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VBG vs ABG

Notes: In a meta-analysis, Bloom et al. note that there is good correlation between arterial and venous pH and HCO3. They also concluded that despite variability in arterial and venous pCO2 and lactate, normal venous levels have good negative predictive values. 1 Zeserson et al. studied VBG and SaO2 (pulse oximetery) results in critically ill patients. This population included 41% ED,

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Radiology Measurements & Follow Up

GB Ultrasound 1,2: GB wall <4mm, measured anteriorly at thinnest portion. CBD width <4mm + 1 mm for each decade after 40. AAA ultrasound3,4,5: Abnormal >3cm Most common infra-renal Mortality at rupture 85-90% Considerations for repair: 5.5 cm (men) and 5.0 cm (women) Growth >0.5 cm in 6 months Surveillance rates: 3-3.4cm – every 3 years 3.5-4.4cm  – annual 4.5-5.4cm –

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RUSH Protocol

Rapid Ultrasound for Shock and Hypotension (RUSH) The HIMAP protocol was originally published by Weingart et al in 2009 after being discussed publicly in lecture format. The original article appears here.  The protocol examines the following areas: H – Heart (parasternal and four-chamber views) I – Inferior Vena Cava (for volume responsiveness) M – Morison’s pouch (i.e., FAST exam) and views of thorax

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Cricothyrotomy

Steps: (right handed) Left hand stabilizes thyroid cartilage (1) Left index rests over cricothyroid membrane (A) Right hand #10 scalpel makes vertical incision over entire cricothyroid area (3cm) Left index finger palpates for cricothyroid membrane Right hand #10 scalpel makes horizontal incision through crycothyroid membrane Left index finger goes in hole (insert bougie if using one) Place 6.0 endotracheal tube

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Glascow Coma Scale (GCS)

 Eyes 4pt – Open spontaneously 3pt – Open to voice 2pt – Open to pain 1pt – No eye opening Verbal 5pt – Oriented, normal conversation 4pt – Confused, disoriented 3pt – Incoherent words 2pt – Incomprehensible sounds 1pt – No sounds Motor 6pt – Obeys command 5pt – Localizes pain 4pt – Withdrawal / flexion to pain 3pt –

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