I love this profession, but not everything about it is puppies and rainbows. In this episode, I give you 10 reasons you may not want to pursue a career in an emergency department. Unless the reasons get you excited. Then you should totally do it!

This episode covers positive pressure ventilation – both invasive and non-invasive, discusses what reasons we may see that use positive pressure to help our patients, and some troubleshooting for ventilators. Patients who are short of breath will be a daily problem that you will encounter, and this gives you the low-down on the aggressive treatments!

After a way-too-long hiatus, I’m back! This episode discusses the state of the podcast, where it’s going in the future, and covering drugs used around rapid sequence intubation. Thank you to everyone who has sent me messages, I feel honored to be a small part of this community!

Today’s episode will guide you through the sea of headache patients in the Emergency Room. From a simple tension headache to a subarachnoid hemorrhage, this podcast will cover your important assessments, treatments, and supportive interventions. You can’t miss this episode if you want to know how to do a good neuro assessment in the ED! www.edcrashcart.com

SIRS – systemic inflammatory response syndrome
Temp >100.4 or < 96.8
Heart rate > 90
Respiratory rate > 20
WBC > 12k or < 4k

Two or more SIRS criteria and a source for infection = sepsis
Sepsis + lactate > 4 or systolic blood pressure < 90 = severe sepsis
Severe sepsis where hypotension persists after fluid resuscitation = septic shock.

Shock is hypoperfusion, hypoperfusion leads to anaerobic metabolism, which leads to increased lactate.

Systemic inflammation leads to increased capillary permeability = leaky capillary beds = 2nd and 3rd spacing of fluid

Levophed (norepi) is first line pressor for septic shock.

CVP = garbage but measure it if your protocol demands it, 8-10 in spontaneously breathing patients, 10-15 in ventilated patients

SVO2 – mixed venous oxygen saturation = > 70%, < 70% means poor oxygen carrying capacity – consider PRBCs or inotropic medications.

a1 receptors – a for artery! – a1 agonists cause smooth muscle contraction (vasoconstriction)
b1 receptors – 1 for 1 heart! – b1 agonists increase cardiac contractility (beta blockers, aka b1 antagonists,  do the opposite)
b2 receptors – 2 for 2 lungs! – b2 agonists decrease bronchospasm and increase bronchodilation (albuterol)

In this episode I talk about why we need to care about sepsis, how we diagnose it, how we treat it, what it’s doing to our patients, and why EGDT (early goal directed therapy) is the best thing you can do to decrease mortality. As a bonus, learn about some receptor sites and hear a minor rant on rising above mediocrity.

Also known as, not happening! I’ve got two more podcasts lined up to be recorded, one on sepsis, and the next chief complaint podcast – headache! Hopefully the copious amounts of sleep and fluids (with a healthy dose of nyquil here and there) will get me back on my vocal feet once more and I can get these recorded and posted later this week.

Blood gas normal values (check with your own facility):

pH – 7.35-7.45
CO2 – 35-45
HCO3 – 22-26

ROME – Respiratory Opposite, Metabolic Equal

Think of CO2 as acid: High CO2 = acidic

Respiratory – fast compensation
Metabolic – slow compensation

Anion Gap: traditional (Na + K) – (Cl + HCO3),  modern equation Na – (Cl + HCO3)

This episode covers interpreting a blood gas, as well as goes more in depth on acid base (though not too in depth) and then applies the discussed topics to a patient in DKA, one of the most common metabolic disorders you will see in the ED. www.edcrashcart.com

So you don’t have to track through all the mnemonics listed in the show, here they are in a quick summary, as well as the link to the  Blakemore Tube Insertion

Pain mnemonic: OPQRST

O – Onset (when did this start, what were you doing at the time?)
P – Provoking and Palliative (what makes this pain better or worse?)
Q – Quality (what does it feel like? Remember, pressure and tightness are pain!)
R – Region and Radiation (point to where it hurts, where does the pain go from there?)
S – Severity (0-10 scale)
T – Time (how long does the pain last, have you had it before, how does it feel compared to times in the past?)

Chest Pain BIG BAD UGLIES mnemonic: PET MAC

P – PE
E – Esophageal Rupture
T – Tension Pneumothorax
M – MI
A – Aortic Dissection
C – Cardiac Tamponade

Chest Pain focused physical assessment: AABBCC

A – Appearance (do they *look* sick? responsive? labored breathing?)
A – Auscultations (remember to palpate the chest while you’re auscultating heart sounds to check for pain you can reproduce)
B – Back
B – Belly (any auscultated or palpated pulses? tender to palpation pain?)
C – Circulation (radial, cap refill, turgor, JVD, edema [unilateral vs. bilateral, pitting vs. non-pitting], dorsalis pedis, cap refill in toes)
C – Color (pale? jaundiced? pink, warm, and dry? lower extremity discoloration?)