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Exam is normal except for tenderness as documented in the diagram. EKG shows atrial fibrillation with a rate of 169. She never had a documented abdominal exam. She had no persistent vomiting, was not dehydrated and had no fever. I just failed to document it. Temp is 98.7 and pulse 121. with 3+ urinary ketones.
An immediate 12-lead EKG was obtained: There is ST elevation in leads aVR and V1, with marked ST depression in I, II, III, aVF, V3-V6. Clinical Course The paramedic activated a “Code STEMI” alert and transported the patient nearly 50 miles to the closest tertiary medical center. What should be done? Should the cath lab be activated?
They stated that the patient was coded for 20 minutes, including multiple doses of epinephrine, and they also gave glucose, calcium, and bicarb. We asked for the ECGs to be faxed over while they prepared to transfer him. Prior ECG on file: Sinus tachycardia, imperfect baseline, otherwise unremarkable.
ICD-10 codes: F00-03 are the ICD codes for dementia and its subtypes F02. environmental factors, pain, infection, dehydration, electrolyte disturbance, head injury, medication etc) Does the individual have capacity? This article outlines the main factors related to the presentation, aetiology, and treatment of BPSD.
Vitamin D, B12, Calcium, foate, iron, and thiamine deficiencies are all well documented complications. Consider IV access and early IV fluids in those at risk for dehydration and intra-abdominal infections. Jeff: Tachycardic patients should make you concerned for hypovolemia 2/2 dehydration, sepsis, leaks, and blood loss.
In fact, cannabis use has been documented for medical use dating as far back as 600 BC in West and Central Asia. Jeff: The hyperemetic phase lasts 24-48 hours and can lead to dehydration, electrolyte abnormalities, and weight loss. Jeff: For any patient arriving with suspected cannabis or synthetic abuse, consider checking an EKG.
Also consider non-hemorrhagic volume depletion, dehydration : orthostatic vitals may uncover this [see Mendu et al. (3)]. Abnormal ECG – looks for cardiac syncope. Abnormal Electrocardiogram (ECG): Defined (San Fran syncope rule) as any new changes when compared to the last ECG or presence of non-sinus rhythm.
Initial work up when suspicious of this process should include ECG, chest x-ray, urinalysis, and the following labs: CBC, CMP, magnesium, phosphate, calcium, uric acid, VBG (for pH), and lactate dehydrogenase (10). Therefore, it should only be administered in life-threatening arrhythmia and not simply for peaked t waves on ECG (2,20).
Bruising- this can be common after a vaginal or instrumental birth or in babies who are large for gestational age, and should be documented carefully. If the fontanelle is sunken then the baby may be dehydrated and if they are bulging then this can be a sign of birth injury or hydrocephalus.
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