Search
261-268 of 268 results by Michael Bond
Direct Pressure: Can be held with two fingers pinching the nares, or you can tape 4 tongue blades together and make your own "clothes pin" that can then be used to pinch the nares. Vasoconstrictor and Anesthesia: Use a 1:1 mixture of topical lidocaine 4% and oxymetazoline can often be mixed together in the same oxymetazoline spray container and then just spray it into the nares. Some IV/IM narcotic pain medication will also help increase patient cooperation. Visualize the bleeding site: Use a HEAD LAMP with an appropriate sized nasal speculum. You may look like Marcus Welby, MD but nothing works as well to see into the nose. Cauterization It is best to cauterize circumferential around the bleeding site prior to directly cauterizing the actual site. Be careful with electrical cautery so has not to perforate the septum. Nasal Packing: Instead of surgilube use Muprion, Bactroban or Bacitracin ointment to lubricate the packing. This will reduce the chance of Toxic Shock Syndrome.
If you are facing the imminent delivery of a newborn with shoulder dystocia remember the mnemonic HELPERR. * Help. Call for it. * Episiotomy. o Necessary only to make more room if rotation maneuvers are required. * Legs (the McRoberts maneuver) o This procedure involves flexing and abducting the maternal hips, positioning the maternal thighs up onto the maternal abdomen. * Pressure, Suprapubic o The hand of an assistant should be placed suprapubically over the fetal anterior shoulder, applying pressure in a cardiopulmonary resuscitation style with a downward and lateral motion on the posterior aspect of the fetal shoulder. This maneuver should be attempted while continuing downward traction. * Enter maneuvers (internal rotation) o Attempt to manipulate the fetus to rotate the anterior shoulder into an oblique plane and under the maternal symphysis. * Remove o Remove the posterior arm. * Roll the patient. o Rolling the patient on all-fours will often dislodge the shoulder, and the position change allows gravity to aid in the disimpaction of shoulder. Baxley EG, Gobbo RW. Shoulder Dystocia, Am FamPhysician. 2004;69(7):1709-1714.
1. Hyperventilation in the pediatric HI causes an increase in cerebral ischemiaand increases in ICP 2. Cuffed tubes can be used in the pediatric airway 3. The most common cause of bradycardia in pediatric RSI is hypoxia and this is NOT prevented with atropine 4. Patients with an underlining neuromyopathy have an upregulation of neuroreceptors (they actually have more in number) the risk if hyperkalemic cardiac arrest is significant if succynlcholine is administered. 5. During Direct Laryngoscopy; the Mac blade can also be used as a Miller negating changing the blades. 6. Intubation is now a bimanual procedure as the use of External Laryngeal Movement (ELM) significantly increase the intubators view.
PPD is considered positive: >= 15 mm Induration: Anybody >= 10 mm induration: Born in a high-revalence country, are in a medically underserved population ( e.g.:Blacks, Hispanics, and Native Americans), individuals with a medical condition that increases risk of TB (e.g.; silicosis, gastrectomy, chronic renal failure, immunosuppressant therapy, malignancy, IV drug abusers, and those that work in the medical field. >=5mm induration: HIV or suspected HIV-positive, close contacts of newly diagnosed TB Cases (everybody on the plane), and abnormal CXR with fibrotic changes suggesting old TB MMWR September 08, 1995/ 44(RR-11);18-34
Supracondylar fractures in children: To assess the likelihood of a supracondylar fracture in a child look at the anterior humeral line. This is a line drawn down the anterior portion of the humerus on the lateral view of the elbow. This line should pass through the center of the capitellum in the distal humerus. If the line does not pass through the center there is a very high likelihood of a supracondylar fracture. Review of the Appearance of Ossification Centers in Children's Elbows CRITOE Capitellum 1 to 8 months Radial Head 3 to 5 years Medial (Internal)Epicondyle 5 to 7 years Trochlea 7 to 9 years Olecranon 8 to 11 years Lateral ( External) Epicondyle 11 to 14 yeras
1. 30% of all ETT placed in the field by EMS are esophageal. 2. Patients that will rapidly desaturate - think "POPS" ie Pregnancy, Obesity, Pediatric, Smoke inhalation. 3. In the adult the only absolute contraindication to performing a cricothyroidotomy is a fractured larynx. 4. Post intubation desaturation think "DOPE" ie Displacement, Obstruction, PNTX, Equipment failure.
The best known peripartum complications are pre-eclampsia and eclampsia. However, do not forget about HELLP syndrome which occurs in approximately 0.2 to 0.6 percent of all pregnancies. HELLP is an acronym for: Hemolysis Elevated Liver Enzymes Low Platelet Treatment consists: 1. Seizure prophylaxis with magnesium 2. Blood pressure control 3. Corticosteriods and plasmapheresis may be helpful in severe causes 4. Supportive care. 5. Early delivery of child.
In follow up to my Shoulder Dystocia Pearl
Dr. DePriest Whye has some legal pearls for us:
Erbs Palsy( Brachial Plexus Injury) is a known complication of shoulder dystocia and is due to traction on the arm that causes stretching of the brachial plexus.
- Should an Erb's Palsy result as a consequence of a shoulder dystocia, a medical malpractice suit is inevitable.
- The medical record documentation is particularly critical in defending the medical care rendered.
- The medical record should reflect timely recognition of the shoulder dystocia.
- It is important that appropriate implementation of the maneuvers described last week are done in a timely fashion.
- Vital documentation should describe the amount of traction placed if any.
- Terms such as minimal or mild or light traction should be used.
- Terms such as strong, forceful, significant traction should be avoided.
- Never state in the record that uterine pressure was used as opposed to suprapubic pressure.
- Uterine pressure is contraindicated.
Erb's Palsy cases are difficult to defend. They are impossible to defend with improper documentation.