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For acid/base purposes, if I'm going to use bicarb my standard is 3 amps in a bag of D5, this gets you a SID close to plasmalyte, and run it at 100 - 200 cc/hr. Only time I can see pushing an amp is in TCA overdose and impending herniation due to elevated ICP (standard bicarb is 8.4% sodium...

There is only one (maybe two) good reason to push (and I mean over like 10 minutes) an amp of bicarb, and it isn't for severe acidosis. Absolutely no reason to give an amp of bicarb as a "push" (i.e. faster than 10 minutes).

I agree with those saying this is DKA. And as to the suddenness of it, I doubt it was. DKA develops over days/weeks. His likely just caught up with him at the mall. You did fine, not much to do with these pre-hospital. I'm surprised the ED was so aggressive with the airway, I wouldn't have...

You can frequently have no deficits with a cervical fracture. Now, someone show me a shred of evidence that pre-hospital immobilization has any positives what so ever? Because I can't find it. Only thing the spine boards on our trucks are for is moving completely unconscious people to the...

Agree on the patient population. As for the SIMV, as I've said in the discussion thus far, at least with our vents the only difference is the number of volume assisted breaths. In A/C all of them will be, in SIMV only the "IMV" breaths. From what I've seen thus far the literature is a...

I just got done spending several months in the SICU here at my school (anesthesia bound so very little time in the MICU in comparison). I think APRV has lost its wind (pun most definitely intended) some, we only used in very bad cases when everything else failed to oxygenate the patient. For...

Puritan Bennett 840. Not sure what you're getting at with your second question? Are you asking what I would do in that case? I would drop my TV (though honestly everyone should probably be at that 6-8cc/kg regardless of process) and increase my expiratory times (and yes this is simplified)...

I'm going IN everyday of the week before I attempt any kind of invasive access.

Not transporting them anywhere. And beyond lung protective strategies for lung injury processes and increased expiratory times for obstructive processes I'm afraid that the details just don't matter much in terms of getting your patient off the blower as quickly as possible.

The only difference between SIMV and A/C on the vents I work with is in SIMV not every breath is assisted (volume wise), where as A/C they are. In this situation it matters very little for meaningful outcomes which you choose.

That's because in modern ventilators it pretty much is, and the only reason to choose one over the other is user comfort with settings.

I don't abbreviate anything any more. My standard negative neuro exam reads: "Alert and oriented to person, place, and time. No gross visual defects. Pupils mid-line, equal, round, and react to light. Extra ocular movements are intact. No facial asymmetry. Hearing intact grossly. Shoulder...

Musician. Finishing grad school in a month (not music related).

Not a great example, we don't generally choose another specialty, not how medical education works.

If it's a relatively stable patient, I introduce the student and ask if they have any issues with them helping me out. If the patient is cool, student runs the call. I'm surprised this is so shocking to people. I find it disrespectful to do anything else.

Just so we're clear, the patients here aren't signing anything extra. The actual consent form has the fact that students will be included in care. I am talking about actually talking to the patients, again it adds very little time (if any), and personally I think it's the right thing to do...

If you're talking emergent conditions obviously that's different. For the most part these cases going to the OR are elective, thus time can taken, and as I said in this facility is in fact done with no problem.

And for the record I'm at a major teaching institution and this is how it works here.

I can on my patients for my portion of care. When patients are pre-oped I talk about the risk/benefits of the anesthesia. The surgeons talk about the surgery. You act as if it's difficult to say to the patient "Also, I have a xxxx student with me today, would it be okay if they help with...

That's tricky. Just out of curiosity how are you going to introduce yourself when you're a resident? Because personally I'll introduce myself as "I'm Dwindlin, one of the anesthesia residents." And if they ask what that is I'll explain it. Again, if it were my family and they were...