EM Quick Hits 29 Vasopressor Failure, Asplenic Considerations, Bronchiolitis Update, ICD Electrical Storm, Night Shift Tips
Jun 15, 2021
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Use Empiric Steroids For Suspected Adrenal Failure
- Think empiric hydrocortisone for suspected adrenal insufficiency, especially with chronic steroid history or suggestive electrolytes.
- Recognize adrenal insufficiency clinically; hyperkalemia and hyponatremia can support the diagnosis.
Replace Calcium After Massive Transfusion
- Check ionized calcium and give calcium salts when hypocalcemia is suspected, especially after massive transfusions.
- Don’t forget calcium replacement during hemorrhagic shock with many blood products.
Look For Hidden Bleeding Sources
- Search for occult bleeding like GI or retroperitoneal hemorrhage when vasopressors fail and examine the abdomen and stool output.
- Treat with transfusion, reverse anticoagulation, and early operative or IR control.