Trauma in a Pregnant Patient

Reference: SOGC, Guidelines for the Management of a Pregnant Trauma Patient. You are working as a rural emergency physician and EMS patches in announcing that they are 10 minutes away with a 28-year-old female at 36-week gestation. She was involved in a multi-vehicle accident, airbags were deployed and there was one death on scene. The nearest tertiary center is 3 hours away. Her vital signs are BP: 74/48, HR 127, O2 sat 92%, RR 33 and a GCS of 12. Her vitals remain the same despite 1 L of NS given with paramedics and O2 2 L Nasal prongs. What are your initial steps before this patient arrives? Pre-Primary survey: before the patient arrives do/prepare for the following: Personal Protective e

Exam Questions About Sleeping Disorders Keeping You Up At Night?

Don’t let an exam question about sleep disorders keep you up at night! Defined as a recurrent, poor sleep quantity or quality that impairs a patient’s function, insomnia loves to pop up in SOOs and SAMPs. The DSM-5 has over 20 sleep disorders listed; make sure you can list at least five! An easy way to remember the broad categories of sleep disorders: 1) Not enough sleep (i.e. insomnia disorder) 2) Too much sleep (i.e. hypersomnolence disorder, narcolepsy) 3) Busy sleep (i.e. restless legs syndrome, obstructive sleep apnea hypopnea, nightmare disorder) When referring a patient for a sleep study, remember that a Level 3 sleep study is done in the patient’s home with monitors for heart rate, o

NEW ACLS Updates: A Brief Summary of Pertinent Changes

ACLS was UPDATED in late 2018! Here is a brief summary of pertinent changes: Basic Life Support Changes Excellent compression with minimum interruptions are paramount (no big surprise there). Compression depth of at least 5cm and no more than 6cm. Extra focus this time around on ensuring complete recoil. Make sure you do not lean on the chest. Compression rate of between 100-120. Greater than 120 is associated with worse outcomes. With an advanced airway ventilation rate is 1 breath every 6 second for everyone including pediatrics. Medication Changes Consider now giving Amiodorone or Lidocaine for pVT /Vfib refractory to Defibrillation and Epinephrine. Not enough evidence to support or refut

Practice Pearls from the Simplified Opioid Guidelines

This month’s CFP journal contains a new Opioid Use Guideline - it contains key points you need to know as a Family Physician. This topic is increasing in importance in primary care, and because this resource was so helpful, we wanted you to have a deeper dive into the key points. Family Physicians can and should treat patients with opioid use disorder. When treated in a primary care setting, opioid use disorder patients can have better outcomes. Promote HARM REDUCTION with a naloxone kit and lock box for take home doses. Remember that naloxone is useless if an overdose happens alone - you cannot give it to yourself! Remind your patients of this and advise further harm reduction: NEVER USE AL

Sepsis Pearls for 2019

The Surviving Sepsis Campaign has decided to do away with the previous 3 hour and 6 hour bundles and come up with a new 1 hour bundle for Sepsis Management. Goal for within the 1st Hours of Sepsis Management 1. Measure a lactate level (plan to repeat the lactate if greater than 2 mmol) 2. Obtain blood cultures and urine cultures 3. Administer broad spectrum antibiotics 4. Rapid administration of 30 mL/Kg of Ringer's Lactate for MAP < 65 or a Lactate > 4 mmol 5. If Map < 65 mmHG during or after fluid resuscitation start norepinephrine Now keep in mind that there is some controversy regarding this “one size fits all approach” and a number of associations such as the American College of Emergen

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