Professional Documents
Culture Documents
• Febrile • Mental status most important to start • Fluid balance for the shift
• Tachypneic • Any cardiac monitor abnormalities
• Complaining of pain • Comfortable
• Hypotensive • In distress Chart review!
• Sleepy/asleep • Is this new for the patient
• What changes were made today
• Unresponsive • Recent medications
(You would hope this wouldn’t just be a page…)
• Capillary refill
• Pulses
• respiratory status
• What is the RNs overall perception of the
patient
Grab your
P waves? PALS card and
call for help!
2. Make sure patient is stable: what is the
hemodynamic status?
Chart review…
To bolus or not to bolus?
Labs?
Imaging?
Other diagnostic studies?
Meds or other interventions?
Re-examination?
2nd and 3rd 20 cc/kg boluses given= 60 cc/kg total for HR up to 170s
FEN: Electrolytes normal with anion gap 17 and BD 8; net negative fluid
balance prior to boluses
Next Steps GI: Abdominal girth slightly increased. LFTs normal. KUB, abdominal US
normal
over the next 6ish hours RENAL: BUN/Cr wnl and stable; normal UOP. Abscess improving in size on
imaging
• CBC stable
• CRP 1.8 (decreased from two days prior)
• Broadened antibiotic coverage
Decided to send
Huddled with
patient to the PICU
Fellow contacted PICU contacted bedside RN and
with significantly
charge RN
elevated lactate
CV: Trended lactates
NEURO: No concerns
MRI Abd/Pelvis:
2. No new abnormality.
Before coming back to the floor….
Worse abdominal distention and increased girth with increased WOB. Lactate 4.75.6. HR 150s
CXR normal
KUB IMPRESSION:
Findings compatible with marked distention of the stomach,
with ingested material and small amounts of gas.
Gastric distention was also noted on 10/20,
but was not noted on abdominal MRI dated 10/25/.
The findings raise the possibility of intermittent gastroparesis.
The next day…
Brenna Benson’s personal experiences on the Lahey team (whatever that’s worth)
UptoDate
PALS
AHA guidelines