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It's fine. So, why were you worried about giving her Benadryl? Why do you think she was itching?

That's a horrible question.

If patient is in an ER somewhere than usually it'll be an ER-to-ER transfer. If they were already admitted and an inpatient than it's usually an ICU-to-ICU (or floor to floor) transfer. Absolutely normal and legal assuming EMTALA criteria is met. We get these frequently with STEMI...

Surprised his pH wasn't lower.

Lactic at this point really isn't/shouldn't change what you do. I think it's safe to assume it's going to be high in this case.... guy is in shock with likely DKA and sepsis.

I think it was already mentioned above, but with unknown history, unknown ingestion, etc I'm not giving flumazenil at the risk of putting them into acute withdraw/seizure. It's a little different if your sedating someone for a procedure and are using it as a reversal if they just got a little...

Just FYI, even if a suspected benzo OD and certainly for benzo ODs that come in that I manage we don't give flumazenil. In fact I have never given it, and ONLY seen it given for a hospital patient inadvertently given too much benzos. Benzo ODs get supported until it's out of their system...

Wasn't questioning need to intubate really. From what it sounds like, intubation was indicated here. If you're truly going to RSI then goal is to not use BVM and achieve rapid induction/paralysis. In this case if she's basically unresponsive for an unknown reason I still agree with RSI...

Why the etomidate and versed? Just questioning why give more benzo to a benzo OD?

Yea you won't forget a BAD nose bleed. I've had a couple in the hospital that I've had to intubate for airway protection just because they were a severe posterior epistaxis and the person was crapping out. If it's pretty severe we give them a couple sprays of neo nasal spray and them pack...

I agree with with WTE said. MCAT is just one hurdle but it's still a standardized test and one that you can and need to prepare for mainly from understanding how and what type of questions will be asked. There are numerous review courses, videos and books available. In general...

I'm not sure, in my experience and opinion, med school has a way of knocking everyone on a level playing field. In my class we had people from pretty much every professional background, from a PhD in chemistry, to a PA, business owners, nurses, all the way to someone straight out of...

That series is what I used in med school. Some of it may be overkill but I think it was very clinically oriented and relevant.

How about a physical exam?

Hemoglobin 2.5 Survived.

I've seen plenty of 90 year olds cathed. Going to be a lot of variables to generalize and assume they're not going to intervene so you shouldn't make that assumption. At least where I am we're routinely even doing CABG's on 80 year olds.

This. I was never a medic but as someone in the healthcare arena looking at your field from the outside, if you to continue to advance your field/profession then some of the above suggestions regarding advanced degrees (doesn't have to be masters or even 4yr bachelors) I think is applicable...

Yea, sounds like DKA which can develop quickly in a type 1 insulin dependent diabetic. She probably seized and then arrested from severe electrolyte disturbances, like hyper OR hypokalemia and/or hypo/hypernatremia or severe metabolic acidosis. They can present as hyper or hypokalemia on...

And definitely wasn't saying or implying that you were saying do not treat. Just speaking to you saying how this patient would be initially treated conservatively in the ED. In my opinion this person is treated no different from any other person who comes in with a similar picture, except...

Yea obviously intubation is off the table with the DNR known but everything else really isn't different from how they'd approach and treat someone who came in with a similar presentation but no DNR. Even in those situations central lines and pressors aren't immediately started until at least...