Wondering why your patient has a critically low or high calcium on labs? Want to know if his/her symptoms are consistent with that derangement, or a symptom of something else? How to start treating immediately in the ER? Look no further than this nifty graphic geared toward the emergency physician!
Importantly, always remember to start looking for the underlying cause of your patient’s derangement in the ER… because treating that is the definitive management in all cases.
Want to broaden your differential for hypotension? Do you have a younger patient with hypotension and lab abnormalities? A patient with hypotension refractory to pressers? Think of acute adrenal insufficiency!
I dont have much in the way of additional pearls today - this is pretty self explanatory.
Concerned that your patient ran out of cortisol? Give cortisol (hydrocortisone). You wont diagnose it if you dont suspect it - so keep it on the differential!
Good Monday Morning all!
This one took me all weekend - but I think it will be particularly helpful! I am always looking up how to dress burn wounds and who to give followup to and who to transfer etc, so I think this will be a nice easy reference.
There is just too much info around burns (from cyanide poising which we just reviewed w/Dr. Harmouche to awake nasotracheal intubation) and there are just so many learning points and I could only include so many - so I apologize for having the leave some things out. its already a dense one!
Prepare to zoom in/magnify, and happy learning (:
A couple key take home points that I wasnt able to fit into the graphic:
Burns are dynamic wounds. Burns can deepen over the next few days, and so it is difficult to know the true depth of the wound for at least 48-72 hours. Even burn specialists are only correct about 60% of the time at accurately identifying the depth of the burn on initial assessment. Burns can deepen after the first few hours to days of assessment. This is particularly important when setting expectations with patients and families at the initial visit.
Initial approach to any patient in a fire:
Don’t get distracted by the burns. Perform your primary and secondary survey as you normally would with a trauma patient and address the burns later.
Carbon monoxide (CO) and cyanide poisoning are also associated with burn injuries. Apply 100% O2 to reduce the half-life of carboxyhemoglobin to all patients with a history of exposure to fire in an enclosed space. Assume the pt is both trauma AND tox until proven otherwise.
Many of these pictures and pearls came from this amazing website:
https://emergencymedicinecases.com/burn-inhalation-injuries/
