about events unremarkable.
Labs: alcohol (271), ASA (wnl), Tylenol (wnl)
Initial VBG: pH 7.34, PCO2 55, PO2 40 lactate 1.5
Carboxyhemoglobin 0.9
EKG- NSR 79, no STT changes. Incomplete RBBB. Flattening T waves laterally
78 yo f presents with generalized weakness. Patient denies any complaints per se and was brought in by family member after patient could not answer her door due to her weakness. Vital signs were stable. Physical exam was unremarkable and she had not other ROS complaints.
Initial venous blood gas revealed pH of 7.21, pco2 40, lactate 2.1 and glucose of 20.
Initial ER venous revealed Na of 140, K 5.1, Cl 109, CO2 23, Bun 19, Cr 1.1 and glu 20.
Patient has a non-anion gap acidosis. Helpful mnemonic for differential in this category is HARDUP.
Of these, RTA is most likely given her history and physical. Which RTA however?
Raviraj Patel