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Questions answered in this AskMED session

 

1:33 - Administration of D10W

6:51 - Would you please explain why the provincial kits administer 8mg of Naloxone and the police and fire are directed to do the same? We administer 0.8mg IN

10:15 - The scenario was an elderly gentleman that had missed his most recent dialysis appointment, with complaints of weakness earlier in the day and was subsequently found unresponsive by family. Patients only pertinent history was end stage renal disease with dialysis 3 x's a week. The scenario was an elderly gentleman that had missed his most recent dialysis appointment, with complaints of weakness earlier in the day and was subsequently found unresponsive by family. Patients only pertinent history was end stage renal disease with dialysis 3 x's a week. Upon arrival the patient presented VSA and cardiac arrest management was initiated, with the patient presenting in a refractory pulseless Vtach, which was shocked once at 0mins and again at 2 mins. Epi, lido, calcium gluconate and salbumatol were all given as per cardiac arrest management with hyperkalemia being the suspected cause. The discussion was focused on lidocaine administration in the setting of cardiac arrest, secondary to hyperK. As we know with severe cases of hyperK, the resting cardiac membrane potential increases significantly, which causes a decreased number of available fast sodium channels, causing slower impulse conduction. In this setting, does it makes sense to administer Lidocaine which will further block sodium channels ie. making a "slow, floppy heart, slower and floppier" ?Or should we consider holding off on Lido admin with priority placed on calcium gluconate and salbutamol?

14:25 - In a ROSC situation that you have a patient intubated but were unable to obtain IV access - patient starts bucking the tube however procedural sedation is only the IV route for Midazolam - is this due to the time of onset of IM vs IV? Just looking for some clarification on this. Thanks!