Pimp Questions

Chase said:
What is the difference between calcium chloride and calcium gluconate?
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The difference is the type of salt used along with the calcium, and the concerntration of the Calcium?

Calcium Chloride can be dangerous because of the Tachycardia and HTN it can cause, and if you infiltrate can cause Necrosis by the extreme draw of Fluid away from the surrounding tissue.

Also, you CAN give Gluconate IM, Chlodide version....... No
 
Chase said:
What is the difference between calcium chloride and calcium gluconate?
Click to expand...

The difference is the type of salt used along with the calcium, and the concerntration of the Calcium?

Calcium Chloride can be dangerous because of the Tachycardia and HTN it can cause, and if you infiltrate can cause Necrosis by the extreme draw of Fluid away from the surrounding tissue.

Also, you CAN give Gluconate IM, Chloride version....... No
 
What is a lethal tx for a ventricular escape rhythm?
 
Anjel said:
Why?
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A ventricular escape rhythm is the heart's last ditch effort to conduct a contraction before asystole, all other pacemakers above the ventricles have failed to pace. Administering Lidocaine can suppress the ventricular escape rhythm and then __________ ruh roh
 
The PA cath one is simply the insertion waveforms as the catheter is introduced into the PA with the last likely a wedge (balloon inflated).

CaCl also provides about 3 times the elemental calcium over gluconate making it a decent choice in cases of arrythmogenic hyperkalemia or other cases with a severe deficit. Sure it's bad if an IV is interstitial but you should probably know that first anyway.

As for the Swan, so rare these days I rarely see them anymore. Mostly in CSICUs.
 
Merck said:
The PA cath one is simply the insertion waveforms as the catheter is introduced into the PA with the last likely a wedge (balloon inflated).

As for the Swan, so rare these days I rarely see them anymore. Mostly in CSICUs.
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Correct. It would be RA - RV - PA - PCWP

Ya Swans are rarely used except for very critical patients (usually cardiac or septic). When I was in the Neuro ICU they used a LIDCO non invasive cardiac output monitor. Pretty cool machine but very complicated to work.
 
Anjel said:
What is a lethal tx for a ventricular escape rhythm?
Click to expand...

It would surprise, and perturb, me greatly if somebody gave lignocaine (or amiodarone for that matter) to a patient who is in a ventricular escape rhythm.

Both are used to terminate tachydysrhythmias and a ventricular escape rhythm is the total opposite, very slow and wide.

Not only that but amiodarone is also very negatively inotropic so the last thing we want to dish out to somebody who is already in a very slow rhythm is a negative inotrope; if anything we want to give them a positive one!

I am not even sure amiodarone is even useful in pre hospital care anymore; we know it increases ROSC but does not increase survival to hospital discharge, patients who in compromising tachyarrhythmias get cardioverted and those who are just in a fast rhythm but not compromised get no specific treatment so I don't really see the point personally but I am not an Intensive Care Paramedic (yet!) therefore don't use it so who knows....

I have the next question - why are medicines bound to different compounds e.g. morphine is bound to sulphate, ipratropium and suxamethonium is bound to bromide, ketamine is bound to hydrochloride and adrenaline is bound to the salt of tartric acid (tartrate)
 
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Partly for patent reasons, especially when you see knockoffs appear with same basic active molecule but a different salt (say, sulphate versus chloride versus tartrate in an oral med.


Yeah, I know, "What's an oral med?".:cool:
 
Chase said:
Correct. It would be RA - RV - PA - PCWP

Ya Swans are rarely used except for very critical patients (usually cardiac or septic). When I was in the Neuro ICU they used a LIDCO non invasive cardiac output monitor. Pretty cool machine but very complicated to work.
Click to expand...

I guess the follow up to this is what is PCWP? Why do we even care?

Edit:
And I guess, cardiac output. How do you measure it using a Swan? Explain mathematically as well.
 
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silver said:
I guess the follow up to this is what is PCWP? Why do we even care?

Edit:
And I guess, cardiac output. How do you measure it using a Swan? Explain mathematically as well.
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Pulmonary Capilary Wedge Pressure, essentially tells us the pressures in the left atrium. Clinically can used to elucidate the cause of pulmonary edema.

You can use a PAC to measure CO by dilution methods (there are several), I couldn't begin to tell you the calculations involved, they are done automatically by monitors every time I've seen a PAC placed (which is only a few times, becoming a rare thing).
 
Describe the Doll's eyes test. What is a contraindication for the test?
 
Chase said:
Describe the Doll's eyes test. What is a contraindication for the test?
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Open the unconscious patient's eyes. Turn their head rapidly to one side. If their eyes don't stay relatively fixed to the front it's bad news (brain stem issue).

Obviously it's got pretty limited utility without a c-spine CT in the trauma patient...

What unit of measure is used to describe pressures for mechanical ventilation?
 
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silver said:
Why though?
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Frankly, that is my question. My best guess is that it relates to how it was originally measured (some kind of water manometer). It gets a little weird when comparing it to mmHg, although curiously the resulting numbers aren't far apart.
 
Pt. presents with back pain, jaundice and dark orange orange urine. Describe why you already know there is a proportionally elevated direct bilirubin (vs indirect) in the labs and how these signs can focus your differential.
 
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