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General's Primo Charcoal Deluxe Drawing Set, Set of 12

$15

General's Primo Charcoal Deluxe Drawing Set, Set of 12

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Product description

The Primo Euro Blend Charcoal Drawing Set offers a collection of premium charcoal drawing pencils and compressed sticks. The pencils and sticks are hand crafted with rich organic blacks to achieve intense drawing tones and values, and feature a creamy, rich formula that can be used alone or in combination with other charcoal, pastel or mixed media. All PRIMO pencils are made in the USA with the highest quality sustained yield cedar wood to ensure smooth sharpening and strength. This set includes three Primo Euro Blend pencils, a Primo Bianco pencil, a Primo ELITE Grande pencil, four Primo compressed sticks, a Factis Magic Black Eraser, a Generals kneaded rubber eraser and a Little Red All-Art sharpener.WARNING: This product contains a chemical known in the State of California to cause cancer.

General's Primo Charcoal Deluxe Drawing Set, Set of 12

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Learning to interpret ECGs is not easy – but there’s a world of help out there.

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Core Cases More Cases →

CC

Nausea, vomiting, and abdominal pain

HPI

Acid-Base Workshop: At the beginning of the conference year, multiple faculty members ran a workshop on acid-base abnormalities where we worked on identifying acid-base disturbances, determining primary respiratory or metabolic abnormalities, causes of such disturbances, and if compensation was appropriate. Perhaps one of the most challenging types of patients we encounter with an acid-base disturbance is an acidemic patient who we believe requires intubation. Below you will find a variety of resources on acid-base disturbances and more specifically, intubation and ventilation in this patient population. Read the case, consider reviewing the resources below, and think how you would approach this tenuous patient.


The Case:

A 23 yo F with a PMH of poorly controlled T1DM presents to your ED complaining of nausea, vomiting, and abdominal pain. She ran out of her insulin 3 days ago and didn’t have the funds to refill it. Her FS is 415 on POC testing.

Physical Exam

Vitals: 123/80, HR 120s, O2 98%, RR 32, Temp 98.2

General: sleepy but arousable to voice

HEENT: dry mucous membranes

Chest: CTAB, kussmaul breathing

Cardiac: regular rhythm, tachycardic

Abdomen: soft, NTND

Extremities: MAE

Labs

VBG: 7.03/14/65, Calculated Bicarb 5

BMP: 132/4.3/99/3/20/.09>423


What next?

You hang fluids and start an insulin drip, but the patient becomes progressively lethargic and has vomited twice despite anti-emetics. You decide you need to intubate. What next?

Questions

  1. What are the risks of intubating this patient?

  2. What would be your intubation strategy? Method, intubation medications, and things to pay attention to?

  3. Would you consider giving any additional medications (apart from paralytics or sedation medications) prior to intubating? If so, why, and what would be the dosing?

  4. What would be your ventilator settings?