TB43DS,L.H.,www.latifsrestaurant.com,Head,,/endocrine472846.html,Dottie,Toggle,Bolt,,Mushroom,1,Industrial Scientific , Fasteners , Anchors,Slotted/Square,,$14 L.H. Dottie TB43DS Toggle Bolt 1 Some reservation Slotted Head Mushroom Square $14 L.H. Dottie TB43DS Toggle Bolt, Mushroom Head, Slotted/Square, 1 Industrial Scientific Fasteners Anchors TB43DS,L.H.,www.latifsrestaurant.com,Head,,/endocrine472846.html,Dottie,Toggle,Bolt,,Mushroom,1,Industrial Scientific , Fasteners , Anchors,Slotted/Square,,$14 $14 L.H. Dottie TB43DS Toggle Bolt, Mushroom Head, Slotted/Square, 1 Industrial Scientific Fasteners Anchors L.H. Dottie TB43DS Toggle Bolt 1 Some reservation Slotted Head Mushroom Square

L.H. Dottie TB43DS Toggle Bolt 1 Some reservation Slotted Rare Head Mushroom Square

L.H. Dottie TB43DS Toggle Bolt, Mushroom Head, Slotted/Square, 1

$14

L.H. Dottie TB43DS Toggle Bolt, Mushroom Head, Slotted/Square, 1

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Product description

Color:zinc

Product Description

The L.H. Dottie TB43DS Toggle Bolt has a mushroom head and a combo slotted/square drive. Size: 1/4-inch-20 TPI by 3-inch length. Made of steel. Zinc plated finish. Spring wing nut type. This listing is for a standard package containing 50 units.

From the Manufacturer

The L.H. Dottie TB43DS Toggle Bolt has a mushroom head and a combo slotted/square drive. Size: 1/4-inch-20 TPI by 3-inch length. Made of steel. Zinc plated finish. Spring wing nut type. This listing is for a standard package containing 50 units.

L.H. Dottie TB43DS Toggle Bolt, Mushroom Head, Slotted/Square, 1

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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?