A Week in Review: Oct 31st-Nov 5th
Sun, 11/06/2016 - 6:45am
- When treating someone with excited delirium syndrome, remember to use at least 5 individuals for physical restraint. Always use sedation in addition to physical restraint. Midazolam (versed) has more rapid onset than lorazepam (Ativan) and is typically dosed at 2.5 mg to 5 mg IV or IM (can repeat in 5 minutes if no effect). Ketamine can also be used at a dose of 4-5 mg/kg IM, or 1-2 mg/kg IV if access is established. Of note, this medication is not to be used for those patients who carry a diagnosis of schizophrenia or significant cardiac disease. Excited Delirium Syndrome and Sudden Death
- Learn how to measure compartment pressures like an orthopedic surgeon! Direct Measurement of Compartment Pressure Using a Stryker Device
- Think neurocysticercosis in altered patients who have recently traveled to Central/South America, Africa, or Asia. Also consider it in patients who have consumed undercooked pork or contaminated water. There are multiple stages of neurocysticercosis, but the most common is the Colloidal vesicular stage. On CT imaging the cyst and the wall become thickened and enhance, there is often marked surrounding edema. (See image below). Don't forget to co-administer IV steroids for prophylaxis against intracranial edema/hypertension, which can increase during death of the larvae with treatment of the disease. Imaging Case: Woman with Altered Mental Status
- In both high altitude cerebral edema (HACE) and high altitude pulmonary edema (HAPE), the partial pressure of oxygen is too low for diffusion to occur. This leads to increase blood flow to brain and/or lungs which causes the edema. Treatment always involves descent when possible, supplemental oxygen, and may include hyperbaric therapy. Add dexamethasone when treating HACE and nifedipine when treating HAPE. The Basics of High Altitude Illness
- In a Cochrane review of antibiotic use in patients with cirrhosis and upper GI bleeding, antibiotics improved overall mortality, mortality from bacterial infections, and rebleeding risk. Give antibiotics empirically! Antibiotic Use in Cirrhotic Patients with Upper GI Bleeding
- Even though they may not wake you up, "peak noises" can disrupt your sleep, make you tired, and may contribute to hypertension. If you have difficulty sleeping, use white noise to improve sleep and reduce sound disruptions. Sound and Your Sleep