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ChrisHansen posted:You've got Cardiac Tamponade Your heart rests in a sack. If fluid collects between this sack and your heart (this can happen a few ways) your heart can no longer expand and contract very well and if it gets worse you die because no blood gets to your brain. They treat it by sticking a wicked long needle into your heart sack, hopefully without also jabbing your heart because that will send it into a chaotic rhythm that may require other aggressive intervention, and suck out the fluid. Then they inject a little of this compound that basically causes the pericardium (the sack) to adhere to the heart again so that hopefully it doesn't fill back up with fluid. This compound is related to anther compound that exists in coffee. In 2009 or so there was supposedly a case where a long term care nurse put coffee in an IV pump machine instead of in the feeding machine that looked fairly similar that was next to it. I say supposedly because this seems beyond the pall of idiocy but I do remember some kind of documentation on it. The patient of course died. Tamponade is an interesting case for students of emergency medicine because it's one of a very very small number of conditions where the diastolic blood pressure matters. Blood pressure consists of two numbers. The first number is when your heart is at maximum squeeze and is as high as it gets on that beast. The second number is at full relax. As the pericardium fills with fluid these two numbers get closer and closer because of the restricted mobility of the heart muscle. You can predict the time where the patient will die if you have a good record of these blood pressures because you will see the numbers narrowing to an unacceptable point (this doesn't matter much because if you suspect tamponade it's a dire emergency and the patient will be rushed to the interventionist, preferably a thoracic surgeon, as quickly as possible). In most other emergency medical cases only the systolic pressure is really needed to make treatment decisions (too low for trauma, too high for CPE or stroke, etc). This is good news in an emergency setting because while you can palpate the systolic pressure (unless it is so low that you cannot feel it -- this itself is diagnostic of serious problems however) you need to listen with a scope to get diastolic, and this isn't always possible or reasonable with background noise and patient movent &c. Please note that there are lots of medical circumstances where it's wise to consider diastolic pressures (many of these involve using a rule of thumb to compute the MAP, or mean arterial pressure, which is the number most closely correlated to perfusions), but in emergency medicine it is a mere curiosity instead of a treatment selecting piece of information, except in tamponade. raton fucked around with this message at 21:10 on Apr 20, 2016 |
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Apr 20, 2016 21:01
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690 If that's taken 960
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Apr 20, 2016 21:02
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ChrisHansen posted:P 690 is flatulence! Thread won bitches
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Apr 20, 2016 21:07
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RolandTower posted:Just FYI all of this except for the fact that tamponade is caused by a pericardial effusion exerting pressure on the heart and using a needle to access the pericardial space is completely wrong. Like, getting medical information from an episode of House wrong. If you are somehow involved in emergency medicine please review cardiac tamponade again. So in other words it's all correct except for the narrow pulse pressure, gee I wonder how I could check to see if that had been misremembered or not oh wait  Or are you ignorant of the fact that jabbing a needle into the heart often causes dysthymia? Is that your little point of objection? Or maybe you're really mad that I said diastolic pressure is unimportant in a cast majority of emergency medical conditions which is also obviously true. Or maybe you're being a pedant about my description of the pericardial sclerosis procedure in one way or another? In any case quit being a goon. raton fucked around with this message at 01:49 on Apr 26, 2016 |
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Apr 26, 2016 01:26
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RolandTower posted:No I'm a cardiology fellow you loving idiot. I deal with tamponade assessment daily, you know, as a job. If you want to kill someone then loving wait until their pulse pressure flattens out and they code, and ask me to give them constrictive pericarditis by injecting sclerosing agents into the pericardium which is not a thing that is ever done because it would kill a person. Meanwhile don't call me about the guy with cold limbs and a blood pressure of 85/66, he's probably septic and needs a couple boluses because diastolic blood pressures are for IM nerds. If you are involved in emergency medicine then at least read uptodate if you're too lazy to look up aha/ACC guidelines instead of loving googling how to kill a dude and acting a fool. Let me summarize all of this for everyone else: "I want to pick and whine about the timing/utility of one treatment you mentioned while on a tangent and pretend like everything else you said was absolutely incorrect because I got into medicine for ego purposes." My scope did not involve treating tamponade ever so forgive me if I'm not 100% up to date on the post pericardiocentesis flowchart you read a few months ago. I would, however, have no issue separating it from loving sepsis. I really appreciate the barrage of high and mighty insulting language over an increasingly small part of my post that you found to pick at (before issuing a disclamer stating that oh yeah actually it does happen like that sometimes a hurr a hurrr BUT NEVERMIND THAT). Must be a real pleasure to work with you. E: Lol I got promoted to intern raton fucked around with this message at 08:13 on Apr 26, 2016 |
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Apr 26, 2016 08:02
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