SadCrit

Clamshell.

Well shit.

#emimcc

Well that's a new low for me. Consultant didn't know the answer, but siding with a chatbot over me. Am I less trustworthy than a robot?

Listening to #emcrit ep with @pulmcrit.bsky.social

Just wondering about the PI in darker skin and whether this has any effect?

#emimcc

Still need to exclude sepsis

The only thing anyone has ever named after me is the A4 folded in 16 to act as the jobs list for the firm

Why are you saving it as a gif?

Oh boy am I going to have a hard time getting people to go along with some of this

The discrepancy between the college referring to itself as RCoA and the exam being called FRCA annoys me every time

#AnSky

Ok got it, thank you!

So the water will remain, the sodium will remain, but not all the bicarb will. So overall, won't the osmolality fall a bit?)

I'm not saying it matters, I just think in practice it's going to be mildly hypotonic

That's its job right? To mop up all the horrible H+ ions that were causing mischief being stuck to proteins, and get them out via the lungs?

derangedphysiology.com/main/cicm-pr...

So this 👆 suggests the quite a lot the bicarb is excreted within minutes (I know it's talking about a bolus of 8.4%, but presumably the 1.26 follows a similar pattern)

So I get that a bicarbonate ion can't cross a membrane, so IF infused 1.26% sodium bicarbonate stayed as sodium bicarbonate in vivo, then yes, it would act as an isotonic solution, because all those osms would be effective osms

I get that the sodium remains, no argument there ✅

But I thought an "effective osmole" is one that can't cross a membrane, so will impact the tonicity?

If it has 150mmol of Na and HCO3-, it will have an osmo pretty close to plasma, yes. But if after a few minutes of being infused the HCO3.has been exhaled as CO2, then it's not going to be existing as an effective osmole still is it?

How about bicarb?

How come we call 1.26% sodium bicarbonate isotonic?
#ansky #emimcc

Oui j'ai compris

Oh she also had a K of 9

She did get bicarb!

Fascinating, thank you

Or to quote my consultant "It's 3am why are you asking me this?"

So do chronically hypercapnic patients have permanently dilated vessels on their heads? Or do they somehow get used to the hypercapnia, and have normal calibre vessels at raised pCO2? If that were the case, then shooting for a normal CO2 would lead to vasoconstriction?

Ok I have another one. What if I have a COPD patient who I can see usually sits with a pCO2 of 8 kpa (60mm) and they sustain a TBI.

Ventilate them down to a pCO2 of 4.5-5, even if it means I make them alkalaemic?

#emimcc

I strongly feel like my learning is enhanced by gifs

About 7.0something, BE -24

A case from a little while ago, she was 19 with a glucose of >100 mmol/L, GCS 3

My unit has this as policy!
Doctor the norad is at 0.5, you need to prescribe vasopressin

DKA with ?cerebral oedema, self ventilating her own pCO2 down to 2 (15 in 🦅 units). If she gets tubed, do I try to keep the CO2 the same, or do I aim for neuroprotective CO2?
#emimcc