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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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ICH and BP management

Spontaneous (non-traumatic) Subarachnoid Hemorrhage (SAH): Goal SBP < 140-160 mmHg Medication options: Labetalol IV 10mg boluses Nicardipine infusion Celvidipine infusion Avoid vasodilating agents like nitroprusside or nitroglycerin Spontaneous (non-traumatic) Intracerebral Hemorrhage: Goal SBP < 140 mmHg AHA / ASA guidelines (2015) give the following recommendation: “For ICH patients presenting with SBP between 150 and 220 mm Hg and without contraindication to acute

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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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PECARN Pediatric Head CT Rule

The PECARN head injury rule was derived in a population of patients younger than 18 years old with blunt head injury. 42412 patients were included in the study population with a goal of identifying patients at very low risk of clinically important traumatic brain injury (ciTBI) by history and exam criteria, obviating the need for CT imaging.  Child <2 yo

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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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Tranexamic Acid (TXA)

Tranexamic acid is a synthetic form of lysine, an amino acid. It is classified as an “anti-fibrinolytic” which means it is a  pro-coagulant. It binds to receptors on plasmin preventing it from breaking down fibrin clots. Tranexamic acid was originally discovered in 1962 and is currently on the World Health Organization’s list of Essential Medicines.  The drug has been studied

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