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What's Wrong with This Picture?: Abdominal X-rays

12/21/2016

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Adapted from a lecture by Stas Haciski

Indications
  • rule out free air (sens 90% in upright)
  • look for foreign bodies
  • chronic abd pain with too many prev scans
  • constipation?


Basic Approach
  • check film position (upright, lateral decub, etc0
  • look at dark areas
  • look at light areas
  • check everywhere else
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SBO

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Improving identification of sepsis

12/14/2016

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The Surviving Sepsis Campaign has created pocket guides, posters, bundle cards, and a list of resources to aid your implementation efforts using the most recent edition of the international sepsis guidelines.

Within 15 minutes

  • Draw stat lactate
  • Draw blood cultures & urine cultures

Within 1 hour

  • Start Broad Spectrum IV antibiotics after the cultures are drawn
  • Administer 30ml/kg crystalloid for hypotension or lactate ≥4mmol/L
  • If initial lactate level is >2, draw a repeat lactate level within 4 hours of positive sepsis screen. (lactate order will be reflexed automatically)
  • If hypotension persists after 30ml/kg bolus, or lactate ≥ 4 = Septic Shock Time
  • Start IV vasopressors for persistent hypotension.
  • Provider to perform focused exam within 4 hours of Septic Shock time 

Improving identification of potentially septic patients

To improve identification, it is recommended to have a consistent approach to every patient who is identified as meeting SIRs criteria. Use our prior posts on sepsis for more education (New Sepsis Guidelines) (Qsofa Score). It is also recommended to utilize a smart phrase to identify any potential infectious etiology and medical decision making to prevent missing a potential source of infection, such as an indwelling catheter or orthopedic device. 
sepsisscreeningtool.pdf
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Peripheral Pressor Use & Treatment of Extravasation

12/14/2016

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Utilizing peripheral IVs for short-term treatment with IV vasopressors is frequently utilized while obtaining additional access. Are we risking skin necrosis for short term gains? 

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NIH Stroke Scale & Training

12/8/2016

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The NIH stroke scale it used to identify the severity of stroke like symptoms, and should be scored on the patient's initial presentation, without coaching or duplication. It is important to be consistent when scoring all patients, and identify all deficits. 

NIH stroke scale scores patients 0-42, with higher scores indicating increased severity.

Training for appropriate use of the NIH stroke scale is free, at http://nihss-english.trainingcampus.net/

iPhone applications, such as StatCoder, are available and free.
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TR Desk: Lithium Toxicity

12/8/2016

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Lithium is an effective treatment for bipolar disorder, and is known to decrease rates of suicide associated with affective disorders. Additionally, lithium is uncommonly used to augment treatments for depression, aggression, and PTSD. Unfortunately, lithium is also frequently the cause of toxic ingestions due to its narrow therapeudic window, renal clearance, and utilization for intentional overdoses. 
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This site is independently owned and operated and not affiliated with the George Washington University, George Washington University Hospital, or Medical Faculty Associates. All information on this site is the opinion of the author alone and in no way should be seen to represent the views of the George Washington University, George Washington University Hospital, or Medical Faculty Associates. The information on this page is for personal use only and should not be see as medical advice or used directly for patient care. The author provides no guarantee of the accuracy of the information provided on this page. ​

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  • Clinical
    • Discharge Macros
    • Procedure Macros
    • Exam Macros
    • Pediatric Macros
    • Antibiogram
    • Follow Up
    • 2023 MDM
    • Heart Pathway
    • Jeromy's Macros
  • Education
    • EM Education
    • Critical Care
    • FOAM
  • Orientation
    • Dept Orientation
    • Cerner
    • Dragon
  • Links
    • Clinical Links
    • StatMacros
    • ICU Bootcamp
  • Private
    • MCS
    • GWU Contacts & Map