Tag: retrieval

Hyponatraemia

https://youtu.be/qiJaxsMlwps

An in-depth look at the management of hyponatraemia, with special attention to a new concept called the “dDAVP clamp.”

Summary:

– only treat hyponatraemia if symptoms are severe – coma, seizures or severe delirium
– use 3% saline 100ml, up to three doses
– consider giving dDAVP to prevent a rapid climb in the serum sodium
– aim to correct the serum sodium by only 3-6mmol/L in the first 24 hours

For more information, have a look at Scott Weingart’s EMCrit Wee, and Josh Farkas’s blog post.

Thanks,
Stacy

Pre-Oxygenation Update

A great discussion on pre-oxygenation in the ED and pre-hospital environments, from the PHARM podcast.

Check out the show notes and references here.

Key Points:

A BVM (with PEEP valve) will provide better pre-oxygenation than a NRBM (non-rebreather) AS LONG AS THERE IS A GOOD SEAL.

Adding nasal cannulae may worsen pre-oxygenation a little, likely more than offset by the additional benefit of apnoeic oxygenation.

 

For me, the problem with a BVM is that the airway practitioner isn’t solely focused on achieving a good seal during pre-oxygenation. They’re doing other things – prepping the eam/patient/equipment etc. Therefore, I’d suggest NRBM and NPs as routine, especially for more inexperienced practitioners. If using a BVM (with PEEP valve), the airway practitioners sole focus needs to be on maintaining a seal.

Also, remember to sit the patient up and use CPAP if necessary.

Thanks,

Stacy