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Post by pbruss on Apr 1, 2015 19:18:13 GMT -5
dont be that doctor!! use your brain!!! working in Athens recently. got a 24 yo male siged out to me. "he took some fentanly, gat narcan, he is pinkslipped. i spoke to psych, they will take him once the tox screen is back." tox positive for opiates and cannibis, negative for anything else including TCAs. ETOH neg. No other tests were ordered. you can see the monitor from the nurses station and he has a heart rate of 130 so an EKG is ordered. when you talk to him he admits to the fentynl, denies anything else. denis ans SI or HI, willing to stay to talk to psych. attahced is his EKG. his nurse and charge nurse and pushing for him to go to his psych bed. what is you interp and treatment? Attachments:brussecg.bmp (264.01 KB)
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Post by pbruss on Apr 1, 2015 20:15:59 GMT -5
this ecg may be better Attachments:
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Post by kemple on Apr 1, 2015 20:17:34 GMT -5
Working with him now, I told him the EKG sucks he said if I want it posted again Stransky has to win a cage fight against him...Bruss' words not mine.
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Post by tyson on Apr 1, 2015 20:43:45 GMT -5
that looks so much like a TCA overdose (from what I can see on the mini EKG), despite assurances otherwise. i'd still give him sodium bicarb.
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Post by Bjs04f on Apr 2, 2015 7:08:46 GMT -5
agree that ekg sucks. TO THE CAGE!!
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Post by mwiepking on Apr 2, 2015 10:25:39 GMT -5
Who won the cage fight? Do we get a new EKG? Did he get bicarb? Was it the new cool acetyl fentanyl that he took or just the ho hum fentanyl of my parents' generation?
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Post by kemple on Apr 2, 2015 11:04:36 GMT -5
Well so far no new EKG so I'm guessing Stransky is laying in a ditch somewhere.
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Post by mwiepking on Apr 2, 2015 12:49:56 GMT -5
...then who am i working with in Luke's...
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Post by Bjs04f on Apr 2, 2015 13:34:34 GMT -5
probably tyson
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Post by tyson on Apr 2, 2015 15:49:50 GMT -5
true.
i was literally working with dr crawford when she looked at april's schedule and was like, "looks like we're going to have another good month together."
uhhhh, i'm tyson. not stransky.
no one is ever going to figure it out.
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Post by Bjs04f on Apr 2, 2015 20:59:08 GMT -5
Hahaha theres also our class photo at UT that says Brandon Stransky and has your photo
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Post by pbruss on Apr 3, 2015 14:20:40 GMT -5
i type this while holding stransky's scalp that i claimed as a trophy in teh cage. Attachments:
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Post by Bjs04f on Apr 3, 2015 15:36:58 GMT -5
finally a good ekg, now while somewhat delerious from blood loss. It looks like wide complex with RsR' and big r' so tca or sodium channel blocking drug
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Post by pbruss on Apr 3, 2015 17:54:47 GMT -5
well played. his TCA was neg which is not 100% but unlikley that tca was his issue. he had a Ph0f 7.1, and anion gap, neg etoh. osmolality was neg. i started him on bicarb drip and HR and ECG normalized. i suspect it was some drug that affects the sodium channels in his heart, but not TCA or cocaine cause his tests were neg. to be hinest i dont care what it was and if you remember my tox lecture, i look for the deadly overdoses with 1. ekg changes 2. ph 3. anion gap 4. tyleonol level. fortunatly it worked in this case. please in the future dont be that doctor that does not use their brain!!!!!!!!
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Post by Bjs04f on Apr 3, 2015 21:04:58 GMT -5
the only problem is thinking is hard, and sometimes when I try really hard to think nothing happens
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