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When and how to treat hyponatremia in the ED

In Clinical Questions, Medical Concepts by Andrei SmarandacheLeave a Comment

Electrolyte imbalances like hyponatremia can be the cause of a variety of vague complaints. At the same time, patients may present with electrolyte abnormalities that are asymptomatic and are incidental findings on bloodwork. Here’s an approach to deciding when and how to treat hyponatremia in the emergency department. We also thank Drs. Joel Topf (@kidney_boy) and Dr. John Neary (@jddneary) for their valuable input on this article! The Case Marjorie, an 83-year-old female, …

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Case Report: Pregnancy and Trauma in the Game of Thrones

In Case Series, Medical Concepts by Will WuLeave a Comment

This is the 3rd Episode of the Game of Thrones Case Series. Be sure to also review Hypothermia and Traumatic Arrest in the Game of Thrones and Toxin-Induced Cardiac Arrest in Game of Thrones. Patient Presentation and History During the wedding of Edmure and Roslin, a young pregnant woman of unknown gestational age was found unresponsive with multiple abdominal stab wounds on the floor of the great hall at The Twins. Lord Frey allegedly planned …

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Shocked? Hands On Defibrillation

In Medical Concepts by Sean McIntoshLeave a Comment

High quality chest compressions and defibrillation are two of the most meaningful interventions in a cardiac arrest1. If you have taken Advanced Cardiac Life Support (ACLS), you’ve heard the mantra “I’m clear, you’re clear, everybody’s clear.”1 During delivery of a shock, valuable seconds of chest compressions are lost. This pause in chest compression translates to a decrease in coronary perfusion pressure, one of the largest predictors of return of spontaneous circulation (ROSC).2 After chest compressions resume, …

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Blood and Clots Series: Does my complex patient have DIC?

In Blood & Clots, Medical Concepts by Andrew ShihLeave a Comment

All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Expert Case Description You are seeing a 56M in your critical care suite who has just arrived as a transfer from a peripheral hospital.  The patient has had a recent diagnosis of acute leukemia and was given chemotherapy and a recent stem cell transplant 20 days ago at this hospital.  When he started getting sicker, they requested …

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Blood and Clots Series: When can patients on direct anticoagulants have surgery?

In Blood & Clots, Medical Concepts by Kerstin de WitLeave a Comment

All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Professional, Collaborator, Medical expert As a Thrombosis specialist, I am often paged by emergency physicians and orthopedic surgeons requesting anticoagulation reversal in order to facilitate surgery. There are some simple and important points to remember when dealing with this clinical scenario. Case Description It is 8am on Monday morning and you are the orthopedic resident on call …