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emDOCs Revamp – Acute Chest Syndrome

EMDocs

mg q20-30 min per dose) PRN naloxone in case of respiratory depression Some patients have SCD crises pain plan for reference Antimicrobials 11 Ceftriaxone + azithromycin if penicillin allergy for both children and adults. Alkindi S, Al-Busaidi I, Al-Salami B, Raniga S, Pathare A, Ballas SK. C or 100.4 mg/kg, max 0.4 C or 100.4

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Sickle Cell Disease Module

Don't Forget the Bubbles

Opioids do not cause ACS but they can exacerbate hypoxia in patients with ACS. Naloxone (opioid antidote) should be available in ED in case of severe respiratory depression. The treatment for ACS is mainly supportive: Oxygen : supplemental oxygen should be given only when the patient is hypoxic (saturation of oxygen < 94%).

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Profound ST depression in II, III, aVF

Dr. Smith's ECG Blog

This 29 year old African American patient was found down, unconscious, not breathing and was given 2 mg of intranasal naloxone by a bystander. I did not think it was due to ACS, but we ordered an ED ECG immediately: What do you think? He then received bag-valve-mask ventilations for several minutes until he became responsive.

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Tranq dope (fentanyl-xylazine combination): A new horizon in opioid withdrawal treatment

ALiEM

Alternatively, one can cut the 2 mg Suboxone (buprenorphine + naloxone combination) strips into 4 pieces after waiting for a longer washout period (72-96 hours of abstinence from non-medical opioids) before starting the induction. Multimodal medication options for fentanyl-xylazine withdrawal management in London et al. 2023 [book].

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