Ultrasound for Lumbar Puncture: how to maximize first-pass success in patients with large body habitus
- Nov 15th, 2014
- Stephen Alerhand
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For your Friday afternoon, here's another batch of excellent write-ups from the EM interns at UT Southwestern. Our ongoing intern report series is the product of first-year residents exploring clinical questions they have found to be particularly intriguing, with an intended audience of med students & junior residents. Enjoy! [Note: These are PDF files.]
[Editor's note: For a limited time, Tintinalli's is making their full chapter entitled "Chest Pain: Cardiac or Not?" available to emDocs readers.]Low-risk chest pain. Examining and challenging "standard of care."
Our AMA with Dr. Mike Mallin & Dr. Matt Dawson from the Ultrasound Podcast, held on Friday, November 14th from 2-3:30pm EST.
These children are often a mixed picture of viral bronchitis/bronchiolitis PLUS an asthma exacerbation. Treatment with albuterol, ipratropium, magnesium sulfate, steroids, fluids, etc are all reasonable and prudent in this population. If they begin to clinically improve within 30 minutes then you can feel good about soothing their reactive airways. However, they still have underlying viral issues which may require non-invasive positive pressure ventilation (either high-flow nasal cannula or BIPAP). If they do not improve within 30 minutes then you should begin to plan for IMC/ICU admission as these patients will require significant monitoring and respiratory support.
Trying to predict the future is a task that is riddled with risk. There is a very high potential that I will be wrong and my thoughts will end up being complete baloney. I'm okay with this. According to Strengths Finder 2.0, I'm futuristic, meaning that I'm inspired by the future and what could be, and hopefully will inspire you. With this in mind, two quotes that I believe should frame our conversation: "The future is already here, it's just not very evenly distributed." -William Gibson "We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next 10." -Bill Gates With these in mind, here are some trends that I see emerging. [...]