Conference 09/14/22

Research “Life Cycle”

• complete required training courses
• develop a research project
• do a lit search
• Start plan/write protocol and IRB. 
• IRB submission. 
  • Must be approved by the IRB, takes time so plan accordingly. 
• Types of research
  • Human research
  • QI
  • Program eval
  • case report. 
• Collect data
• Data analysis (you don’t have to crunch numbers)
  • schedule something with Jacob, He’s awesome!
• Write the paper. Read papers. Learn the format and write it. 
• Publish: LONG process. 

Room 9 Follow up: Josh French

• 45 yo F presents via EMS after being found unresponsive. reports she fell earlier in the evening. “Oh btw she’s having a GI bleed” per EMS. 
• Unresponsive, ill appearing, GCS 3, severely hypotensive and requiring BVM for respiration. 
• Dark blood per rectum. 
• pH unreadable, hgb. unreadable, lactic acid greater than 20
• Triaged to CT with nonspecific findings of the abd/pelvis. 
• Upper vs Lower GI Bleed: Broad differential 
• Protip: BUN can be elevated from upper GI bleed due to absorption of blood through the upper GI tract. 
• Resuscitate, support pressures. get blood ASAP. 
• Needs a GI consultation for treatment of bleed through EGD/Colonoscopy. 
• MTP at U of L 
  • volume replaced exceeds patients estimated blood volume in a 24 hour period. 
  • 4 units RBC in 1 hour. 
  • 10 units of RBC, 10 units FFP/plasma, 2 units of platelets. 
• pmts who require significant blood products need calcium! Citrate as a preservative will bind the body’s calcium. 
• Resuscitate until normotensive. 

One Pill can Kill: Kaci Eastep, PEM. 

Incidence

• 70,000/year pediatric ingestions. 
• Peak incidence 1-3. 
• Most mild or clinically negligible. 

CCBs

• pediatric patients rely primarily on heart rate for cardiac output. 
• ingestion causes bradycardia, hypotension 
• Decon if able with charcoal. 
• ABC’s: atropine, pressers, fluids if needed. 
• Calcium, high dose insulin, glucagon, lipid infusion. 

Camphor (icy-hot, bengay, vics vapors)

• causes rapid GI distress in 10-20 minus. 
• delirium, restlessness, seizures
• coma, CNS depressant. 

Clonidine + Opioids

• clonidine has opioid receptor agonism and may look largely like opioid intoxication. used for ADHD treatment. 
• naloxone, higher doses required for clonidine. Up to 10mg. Start high dose. 
• Lomotil- diphenoxylate (opioid) + atropine
• Able to provide intranasal narcan for free upon discharge. 

TCAs

• leading cause of pediatric toxicities until 1993. 
• multiple areas of receptor interactions primarily norepinephrine and serotonin. 
• CNS depression, seizure, arrhythmia, anticholinergic toxicity. 
• treat with Bicarb. 1-2mEq/Kg. Alkalinize urine to expedite urinary secretion. 

Salicylates: peptobismol, oil of wintergreen, Aspirin

• minumum 150mg/kg for toxic dose.
• nausea, vomiting, diaphoresis, tinnitus(ototoxicity), pulm edema, hyperthermia, coma, death
• Mixed AG acidosis with resp alkalosis. 
• Alkalinize urine (bicarb). for severe ingestions hemodialysis. 

Sulfonylurea

• stimulate insulin release. 
• leads to profound hypoglycemia
• Treat with octreotide 1-2 microgram/kg/dose and dextrose as needed. 

Toxic Alcohols: ethylene glycol, windshield wiper fluid, rubbing alcohol. 

• Methanol: visual disturbances, AG acidosis, treat with 
• Ethylene Glycol: renal dysfunction, calcium oxalate crystals.  AG acidosis
• Isopropanol: no AG acidosis, increased osmolar gap. 
• toxic alcohols are broken down by alcohol dehydrogenase, which is targeted by fomepizole (used for methanol and EG) 
• Can technically use ethanol
• Hemodialysis for severe ingestions.