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d******a
发帖数: 127 | 1 Teaching attendings love to say: Treat patient, not the lab.
Here were some labs I had when I was a resident and I have to treat the
number:
1) 24 yo male w/ type I DM was sent by EMS for AMS. EKG showed V-tech. What
is the first thing I let nurse do?
2) 70 yo male in ER with AMS. BMP showed Ca 18.5.
3) 75 yo female sent by PMD w/ BUN/Cr 250/18.
4) 34 yo HM w/ new onset DM w/ Glucose 2500.
5) 38 yo AA male w/ DM,depression and drug abuse admitted for NSTEMI. CPK 75
,000.
6) 26 yo AA female w/ CM | k**********n
发帖数: 438 | 2 俺试着回答一下，抛砖引玉哈.
1) 24 yo male w/ type I DM was sent by EMS for AMS. EKG showed V-tech. What
is the first thing I let nurse do?
ABC, I will do IV line first, followed by shock.
2) 70 yo male in ER with AMS. BMP showed Ca 18.5.
IV NS/lasix
3) 75 yo female sent by PMD w/ BUN/Cr 250/18.
BMP, check K. ABG,for pH.
4) 34 yo HM w/ new onset DM w/ Glucose 2500.
IV line, insulin drip in NS
5) 38 yo AA male w/ DM,depression and drug abuse admitted for NSTEMI. CPK 75
,000.
I would call Cardio give him a cat
【在 d******a 的大作中提到】
: Teaching attendings love to say: Treat patient, not the lab.
: Here were some labs I had when I was a resident and I have to treat the
: number:
: 1) 24 yo male w/ type I DM was sent by EMS for AMS. EKG showed V-tech. What
: is the first thing I let nurse do?
: 2) 70 yo male in ER with AMS. BMP showed Ca 18.5.
: 3) 75 yo female sent by PMD w/ BUN/Cr 250/18.
: 4) 34 yo HM w/ new onset DM w/ Glucose 2500.
: 5) 38 yo AA male w/ DM,depression and drug abuse admitted for NSTEMI. CPK 75
: ,000.
| n*******c
发帖数: 501 | 3 1) 24 yo male w/ type I DM was sent by EMS for AMS. EKG showed V-tech. What
is the first thing I let nurse do?
check blood glucose? could be hypoglycemia, prepare to shock him at the same
time.
2) 70 yo male in ER with AMS. BMP showed Ca 18.5.
rehydration and lasix, consider dialysis
3) 75 yo female sent by PMD w/ BUN/Cr 250/18.
ECG,check if widened QRS,ABG,BMP for k.
4) 34 yo HM w/ new onset DM w/ Glucose 2500.
urinalysis for ketone, rehydration and insulin drip
5) 38 yo AA male w/ DM,depressio | d******a
发帖数: 127 | 4 1) 24 yo male w/ type I DM was sent by EMS for AMS. EKG showed V-tech. What
is the first thing I let nurse do?
ABC and vitals. BP 110/70.
2) 70 yo male in ER with AMS. BMP showed Ca 18.5.
IV NS/lasix? When will you give lasix.
3) 75 yo female sent by PMD w/ BUN/Cr 250/18.
Patient needs stat HD. But something happened.
4) 34 yo HM w/ new onset DM w/ Glucose 2500.
IV NS 10L and insulin drip. Repeat a BMP.
5) 38 yo AA male w/ DM,depression and drug abuse admitted for NSTEMI. CPK 75
,000.
BMP showed | u*******l
发帖数: 107 | 5 2) 70 yo male in ER with AMS. BMP showed Ca 18.5.
IV NS/lasix? When will you give lasix. | g***r
发帖数: 285 | 6
What
75
when your attending said treat the patient, not the lab, it means you have
to look at the patient first, lab is just a tool to help you understand the
patient's condition better;
for instance, a patient on dilantin 100mg tid and has not had a breakthrough
seizure for many years and for whatever reason you ordered a dilatin level
and find it subtherapeutic, you do NOT just increase the dose of dilantin,
for all the patients/case scenario you listed, i bet all the patients were
symptomati
【在 d******a 的大作中提到】
: Teaching attendings love to say: Treat patient, not the lab.
: Here were some labs I had when I was a resident and I have to treat the
: number:
: 1) 24 yo male w/ type I DM was sent by EMS for AMS. EKG showed V-tech. What
: is the first thing I let nurse do?
: 2) 70 yo male in ER with AMS. BMP showed Ca 18.5.
: 3) 75 yo female sent by PMD w/ BUN/Cr 250/18.
: 4) 34 yo HM w/ new onset DM w/ Glucose 2500.
: 5) 38 yo AA male w/ DM,depression and drug abuse admitted for NSTEMI. CPK 75
: ,000.
| s*******w
发帖数: 1879 | 7 This reminds me of the book I'm reading now: Hippocrates's Shadow.
The author mentioned the same thing in the preface. | k**********n
发帖数: 438 | 8
>5) 38 yo AA male w/ DM,depression and drug abuse admitted for NSTEMI. CPK
75
>,000. BMP showed BUN/Cr 80/4.
He has renal dysfunction, there might be a prerenal factor, as BUN is higher
than normal ratio. Contrast use can exacerbate renal dysfunction, so check
CBC/BMP and hydrate pt if needed.
I guess cath is still OK, dialysis can be used to remove contrast and
correct electrolyte imbalance afterward.
>7) 48 yo WF, heavy smoker, was intubated in ER for acute resp distress.
>Lactic acid was 8.5
【在 d******a 的大作中提到】
: 1) 24 yo male w/ type I DM was sent by EMS for AMS. EKG showed V-tech. What
: is the first thing I let nurse do?
: ABC and vitals. BP 110/70.
: 2) 70 yo male in ER with AMS. BMP showed Ca 18.5.
: IV NS/lasix? When will you give lasix.
: 3) 75 yo female sent by PMD w/ BUN/Cr 250/18.
: Patient needs stat HD. But something happened.
: 4) 34 yo HM w/ new onset DM w/ Glucose 2500.
: IV NS 10L and insulin drip. Repeat a BMP.
: 5) 38 yo AA male w/ DM,depression and drug abuse admitted for NSTEMI. CPK 75
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