Blog Archives

Hyperkalemia Management

6/9/2023

Hyperkalemia Management
https://youtu.be/xnaHLTwqDLw

Hyperkalemia Management:

ECG changes of hyperkalemia include: Peaked T waves, P wave widening or flattening, PR prolongation, severe bradycardia, high-grade AV block, slow junctional or ventricular escape rhythms, slow atrial fibrillation, QRS widening, sine wave pattern, ventricular fibrillation, or asystole.
The five potential causes of hyperkalemia: medications, kidney failure, massive cell death, conditions causing acidosis, and pseudo-hyperkalemia.
Treatment should be initiated if the potassium level is greater than 6.5 or if the ECG shows changes associated with hyperkalemia. Calcium should be given when there are ECG changes.
The management of hyperkalemia can be summarized by the mnemonic C BIG K DROP, which stands for Calcium, Beta-agonists, Insulin, Glucose, Kayexalate, Dialysis, and Diuretics.

6/9/2023

Posterior STEMI
https://www.youtube.com/watch?v=salDIqDIjoM

Wellens syndrome:

Also known as LAD coronary T-wave syndrome, is a specific pattern observed on ECG that indicates a critical blockage in the left anterior descending (LAD) coronary artery.
Diagnostic criteria of Wellens syndrome include:
- a recent chest pain that has resolved,
- negative or minimally elevated troponins,
- abnormal ECG pattern which include:
- biphasic or deeply inverted symmetric T waves in precordial leads, mainly in V2 and V3,
- absence of pathologic Q waves,
- isoelectric or minimally elevated ST segment, and
- normal R wave progression.
Note that, the ECG may appear normal during chest pain period.

Treatment of Wellens syndrome include:

Immediate cardiac consultation
Wellens syndrome is considered a high-risk finding that requires urgent evaluation by a cardiologist. Cardiac consultation is crucial to confirm the diagnosis and determine appropriate management.
Avoid stress testing
Stressing the heart through exercise or pharmacological stress tests is contraindicated in patients with Wellens syndrome, as it can potentially lead to a complete blockage of the LAD artery, resulting in a heart attack.
Coronary angiography and revascularization as needed
The gold standard for diagnosing LAD stenosis is coronary angiography. This invasive procedure allows visualization of the coronary arteries to identify and assess the severity of the blockage. Once LAD stenosis is confirmed, revascularization procedures such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) may be performed to restore blood flow to the affected area of the heart.
Medications
In addition to revascularization procedures, appropriate medical management includes antiplatelets, statins, beta-blockers, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers to manage blood pressure and optimize heart function.

Summary:

It is crucial to emphasize that Wellens syndrome is a time-sensitive condition requiring prompt recognition and management to prevent a major adverse cardiac event.

6/8/2023

Pitfalls in Shock Management
https://youtu.be/Mml_iEeh4qo

Pitfalls in Shock Management:

Avoid over-reliance on systolic blood pressure; diastolic blood pressure and mean arterial pressure are better indicators than systolic blood pressure.
Avoid a lackadaisical approach; timely and aggressive treatment is essential, as every minute counts. Initiate norepinephrine early to improve lactate clearance.
Do not hesitate to perform cardioversion in patients with unstable tachyarrhythmias, such as ventricular tachycardia.

Do not forget to resuscitate before intubation, especially in patients with a shock index greater than 0.8. Push-doses of vasopressors may be considered during airway intubation.

6/7/2023

Specific seizure management
https://youtu.be/ife3J-9Xw68

Specific Seizure Management:

Notable seizures with specific treatment include: 1. eclampsia, 2. alcohol withdrawal, 3. isoniazid toxicity, 4. hyponatremia.
Magnesium is used to treat seizures in eclampsia of pregnant or postpartum women.
High-dose benzodiazepines and phenobarbital are used to treat alcohol withdrawal seizures.
Pyridoxine or vitamin B6 is used to treat seizures due to isoniazid toxicity.

6/5/2023

Chest tube and Pigtail Catheter
https://youtu.be/RR01rxoWino

Chest tube or pigtail catheter:

The complication rate of chest tubes can be as high as 30%.
Studies suggest that traumatic pneumothorax under 35 millimeters and hemothorax less than 300 ml, can be managed with observation if the patient is hemodynamically stable and saturating well.

Pigtail catheters have several benefits over chest tubes for the treatment of spontaneous pneumothorax, including less pain and shorter procedure time.