EMS Prehospital US- Dr. Heppner

1. Pre hospital US began in the early 2000s
2. Advantages include possible early diagnosis of pneumothorax, intrabdominal hemorrhage, cardiac tamponade, and tube confirmation
3. Also, may improve triage process
4. Barriers include costs of equipment and training as well as operator dependence
5. Could also cause delay in transport times

Capstone- Dr. Davenport

1. Heterotopic pregnancy risk is 1/100,000
2. Consider this in patients with persistent symptoms despite IUP
3. Zebra diagnoses are rare but still must be considered if nothing else explains the diagnosis
4. Be cautious in pregnant patients if you are concerned with ectopic rupture, even in patients with stable vital signs

Hyponatremia- Dr. McGee

1. For hyponatremia consider history closely when deciding volume status.
2. Primary polydipsia is rare and requires huge amounts of water intake.
3. Doing a repeat confirmatory test on a hyponatremic patient with minimal symptoms is important.
4. Use serum osms to determine pseudohyponatremia
5. In true hyponatremia, sodium and osms are low
6. Low Urine Osms and low specific gravity point to ADH independent hyponatremia, high Osms and SG would suggest ADH dependent
7. Consider Uric Acid test which may be low in SIADH
8. Beware of elderly patients with mild hyponatremia because they are at much higher risks of falls
9. Goal of hypertonic saline is to raise sodium by 5 mEq or improve LOC

Room 9 Follow up- Dr. Thomas

1. 45 yof hx of obesity, HTN, DM, complaint of weakness and slurred speech with a GCS of 6
2. Intubation complicated by black emesis but achieved with reverse trendelenberg position.
3. Head up intubation increases time until desaturation.
4. Consider bougie for increased first pass success
5. Consider post intubation complications when selecting head up vs conventional intubation

Pediatric DKA- Dr. Patterson

1. Pediatric DKA can many varied presentations
2. Blood pressure is usually last thing to decompensate in pediatric shock
3. Don’t bolus insulin initially. Make sure patient is resuscitated and potassium is appropriate
4. 10-20 ml/kg fluid bolus is correct based on PECARN
5. Most new evidence suggest that cerebral edema may be less iatrogenic than initially thought