#empearls

[gmergency]

Hypercalcemia of Malignancy

Correct for albumin! Mild = 10.5-11.9, consider dc if close f/u, pt asymptomatic * Oral hydration * High-salt diet * Avoid meds that cause hyperCa Moderate = 12-13.9, admit Severe = >14, admit - IVF, Goal UOP = 150ml/hr - Consider lasix - Consider bisphosphonates: -- zolendronic acid: 4mg IV over 15 minutes, 8mg 2nd dose if required -- pamidronate: over 2-24 hours, give 60mg (Ca 12-13.5), give 90mg (Ca > 13.5) If >18 or >13.5 with AMS, renal failure, CHF, emergent dialysis

[gmergency]

Hyperviscosity Syndrome

* Triad of bleeding, visual changes, neuro symptoms * Get CBCdiff, coags, BMP, peripheral smear for roulette formations, serum and urine electrophoresis * Careful hydration and diuresis * If extreme WBC, needs leukophoresis * If extreme proteinemia, needs plasmapheresis * If not immediately available, do 100-200cc phlebotomy

[gmergency]

Stroke Lacunar Subtypes

* Pure Motor * Pure Sensory * Sensory-Motor * Clumsy Hand/Dysarthria

[gmergency]

Stroke Mimics

* Conversion Disorder * Delerium * Todd’s Paralysis/Postictal * Hyperglycemia * Hypoglycemia * Intracranial Mass * Metabolic/Toxic Encephalopathy * Complex Migraine

[gmergency]

Adult Pressor Dosing


[gmergency]

Neonate Growth Pearls

* Lose 10% of their birth weight by day 3 * Should be back to birth weight by 1 week * Should gain 1 oz per day * Fever for every 1deg F > 100.4 can cause 10 bpm of tachycardia

[gmergency]

Carbon Monoxide Hyperbaric Indications

(These totally vary by center.) * Level > 25% * Level > 15% (if pregnant) * Fetal Distress * Syncope * Coma * Acidosis * Age > 60 * Neuro Findings * Children * Cardiovascular Disease * Headache or Chest Pain * Maybe Prevents Delayed Neuro Sequelae (Conflicting Data): * Numbness * Paralysis * Paresthesias * Basal Ganglia Infarcts * And Psych Sequelae: * Cloudy thoughts * Trouble concentrating * Amnesia * Depressed Mood * Remember, all tubes (foley, eg) must be filled with water, not air!

[gmergency]

Carbon Monoxide Half-Life

HbCO levels often do not reflect the clinical picture, yet symptoms typically begin with headaches at levels around 10%. Levels of 50-70% may result in seizure, coma, and fatality. CO is eliminated through the lungs. * Half-life of CO at room air temperature is 3-4 hours. * One hundred percent oxygen reduces the half-life to 30-90 minutes; * Hyperbaric oxygen at 2.5 atm with 100% oxygen reduces it to 15-23 minutes.