Sat, 02/15/2020 - 5:00am

 

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Fri, 02/14/2020 - 3:34am

 

Venous thromboembolism is considered one of the most preventable causes of in-hospital death. Venovenous extracorporeal membrane oxygenation (VV ECMO) utilization for severe respiratory failure has increased in the decade following the 2009 influenza A H1N1 pandemic and the publication of the CESAR trial.1 The interaction between a patient’s blood and the ECMO circuit produces an inflammatory response that can provoke both thrombotic and bleeding complications. In a systematic review of patients with H1N1 treated with VV ECMO published in 2013, the incidence of cannula-associated deep venous thrombosis (CaDVT) was estimated to be as low as 10 percent; however, more recent data suggests the incidence of venous thrombosis after decannulation is much higher. Additionally, a significant proportion of CaDVT are distal thrombi located in the vena cava, which would be missed with a traditional ultrasound diagnostic approach after decannulation from VV ECMO.  

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Thu, 02/13/2020 - 5:00am

Your patient appears intoxicated but their ethanol level is ZERO ... think toxic alcohols 

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Wed, 02/12/2020 - 7:00am

A 61 yo female with a history of DM presents with 3 days of severe R ear pain.

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Tue, 02/11/2020 - 6:22pm

A 55 year old male presents to the ED with complaints of anterior chest pain radiating through to the thoracic area X 2 days...you mentally run through a check list of the potential "red flag" signs/symptoms for serious back pain before you enter the room. Will this be another benign musculoskeletal pain or something more sinister?

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Mon, 02/10/2020 - 5:00am

Review the basics of local anesthetic systemic toxicity. Make it L.A.S.T. in your memory!

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Sat, 02/08/2020 - 5:00am

 

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Fri, 02/07/2020 - 3:00am

A 68 year old male with a history of a right ankle ORIF three weeks ago is transferred to your ICU for management of a pulmonary embolism. He developed acute dyspnea while at physical therapy and was taken to an ED where he was found to have bilateral pulmonary emboli extending into both segmental and subsegmental pulmonary arteries on CTPE. His workup included elevated troponins and an echocardiogram that showed a dilated RV with hypokinesis of the RV free wall and reduced tricuspid valve annular systolic excursion. He was started on a heparin infusion prior to transport and was hemodynamically stable when you took the transfer call. When he arrived to your facility he was mentating well but his BP was 85/50 with a HR of 115 and an spO2 of 96% on 2L NC. How will you address his hypotension?

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Thu, 02/06/2020 - 6:00am

Quick review on Digoxin Toxicity 

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Wed, 02/05/2020 - 9:22am

 

A 60 yo female c/o left ankle pain after fall from ladder

 

 

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