Which Chest Pain patient needs a CT scan?
2 days ago
Friday, October 19, 2012
Monday, October 8, 2012
How can you calculate heart rate on ecg of arterial fibrilation?
1. Count out 6 seconds (ie 30 big squares)
2. Count the number or QRS complexes in that period
3. Times the number of QRS complexes by 10.
Carotid massage
Carotid massage: Carotid massage can release chemicals to slow the heart rate. Carotid massage is generally limited to young, healthy people because older people are at risk for stroke. In the emergency department, the patient will be connected to a heart monitor because the decrease in heart rate can be dramatic. Carotid massage involves gently pressing and rubbing the carotid artery located in the neck just under the angle of the jaw.
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Friday, October 5, 2012
Indication of Intubation--AVO HER
AVO HER
1.Apnea
2.Airway compromise
3.Ventilation compromise
4.Oxygentaion compromise
5.Anticipate AVO compromise
a. Inhalational injury
b. Maxillo facial injury
6.Aspiration----vomitus,blood
7.Head injury GCS 8 and less
8.Enviromental contol
a.Transportion of patient with GCS less then 12
b.Polytrauma patient
c.Aggresive patient
d.For longer prosedure outside ED---CT brain
9.Respiratory fatigue/failure/distress
a.Asthma/COAD
b.DKA
c.Severe acidosis
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Thursday, October 4, 2012
Stroke vs Bell`s Palsy
Diagnosis
How the doctors knew Julia did not have a stroke...
When Julia awoke with a crooked smile she thought she had suffered a stroke because she could not move the right side of her face. Her eye would not close completely and she could not raise the corner of her mouth. Her grandfather had recently suffered a stroke and Julia worried that she also had a stroke because, in the mirror, her face looked like her grandfather's. However, the doctors could see a subtle difference in the weakness caused by a stroke and weakness caused by Bell's palsy also known as facial nerve paralysis. A stroke is a condition that arises when cerebral neurons are injured by the sudden blockage of blood supply to that part of the brain. These neurons initiate movements of the face by sending signals to neurons in the brainstem. From the brainstem nerve fibers spread out to cover the face (see Figure 1).
Why the face looks different following a stroke compared to following a primary facial nerve injury (Bell's palsy)
Figure 1. The facial nerve and muscles of the face*
In general, cerebral neurons from the left side of the brain send their signals to brainstem neurons whose nerves innervate muscles on the right side of the face and right sided cerebral neurons go to brainstem neurons that innervate muscles on the left side. However, the facial nerve is somewhat unusual in that the fibers that spread to the upper face (muscles around the eye and the forehead) come from cerebral neurons on BOTH the right and left side of the brain. This results in a difference between how facial paralysis looks if there is injury to the brain (from a stroke) or injury to the facial nerve itself (Bell's palsy). Look at the faces in Figure 2. Why is the woman's face that of someone who had a stroke and the man's face that of someone with Bell's palsy?
Figure 2.*
Answer: If you can raise both eyebrows, the facial nerve is intact. Therefore, the woman has had a stroke involving the left side of the brain producing paralysis of the right lower face and the man has a right Bell's palsy.
* Topical Diagnosis in Neurology, by Peter Duus, Thieme Medical Publishers, Inc. New York 1989
Photographs and diagrams reprinted with permission
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Monday, October 1, 2012
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