Off Label

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Off Label last won the day on September 20 2016

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  1. Curious as to choosing NE instead of an inotrope like epi or even dopamine. Is there a specific element here that you like NE for?
  2. Counter intuitive, giving volume in that situation. Then take it off with Lasix. Perhaps just a stop gap measure to get the coronary perfusion pressure up.
  3. O2 for SaO2 > 92, epi for MAP > 70 mmHg (start with .03/kg/min) while en route. Determining DNR is a good idea, verbal is OK just to tell the receiving hospital what the patient said in the event he becomes unresponsive. A pretty hard buy to not resuscitate then and there based on what the guy says in his living room or back of the ambulance unless someone produces a document or corroborator. Based on hx/ PE, I'd say his LV was pooping out (as opposed to his RV 2/2 PHTN). If he pulls through, someone could suggest palliative care?
  4. Sound like the Afib here was 2/2 the type of surgery and problem the patient was having. I'm going to guess he didn't have a CHADS score that would suggest risk of a LA thrombus. I'd say you were pretty safe in DCCV'ing this guy (not that it sounded like you had much of a choice.) Good call on the pads. I can't say I'd have thought to do that.
  5. All of our Stoner Ford Type II's (mid/late 80's) had stretcher hooks you could suspend over the squad bench and put a third patient "bunk bed" style on a scoop or flat folding stretcher over the bench patient.
  6. Whoops...I got it. Was referring to OP of 120/80 blood pressure, not Ruff's post. Good point. LVADs are becoming so much more common around larger metro areas, not so much in "flyover" towns. Worth paying attention to, though, as people with LVAD's get into cars and drive to places far, far away from the centers that place them.
  7. That'd be some kinda lvad
  8. Had a patient brought in by ambulance with a pillow case over his head because he was trying to spit at the cops and the ambulance crew. Initial call was from the police for a disoriented and combative patient. He had kind of calmed down when I saw him, but was still thrashing his head from side to side...he was handcuffed to the stretcher. I told him I'd take the pillow case off of his head if he promised not to fight or spit at me and he nodded his head that he wouldn't. When I took it off, he made a herculean effort to flip his tongue back, up and out of his mouth to present a zip lock sandwich bag of densely compressed marijuana bud. Poor guy was choking.
  9. That's a really cool concept. So, fire doesn't send a first responder unit where you are?
  10. Sex crimes as a 13 year old? 24 years old now? That's a lot of water under the bridge. Caution? Definitely. Full disclosure? Absolutely. But I wouldn't dismiss the guy out of hand without so much as a glance. I'd worry way more about the folks you don't know about.
  11. Sure it can, but hypotension isn't shock. And we need a new word for the physiologic condition known as "shock"...There is a broad spectrum of hypoperfusion and it's consequences, if any.
  12. Good advice about getting into the multiple choice question frame of mind... taking these tests is a skill over and above mastering the subject matter. I do feel the OP's pain though... if a question like that were a deliberate curve ball and not just an error (they do happen), you'd really have to question the quality of the question writers. Can't have a pulse pressure of 40 without a pulse. Questions that contradict themselves don't muster a lot of confidence in the rest of the exam. I suspect, though, it was a typo...
  13. As a new member on this forum, I'm pretty reticent to give advice of this magnitude to someone I don't know. But from what I've read of your posts, you seem to be a pretty experienced dude that has some respectable chops. And a stand up dude to boot. So take this with a grain of salt and an open mind. 5 years is a really long time. It's only my opinion, Ruff, but were I you I'd seek a precepted couple of months with a busy service before going back. I say this for a couple of reasons. Firstly, it's a PRN spot where your exposure to bona fide emergencies is limited. They don't know you and credibility is a big deal. Nothing you don't already know, I get that. Second, as you kind of implied, stuff changes so quickly in medicine. What might be second nature to you now has been old news for a while in some services. Lastly, when folks in my business leave for that long and come back, they are welcomed with open arms as they do a precepted stretch on the job. These are people that have intubated thousands and thousands of time in the operating room under ideal conditions, let alone on a rainy highway in the dark. If I take two weeks off, I'm all thumbs when I get back. It's just a safe way to go and make a good impression. It would make for a really smooth transition back, IMHO. Best of luck.