Dr. Cook- Room 9 Follow Up

AMS in young person – Concern for toxidrome. But keep wide differential.

Prolonged QTc. Look at T-wave as it related to QRS complexes, if greater than halfway between two QRS complexes, think prolonged.

Serotonin Syndrome- Nystagmus, Sustained Clonus, elevated BP, HR, Respiratory Rate, Hyperthermia, Altered Mental Status, Diaphoresis.

Hunter’s Criteria to help diagnose.

Treatment = Stop offending medication, supportive care, Benzos

In TCA overdose, treatment for EKG changes is bicarb. Serial EKG’s to monitor following bicarb administration.

Dr. Lund- Peds ED

See sicker patients first

Lots of order sets for specific cases (neonatal fever, DKA, Asthma, etc.)

Vaccine status very important

Finish notes within 24 hours

All medical subspecialties aside from heme/onc admit to JFK (medicine)

Newborns eat 2oz every 2 hours on average

1 month oz, 4oz every 4 hours on average

Newborns may poop once a week or multiple times a day

Ibuprofen/Tylenol 10mg/kg every 6 hours, Ibuprofen > 3 months, Tylenol any age

Versed PO dose 1mg/kg, IV .1mg/kg, IN .2-.3mg/kg

Morphine .1mg/kg

Fentanyl 1mcg/kg

Need high dose amox to kill strep pneumo (pneumonia, AOM)

Bolus = 20cc/kg

Sepsis= 60cc/kg in first hour

Dr. Ferko- Shock

Shock = Hypoperfusion

Signs of shock – hypotension, tachycardia, decreased urine output, altered mental status

Types of shock- cardiogenic, obstructive, distributive, hypovolemic

Distributive shock- Example is sepsis. Inappropriate vasodilation.

Use lactic and blood pressure to determine severity of sepsis. Severe sepsis needs 30cc/kg bolus

Norepinephrine is first line. Vasopressin 2^nd line. Then epinephrine or phenylephrine.

Cardiogenic shock- Most likely caused by acute MI. Severe decrease in cardiac output.

Norepinephrine is first line pressor again (pretty much first line for all shocks)

Distributive shock- Another example is distributive shock. Again, inappropriate vasodilation. Also classically involves no appropriate increase in cardiac output

Hypovolemic shock- In trauma, number one cause of shock. Treatment is blood or fluids, depending on cause of hypovolemia

Obstructive shock- Example is cardiac tamponade or tension pneumothorax. Decrease in cardiac output secondary to physical obstruction. Treatment is to relieve the obstruction.

Dr. Danzl- Law and Emergency Medicine

Document everything you do

When in doubt, treat the patient

Be kind and compassionate to your patients

Do everything you can to prevent patients leaving AMA. Give them the best chance to succeed if leaving AMA (give follow up, antibiotics as needed, etc.)

Take x-rays of all foreign bodies

Be sure patient can walk prior to discharge if they can normally walk

Always get a pregnancy test in women of childbearing age