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Why is the routine use of bicarbonate NOT recommended in the management of DKA?
- -Worsening hypokalemia
- -Leftward shift of the oxyhemoglobin dissociation curve, worsening tissue hypoxia and intracellular acidosis
- -Hypertonicity
- -Sodium overload
- -CSF acidosis
- -Cerebral edema in children
- -Only benefit is that it will decrease the work of breathing
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7 P's of RSI
- Prepare
- Personnel
- Preoxygenate
- Premedicate
- Potent induction agent
- Paralytic
- Pass tube
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When should you think about using Rocuronium instead of Succinylcholine?
- 1. Concern for hyperkalemia (Burns > 10% of body surface, > 72hours old, < 6 months; Paralysis > 3d, < 6mo; Denervation syndrome; Crush injury > 3d, < 6mo; Abdominal sepsis > 3d)
- 2. Concern for increased intraocular pressure
- 3. Hx of malignant hyperthermia
- 4. Hx of musculodystrophy/MS/ALS
- 5. Recent cocaine use (at risk for prolonged neuromuscular blockade from low cholinesterase levels)
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