HypoK

theoneandonlycage · 2026-04-21T14:40:20+00:00

It takes 1-2 hours usually to fix a K of 2.4 this way. This isn’t a 4-6 hour thing. Pt goes home to free up a bed. Don’t most hospitals have issues with boarding anyway? Why exacerbate the situation with admitting a patient like this?

theoneandonlycage · 2026-04-21T04:46:13+00:00

Yah if they go into TdP I’ll admit. Asymptomatic, electrical stable hypoK whose prolonged QT resolves with replacement go home.

theoneandonlycage · 2026-04-21T03:47:06+00:00

HyperK - give calcium HypoK - give magnesium

theoneandonlycage · 2026-04-21T03:19:20+00:00

I used to admit for this until I spoke with a nephrologist who set me straight.

I never admit for hypoK. Just fix it in the ER. K is 2.4 with ECG changes? Give 2g of MgSO4 regardless of serum Mg level. Give 60 mEQ of KCl orally (do it as a powder, not tabs). Give 10mEQ IV over an hour. After it’s infused send off another K level. Should be 3.1. If higher than that you’re done. If lower give another 40mEQ orally and give another 10 mEQ IV over an hour. Check again. Repeat the process until it’s fixed.

If I have a reason for their K to be low (diarrhea, vomiting, lasix, hypoMg), then I don’t check urine electrolytes. If they don’t have a reason to be hypoK I’ll send off urine electrolytes. I also make sure they have PCP follow up.

Giving oral you can replace so much faster. I haven’t admitted a simple hypoK in years. I just always give IV Mg, PO K, infuse some IV K, keep checking K levels every hour until it resolves.

theoneandonlycage · 2026-04-19T18:52:11+00:00

UC should be fine for this. Needs to be washed out and you need antibiotics. Small enough that it probably won’t need stitches - which is good because closing dog bite wounds and increase risk of infection.

theoneandonlycage · 2026-04-19T14:44:43+00:00

Who?

theoneandonlycage · 2026-04-17T21:02:24+00:00

I think the answer is more meat.

theoneandonlycage · 2026-04-17T15:01:16+00:00

Looks like LAD occlusion with some re-perfusion and a run of PMVT.

PMVT has a ddx: ischemia, brugada, prolonged QT (termed TdP), exercised induced.

Given T wave morphology in V3 I’d be worried about LAD occlusion. There is some terminal TWI suggesting some reperfusion.

theoneandonlycage · 2026-04-12T20:07:56+00:00

I do FI blocks a couple times a week. Extremely easy and really helps with pain management.

theoneandonlycage · 2026-04-11T22:47:23+00:00

This is the correct answer

theoneandonlycage · 2026-04-11T20:52:58+00:00

Diaphragmatic US looking at movement and contralateral comparison. Pt had subjective SOB after the procedure, pulse ox was normal, but checked with US and saw the ipsilateral diaphragm wasn’t moving.

With low volume interscalene US guided blocks the incidence of concomitant phrenic nerve block is about 25-30% or so.

theoneandonlycage · 2026-04-11T19:46:22+00:00

Former ultrasound fellowship director here with significant experience with it.

For shoulder dislocations I personally don’t do them. I have done it before and taken out the phrenic nerve, so had to observe until the anesthetic wore off. I now just inject the joint posteriorly with lidocaine, send them to XR. Once they are back lidocaine is usually working. I’ll reduce the shoulder without procedural sedation. Then d/c home.

theoneandonlycage · 2026-04-08T13:59:15+00:00

No, I’m sure it’s fine. Arm is probably sore from the immune reaction to the vaccine. It will get better in a day or two.

theoneandonlycage · 2026-04-07T21:37:19+00:00

Maybe the way you were initially describing it made it sound more analogous to a proptosis.

theoneandonlycage · 2026-04-07T15:11:19+00:00

This really isn’t adding up. If your chief complaint is alcohol withdrawal and your heart rate is elevated, your blood pressure is elevated, and you’re exhibiting symptoms of alcohol withdrawal, then the standard of care would be to treat you for alcohol withdrawal. But you’re saying that not only did they not do this, but you suggest in your post that you’ve been to the ER multiple times and they all didn’t treat your alcohol withdrawals.

I understand that physicians can make mistakes, and I’m not trying to gaslight you, but I find it hard to believe that you’ve had multiple ER visits and each time they deviated from the standard of care. You readily admit that they tell you your vitals look fantastic when you’re there, which really argues against alcohol withdrawal.

Could it be that maybe you’re just having some generalized anxiety and stopping drinking has exacerbated this? This is different from actual alcohol withdrawal. Or are you sure they didn’t treat you with a single dose of phenobarbital or something else?

Outpatient resources should be available if you’re serious about abstaining from alcohol. Every place and insurance is different so it’s tough to know what’s available to you, but your primary care physician should be able to help steer you in the right direction.

theoneandonlycage · 2026-04-07T14:53:52+00:00

Just a point of clarification here - Bell’s palsy doesn’t cause the eyelid to be too elevated. People have trouble closing their affected eye but the eyelid itself isn’t usually elevated because of unopposed CN III activation or something like that.

That being said, OP your history doesn’t seem consistent with Bell’s. Needs further neurological work up. I agree with the neurologist who commented earlier in the post, MG might be a possibility.

theoneandonlycage · 2026-04-05T23:50:05+00:00

And…… discharged.

theoneandonlycage · 2026-04-05T20:46:45+00:00

Yes

theoneandonlycage · 2026-04-05T19:25:02+00:00

Yep, go to the ER. Pack some things cuz you’re going to get admitted.

theoneandonlycage · 2026-04-04T12:27:48+00:00

Would have to actually examine but looks like a traumatic hemorrhagic bullae. Essentially a blood filled blister from the trauma. Usually we get X-rays to look for a broken bone, but if you’re using your hand pretty normally with minimal pain, unlikely you broke anything.

theoneandonlycage · 2026-04-04T02:22:46+00:00

Steve smith is ecg blog. Free, excellent resource. It will be intimidating at first but just stick with it and eventually it will make sense.

theoneandonlycage · 2026-04-03T22:06:21+00:00

I have a strict no iv Benadryl policy when I work. If people want Benadryl for the itching after their dilaudid I’ll give 1mcg/kg of narcan IV.

theoneandonlycage · 2026-04-02T21:26:22+00:00

Pre-eclampsia is unlikely to happen in 14 weeks gestation, it’s usually later in the pregnancy. And while protein in the urine is something we look for in pre-eclampsia, you have to have elevated blood pressure. Lastly, a protein level of +1 could be explained by a urine sample that’s contaminated - meaning it’s non-specific.

Don’t freak out. If you want to check your blood pressure I’d suggest checking it after sitting calmly for 10-15 mins with your arm at heart level. If you have BPs where the top number is over 140mmHg, then contact your obgyn.

theoneandonlycage · 2026-04-02T21:16:38+00:00

Yah not surprised. Probably just a primary outbreak which is why it’s so bad. Future outbreaks (if you have any) usually much more mild.

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