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Probably just artifact. The machine may also be interpreting (wrongly) that part of the ECG as from a pacer and placing a "pacer spike" there. The current bipolar leads used on pacers deliver very little energy and the actual pacer "spike" can be extremely low amplitude or not seen at all on...

How was EM this year? Pretty competitive? Last several years it has seen that way..... At least more popular. Even outside the match during/after SOAP (I guess that's the new scramble?) I've heard pickins' were slim.

And really NMB is not needed here and won't help. Anticonvulsants, benzos and maybe barbiturates to stop the seizures. In the hospital we'll just induce basically general anesthesia or something like a phenobarbital drip while monitoring an EEG.

Get thee to a hospital. So no luck stopping seizures after how much benzos? Keep them coming and intubate.

In an ICU where I have patients on vents for days I just don't see these folks needing lots of opioids for pain control while in the vent. Usually if adequately sedated they may not need any. Even in the patients lightly sedated who can still follow commands they usually tolerate the tube...

In general, I just don't see nor am I concerned about clinically significant dysrhythmias from inhaled beta2 agonists. Even with underlying afib/flutter I don't have problems with it and get calls from RT or nursing freaking out about giving an albuterol or duoneb to the COPD exacc patient...

What are the QRS amplitudes? And I don't see the problem with posting it if it's properly de-identified.

Yea he's sick. He's on pradaxa so PE goes down the list in my mind, though w/ I guess a hx of recent DVT it's a possibly if it wasn't compliant. Was there a temp?

I think it's a judgement call. Obviously in an respiratory arrest/code situation where getting an airway is crucial then yea, secure it and do whatever you need to there. In something like this where ultimately they're probably going to end up intubated for impending respiratory failure but...

I'm assuming they were admitted to a pediatrics service? Yes, assuming they were physicians that went to med school and completed a residency in some pediatrics related field they should be familiar with one of the more common and more serious complications of sickle cell disease in...

Even if a community hospital setting it's one of the more known sickle cell emergencies, especially in pediatrics which an ER doc would/should be familiar with.

And I wouldn't just say that infection causes it as it has several causes with some complex pathogenesis. Fat emboli from bone/marrow infarction, multiple viral/bacterial causes, and in a good number of cases the cause is frankly not known.

Did the initial admitting hospital not recognize acute chest syndrome in a kid with sickle cell?

In evaluating syncope the most important element is arguably the history. Taking a good history will most of the time give you an idea of the etiology, but can be tricky to do. If he says he had the exact same episode before due to hypoglycemia then just playing the odds that's probably...

Fever? Rash? Sick contacts?

Whatever is going on here it's bad. Acute Pulm edema is a good thought on what's currently happening, but the question would be from what? Acute MI/CHF/cardiogenic shock, viral illness/sepsis, alveolar hemorrhage, aspiration are all possibilities. Lots of other causes as well but they don't...

I agree, being off duty and and coming up to a scene where others are already "in control" you just see if you're needed and if not then just offer assistance if needed and stand by. On duty is a different story, and frankly unless the physician is trying to live out some adrenaline rush I...

Not sure what protocols would say but I wouldn't let an iffy BP stop me from using BiPAP/CPAP in a patient in resp distress which it appears this pt is in.

I'll let him look into the metabolism, but personally I've never thought twice about giving a bad liver disease patient an occasional dose of Benadryl.

Also, look up the metabolism of Benadryl. That article was more dealing with chronic liver disease. May not necessarily be similar to what this lady had/has. If she has long standing liver disease (alcohol, NASH, hepatitis, etc...) then that's one thing, but right now we only know she has...