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Strangulation of Adult & Pediatric Patients

As a trauma nurse that is cross-trained with a master of forensic science degree, I spend a lot of time thinking about recognition & assessment of strangulation patients. •

Strangulation and Domestic Violence

Strangulation has been identified as one of the most lethal forms of domestic violence. It is one of the best predictors for subsequent homicide. Prior strangulation increases the odds of strangulation homicide by more than seven times. For perpetrators, strangulation is the ultimate form of power and control. However, because there are often no visible injuries, patients, physicians, and law enforcement often minimize the possible health consequences of reported strangulation.


The vasculature of the neck is relatively unprotected and vulnerable to injury and vascular occlusion. The application of 4.4 pounds of pressure to the jugular veins causes venous outflow obstruction from the brain and thus stagnant hypoxia. Eleven pounds of pressure to the carotid arteries can cause loss of consciousness in approximately 10 seconds. Compression of the trachea requires significantly more force: 33 pounds of pressure for occlusion and 35 pounds to fracture tracheal cartilage.

Strangulation can be fatal in as little as four to five minutes. Mechanisms in addition to hypoxia due to vascular occlusion have been proposed. Pressure on the carotid body may cause bradycardia and subsequent cardiac arrest. Delayed mortality may be caused by carotid artery dissection, aspiration, postobstructive pulmonary edema, acute respiratory distress syndrome, or tracheal injury.

📓: ACEP Now, Heather V. Rozzi, MD, FACEP; and Ralph Riviello, MD, MS/April 2019


Answer: Bradycardia & hypotension are the hallmark signs of neurogenic shock. This type of shock falls under the distributive umbrella.

Pediatric Hyperthermia

Have you ever taken care of a pediatric patient who was left in a hot car during the summer and suffered from hyperthermia? •

Have you even thought about what kinds of clinical complications you may see w/this type of case? If so, tune in now to my new podcast episode….👂🏼

👶🏼🚁🚑🏩 #newpodcastalert #newpodcastepisode #pals #enpc #ena #emergencynurse #pediatrichyperthermia #rhabdomyolysis #hypoglycemia #electrolyteimbalance #emergencytraumamama


Stop The Bleed Instructor Course

Being a trauma nurse means studying on your days off. It means reading EBP articles because you want to know what is “cutting edge”. It means going to a class on a Sunday morning because you want to do more, teach more, and above all save more lives. Stay thirsty for knowledge my friends 💉💯💪🏻

~The Verkinator ✌🏼

Sepsis Alert💉🦠Vanco

• @theedtraumacist Vancomycin is a tricyclic glycopeptide antibiotic used to cover gram➕bacteria such as methicillin resistant Staphylococcus aureus. 💉

Vancomycin works by inhibiting bacterial cell wall synthesis by binding to D-alanyl-D-alanine cell wall precursors, inhibiting polymerization and preventing linkage to the glycopeptide polymer located within the bacteria’s cell wall.


When dosing vancomycin a couple of factors should be considered including the patient’s weight, renal function, and presenting disease state. It is normally

dosed at 15-20 mg/kg, and even higher for more severe infections (25-30 mg/kg in patients with sepsis, infective endocarditis, meningitis, etc. with a max dose depending on your hospital protocol).


In a study by Fuller and colleagues that reviewed vancomycin management in the ED, they reviewed 4441 doses of vancomycin given to patients with a weight measurement available. Vancomycin was dosed correctly in only 22.1% of patients 😧 with 71 % of patients being dosed below the recommended dose of 15-20 mg/kg 😱. Vancomycin dosing is not one size fits all and patient specific characteristics should be considered when dosing this medication. 💉

#theedtraumacist #trauma #traumaninjas #miamitrauma #traumiami #emergencymedicine #emergencydepartment #pharmacy #pharmacylife #pharmlife #pharmvida #pharmsohard #pharmacystudent #pharmacyresident #pharmer

AEIOUTIPS Mnemonic DDx for Altered Mental Status

Have you ever taken care of a pt who had an altered mental status (AMS)? Patients with an altered mental status (or ALOC)are among the toughest to assess since there is no classic, “one size fits all” presentation.

The clinical presentation is often obscure, which makes recognizing changes in mental status a challenging endeavor. There are certain underlying pathophysiological conditions that can cause AMS. This is one of the largest differential diagnoses you may encounter in the ED, EMS or hospital setting. 

1-START WITH THE ABCS, IV, O2, ✔️skins & 12 lead 🖤💙🖤

2-ASSESS the pt & extrapolate info from the family (i.e. med list) 💊

3-GET labs: ISTATs, & venous blood gas (VBG) 💉

4-Use AEIOUTIPS mnemonic to help w/DDx

5-Listen to emergency trauma mama’s new podcast to review a super interesting case study 😲💪🏻💯🤗