General Principles: Administer stroke scale items in the order listed. Record performance in each category after each subscale exam. Do not go back and change scores. Follow directions provided for each exam technique. Scores should reflect what the patient does, not what the clinician thinks the patient can do. The clinician should record answers while administering the exam and work
Read moreSuction Assisted Laryngoscopy for Airway Decontamination SALAD is an airway intubation technique utilized for patients who are actively regurgitating. It was pioneered by Dr. Jim DuCanto. Steps in the technique include: Lead with suction catheter to remove debris. Insert laryngoscope while catheter remains in pharynx. Move suction catheter to left side, behind the laryngoscope blade and leave tip in the
Read moreCardiac Arrest: CPR Shock VF/VT Epinephrine 1 mg q3-5min One of the following may be considered for shock refractory VF/VT: Amiodarone 300mg IV/IO bolus (1st dose), 150 mg IV/IO (2nd dose) Lidocaine 1-1.5 mg/kg IV/IO (1st dose), 0.5 – 0.75 m/kg IV/IO (2nd dose) Treat reversible causes: Hypovolemia Hypoxia Hydrogen ion (acidosis) Hypo / Hyperkalemia Hypothermia Tension pneumothorax Toxin Thrombosis
Read moreNotes: 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,
Read moreGB 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 –
Read moreRapid 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
Read moreFor use in children age <2. If Child over 2 years old, standard GCS has been shown to be slightly superior. (Standard GCS page) Eye 4pt – Open spontaneously 3pt – Open to verbal stimuli 2pt – Open to pain only 1pt – No response Verbal 5pt – Coos, babbles 4pt – Irritable cries 3pt – Cries in response to pain
Read moreSteps: (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
Read moreSource: Pedscases.com (reproduced with permission), Printable Chart Further information regarding pediatric hypertension: National Heart, Lung, and Blood Institute, NIH
Read moreEyes 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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