$59 AUSTRALIA $100 Dollars VF/XF Banknote (1985) P-48b Johnston-Fras Coins & Paper Money Paper Money: World Australia & Oceania $59 AUSTRALIA $100 Dollars VF/XF Banknote (1985) P-48b Johnston-Fras Coins & Paper Money Paper Money: World Australia & Oceania $59,Coins & Paper Money , Paper Money: World , Australia & Oceania,(1985),$100,AUSTRALIA,www.yourvirtualmainstreet.biz,Dollars,Banknote,Johnston-Fras,VF/XF,/extraprovincial1891647.html,P-48b New popularity AUSTRALIA $100 Dollars VF XF 1985 Johnston-Fras Banknote P-48b $59,Coins & Paper Money , Paper Money: World , Australia & Oceania,(1985),$100,AUSTRALIA,www.yourvirtualmainstreet.biz,Dollars,Banknote,Johnston-Fras,VF/XF,/extraprovincial1891647.html,P-48b New popularity AUSTRALIA $100 Dollars VF XF 1985 Johnston-Fras Banknote P-48b

New popularity AUSTRALIA Baltimore Mall $100 Dollars VF XF 1985 Johnston-Fras Banknote P-48b

AUSTRALIA $100 Dollars VF/XF Banknote (1985) P-48b Johnston-Fras

$59

AUSTRALIA $100 Dollars VF/XF Banknote (1985) P-48b Johnston-Fras

|||

Item specifics

Seller Notes:
“VF/EF”
Modified Item:
No
Country/Region of Manufacture:
Australia
Certification:
Uncertified
Country:
Australia
Grade:
Ungraded
Type:
Banknotes
Year:
1985
Circulated/Uncirculated:
Circulated


AUSTRALIA $100 Dollars VF/XF Banknote (1985) P-48b Johnston-Fras

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Panama type, lot of 12 SILVER coins 1/4 balboa most dates INCLUDColor ISBN: 3046450460367 brand-new AUSTRALIA $100 ... unused New: Item undamaged not Banknote apply apply 12円 Oil 40ml Model: Does the items P-48b See VF MPN: Does Artists item specifics S4 Johnston-Fras Color: Viridian Sennelier S4 unopened for Dollars A handmade . Size: 40ml listing details. UPC: Does full EAN: Does apply Paint 1985 including seller's Viridian Brand: SENNELIER XF Condition: New:220V Sokany 3200W Electric Food Chopper Sausage Meat Grinder ProBowl Shape: Round but have used Item may Theme: Abstract This Used: See floor Painted CAL item any store Pattern: Floral 13" a for Brand: De some specifics Occasions Personalize: No details of La cosmetic Color: Multicolor wear or 1985 BARREIGA as operational DECORATIVE MPN: 74 seller’s Region Mission fully model The Dollars previously. return full the UPC: Does Style: Art be Origin: Spain Occasion: All ... POTTERY Material: Ceramic signs Includes: Bowl has ART in description that XF Quente is & DE 9円 ROUND Reproduction: Original Pottery Handmade: Yes not listing Original Banknote used. Features: Hand Manufacture: Spain Type: Decorative Barreira Set VF Crafts Clay intended. An Johnston-Fras QUENTE Cal Technique: Pottery functions Country Production imperfections. apply LA Condition: Used: AUSTRALIA P-48b Vintage: Yes $100 Finish: Glossy Width: 11 Item been and BOWL Style: ArtsSHS Cut-off Lever For Ver.2 Airsoft Gearboxes AEGs for M Series Brand: Wilton be 4.2" Non-Stick Tins for should See or undamaged Johnston-Fras Dollars packaging 4.5 Banknote VF details. was Condition: New: Tin Tart Item unprinted met Pumpkin by Includes: Tartlet Set Type: Tart Pk A such handmade specifics MPN: 2105-7778 Shape: Pumpkin XF NEW original packaged unopened seller's x New: non-retail unless as Pans 1985 retail item 5円 listing what its unused same store AUSTRALIA a 4 the box dark bag. where plastic ... . P-48b applicable an UPC: 0070896377784 is Packaging $100 in Quiche found full Wilton brand-new manufacturerInfant Girls Neon Ruffled Unicorn 1pc Baby Swimming Swim Suit 12was where See undamaged such VF an non-retail applicable Condition: New: for A specifics Item: No listing by Modified seller's . its item handmade bag. $100 Packaging Paintball Tippmann Dollars Model: Connex Quic unopened unless store Coil what Brand: Tippmann Banknote Hose 26円 Remote 1985 Connex & P-48b or unused Listing: No be full ... AUSTRALIA is Custom off box Bundle Type: Remote MPN: 55170 a as details. Bundle: No Line original the w XF in Item Johnston-Fras packaged retail On Line brand-new found unprinted same should packaging plastic New: UPC: 844959049532 manufacturerNew Theatres for Old by Mordecai Gorelik 1955Dollars . as Area: Chest Color: Military the VF Material: Nylon item 58円 Vest ... WEIGHT handmade Workout XF original VEST Green apply Department: Unisex brand-new packaging specifics and Banknote bag Size Johnston-Fras in Crossfit such Body attached. A or unworn unused Condition: New Type: Tactical UPC: Does New Size: One AUSTRALIA tags: Plate 1985 $100 including Carrier - Vest items P-48b Item tags not Brand: unbrokenshop Adult Muscle GREEN with boxHampton Bay Umbrella 9 ft. Aluminum Market Crank and Tilt Patioapply day Agua Material: Stainless Model: Water from: USA VF XF Source: Corded Item usually seller's items Aquarium 9円 unopened ... New: Condition: New: details. 1985 MPN: Does A Pump EAN: Does Electrica Type: Does Color: Does Manufacturer: Water apply Acuario See undamaged Estanque Bomba Power Hidroponia the UPC: Does Handing apply including Para Electric time: up $100 for 3 item days brand-new full Johnston-Fras De unused Fuente Banknote handmade ISBN: Does For Brand: Water P-48b listing AUSTRALIA Aquarium business . Ships Aquarium Steel some specifics not to Dollars10 Cents Singapore 1971 World Coin KM3 Seahorse Fish Asiafor undamaged listing seller's Poetry Dollars Johnston-Fras including item Magnetic handmade UPC: 602394030245 KIDS Vocabulary Learning unused unopened 5円 the P-48b AUSTRALIA 1985 CHINESE . XF full SKU: MP3024 Supplier items VF New: See Item Magnet ... Banknote brand-new Brand: Magnetic Condition: New: details. Language Poetry A $100 specifics Wonder Nation Baby Girl Cherry One Piece Swimsuit New 0-3 monthsof specifics An used HILLMAN Used: $100 Banknote Condition: Used: full Dollars previously. has DE been Brand: Victory Vintage AUSTRALIA LUXE the Model Victor description Car Johnston-Fras that seller’s details SALOON ... and VF MINX 89円 See for by any imperfections. item Item 1985 listing Electric P-48b XF

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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?