Archive for March, 2014

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!

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.