Pearl of the Day!

When calculating anion gap in a hyperglycemic patient, use the measured serum sodium, NOT the corrected serum sodium.
Or does everyone know that, like,duh, in which case, my apologies.

This just in: Modified Valsalva for SVT

A variation on the Valsalva maneuver for converting SVT, sent in by Mike Kiernan:
https://www.youtube.com/watch?v=8DIRiOA_OsA
In this video by the Lancet, Valsalva x 15 sec followed by placing patient supine with legs elevated increased rate of successful cardioversion. They also have a pretty cool way for the patient to perform the Valsalva maneuver.
Hat tip to MK!https://www.youtube.com/watch?v=8DIRiOA_OsA
*Please let me know if clicking on the link does not work!*

Neonatal O2 sat

We interrupt the regularly scheduled ACEP posting to bring you this tidbit from AudioDigest Emergency Medicine:
When measuring SaO2 on a newborn, it takes 10 minutes for the SaO2 to reach 85-95%.
Avoid hyperoxia, this may cause tissue and organ injury due to free radical formation. Start with RA or blended O2.

In addition, studies show that bundling an infant raises the skin temp but not the rectal temp, except in infants 1-2 days of age.
A neonate with rectal T >100.4 F at home warrants a workup even if afebrile in the ED.

Courtesy of Phyllis L. Hendry, MD "Emergency Presentations in the First 28 Days of Life"

ACEP 2015 Pearls Part 1

I'm starting a series of practice-improving information that I learned at ACEP 2015.
The first few in the series are from David Pearson, MD, FACEP, Associate Residency Director, Carolinas Medical Center and his "Critical Care Pearls" session.
*Shock Index: A better predictor of shock than SBP alone. According to Dr. Pearson, a SBP< 90 is actually a late and insensitive finding.
The shock index is HR/SBP. A value > 0.9 indicates tissue hypoperfusion.
4% of intubated patients have peri-intubation cardiac arrest and the shock index can predict risk of peri-intubation arrest
A preintubation shock index of 0.8 or higher predicts post-intubation hypotension and peri-intubation cardiac arrest
Other predictors include intubation for acute respiratory failure, chronic renal insufficiency, and advanced age
*Fluids: A balanced electrolyte solution is more physiologic than either LR or NS.
pH of NS= 5.5
pH of LR= 6.5
Balanced electrolyte solution, eg. Plasmalyte: pH= 7.4
With NS, chloride is exchanged for HCO3- in serum which can lead to acidosis and hyperchloremia
In severely ill acidotic patients, NS can further drop pH
In absence of BES such as Plasmalyte, LR has higher pH and is more physiologic

More pearls from Dr. Pearson's session coming soon!
Feedback is appreciated! Hope this is helpful.

**CORRECTION: The original post incorrectly attributed this session to Dr. Scott Weingart. The author apologizes for any inconvenience/misunderstanding.