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Benadryl is thought to work because it stabilizes the central dopamine receptors; which are also thought to impact muscle coordination/fine motor. As an example, Parkinson patients are given dopaminergic medications to achieve the same thing. I suppose the degree that it resolves the issue is...

Yeah, the myoclonus is a good clue, I see dystonia as more of a tremor or fasciculation; shame there's no temp included.

Interesting. I suppose it makes sense, since they're using the right drugs now. It's amazing how things change.

I wonder if they've become better at treating sepsis in general, and they haven't needed the amount of fluids that they used to as a result?

Yeah, I gotcha, but you're addressing two pathologies here, a) the leaky bucket, and b) the uncontrolled, sustained release of nitric oxide (for one), which they have found is specifically addressed with vasopressin (probably in conjunction with norepi). So yeah, I don't think anyone was all...

I suppose it would all depend on how they meet their endpoints, primarily urine output.

I'll play. Being that they're ready behind the eight ball due to the third spacing, vasoactive substance release, and toxins worsening both of these, not to mention the acid/base disturbances and electrolyte derangement, I'd say they need all the atrial kick they can get. New onset? You manage...

Hey guys, I normally lurk on here and chime in when I can, but I'm really interested in seeing what you guys have seen in your septic patients. A good chunk of severe sepsis patients I have are in new-onset a-fib. More often than not, emergency rooms seem to be baffled at this information...

Sure, but reducing risk for the sake of reducing risk can interfere with good clinical decision making. There is literally nothing that we do that is risk free.

Yeah, even in tintinalli, blind pericardiocentesis is still a thing, just not a very "popular" thing. But then again, they've got surgeons to do a cardiac window and stuff like that at the hospital. Whenever it comes up in the field, it always seems like a hail mary, so the risk/reward on a...

Thoracentesis isn't done blind? God, don't tell me they're using ultrasounds for that too nowadays. They're practically using them for digital blocks anymore. Which is funny, because every time I see a chest tube done, (including the ones I've performed), that was pretty much as blind as a...

This. This may not be the most popular opinion here, but shortness of breath that worsens in the presence of a known or suspected (ANY chest trauma, including blunt, penetrating, or barotrauma) pneumothorax is enough to buy a decompression. Too often I see people rationalizing that the...

The problem with studies like this is, cardiac arrest survivers often recover neurologically based on the most basic of factors (e.g down time, comorbidities, underlying cause, age etc) that more often than not, they can't tell the difference between the other stuff (remember the...

Well, and (this is only to play devils advocate), sometimes cases like that just need diesel more than anything else. Even the saline lock is more a "just in case" thing for: - Seizures - RSI drugs if she goes downhill - Preventing hypotension (DEVASTATING in head injuries) Other than that...

So a guy with shocky vitals, malaise, poor general appearance, and lower abdominal pain who went straight to the OR? At first glance that sounds like appendicitis. Too bad a temp wasn't included. Remember that appendicitis usually starts around the belly button, then migrates to the right...

For an adolescent female, the pressure climbing isn't necessarily "better". The first consideration is that adolescent females have a dump of estrogen during puberty--- and as a smooth muscle relaxer, estrogen plays a role in why women have "lower baselines" than men. While we're on that...

I rearranged "CASH" to "CRAP" because it's a) funny and b) more retainable for the young students C- chest pain R- respiratory distress A - altered mentail status P - piss poor perfusion If they look like crap...

Yeah good point! I was keeping it there because the question was about giving o2. Thanks!

ETCO2 is a measure of ventilation, not oxygenation. Sure, the two aren't mutally exclusive, but in this case it is.

NO. Well, at least not with anesthesia/analgesia. Here's a little story for ya: One of our dogs got caught up in the razor wire at the COP. Really deep, big lacerations. Pup looked miserable. I decided to repair them, and since you can't rely on local or regional anesthesia for dogs, I...