EM Quick Hits 52 Infant Vomiting, Orbital Cellulitis, Prehospital TXA in Trauma, Prevention and Treatment of Delirium, Procedural Skills Decay, Altitude Sickness
Experts like Sarah Reid, Brit Long, Justin Morgenstern, and others discuss Infant Vomiting, Orbital Cellulitis essentials, Prehospital TXA in Trauma, Prevention and Treatment of Delirium, Procedural Skills Decay, and Altitude Sickness in this informative podcast.
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Quick takeaways
Recognize altitude sickness symptoms early and intervene promptly with descent, oxygen, and appropriate medications.
Combat procedural skill decay in healthcare by implementing spaced repetition, mental modeling, and stress inoculation techniques.
Prevent and manage delirium by avoiding high-risk medications, using non-pharmacologic approaches, and considering low-dose antipsychotics if necessary.
Deep dives
Acute Mountain Sickness (AMS) and High Altitude Cerebral Edema (HACE)
Altitude-related illnesses include AMS, which progresses to HACE. AMS symptoms like headache and nausea are relieved by supplemental oxygen and medications like acetazolamide. AMS progression to HACE with severe symptoms like ataxia requires immediate descent, dexamethasone, and oxygen.
High Altitude Pulmonary Edema (HAPE)
HAPE involves dysponea and fatigue, progressing to dyspnea at rest and severe respiratory symptoms. Treatment includes immediate descent, oxygen, and sustained-release nifedipine. Dexamethasone can be considered for coexisting HACE.
Recognition and Treatment of Altitude-Related Illness
High-altitude sickness with AMS, HACE, and HAPE are life-threatening conditions. Management involves recognizing symptoms and promptly addressing AMS with descent, oxygen, and medications like acetazolamide and dexamethasone. If symptoms progress to HACE or HAPE, immediate descent is crucial for patient safety.
Procedural Skill Decay and Maintenance
Procedural skill decay is a risk in healthcare due to infrequent practice. To combat this, spaced repetition through active video review, mental modeling, and simulation can help maintain skills. Incorporating stress inoculation techniques like timed practice, exposure to stressors, and performing in front of an audience can enhance learning and retention.
Prevention and Management of Delirium
Preventing and managing delirium involves avoiding high-risk medications, restarting home medications, treating pain, and maintaining hydration and body functioning. Non-pharmacologic approaches like reorientation, distractions, and reassurance are initial treatments, followed by low-dose antipsychotics if needed. Stress inoculation methods like timed practice, audio cues, and performing in front of others can improve skill retention and performance.
In this month's EM Quick Hits podcast: Sarah Reid on an approach to Infant Vomiting, Brit Long on Orbital Cellulitis essentials, Justin Morgenstern on the PATCH trial - Prehospital TXA in Trauma, Christina Shenvi on Prevention and Treatment of Delirium, Jason Hine on Procedural Skills Decay, Aaron Billin on Altitude Sickness...
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