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Product description

Size : Width 112mm x Depth 21mm x Length 32mm. [Material] Body = PS · ABS · POM · stainless steel /Cartridge = PS · POM · PET. Pentel is a Japanese company that manufactures and sells Stationery and office supplies (art materials, writing instruments, etc.), electronic devices (touch panels, touch switches, pen tablets, etc.), industrial robots, industrial automatic assembly machines, precision molds for injection molding, precision hand presses, chemical products related products (cosmetics Parts, medical equipment etc). For over 70 years, Pentel has supplied the world with the highest quality products. Pentel is the only writing instrument company to receive the Deming Award for recognition of the highest standard of quality. Pentel invented roller ball technology...the smoothest way to express ideas. Pentel pioneered graphite lead and our Super Hi-Polymer Lead is the market leader. Our mechanical pencil inventions remain the hallmark of the industry. Every Pentel mechanical pencil, lead, eraser, pen and correction fluid is manufactured by our own factories. No other manufacturer can match this commitment to manufacturing excellence. Pental sponsor numerous educational programs and donate products to libraries, schools and organizations of need. Pentel proudly offers a environmentally friendly line of writing instruments, Recycology. Our product's dozen boxes, master cartons and blister cards are printed on recycled and recyclable materials. Pentel is working with you to create a healthier environment. At Pentel, your satisfaction is guaranteed. Every product is backed with a lifetime warranty against defects in materials and workmanship.

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Core Cases More Cases →

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?