1. There is some data that during REM sleep, there is an interruption between the hippocampus and the neocortex, which interrupts our ability to form strong memories; this is one explanation for why dreams seem to escape us so quickly. This connection is also necessary to synthesize sensory elements of memories into one coherent experience, which is why our REM dreams, although highly vivid and emotional, are often fragmented and nonsensical. c/o Penelope Lewis (neuroscientist) in an interview with NPR:  http://www.npr.org/templates/transcript/transcript.php?storyId=212276021
2. EKG tips: 
-check top L corner for scale of measurement/recording
-sinus rhythm? check if every QRS is preceded by a P, PR intervals symmetric, P wave is not too large (suspect atrial hypertrophy)
-check axis: lead 1 is at 3 o'clock, aVF at 6 o'clock.
-RVH: right-axis deviation (except endocardial cushion defect), R>S wave in V1, S>R wave in V6.
-LVH: L axis deviation, S in V1 and R in V6 add up to >5mm.
3. Sedation options in peds: 
-Fentanyl/Midazolam: tried and true. Good pain control. Warnings: narcotics in kids can lead to resp suppression, midazolam works great most of the time but rarely can cause a paradoxical opposite effect and lead to anxiety, involuntary movements, aggressive/violent behavior.
-Precedex/Propofol: Precedex offers adequate pain control for most procedures, is long-acting and is good for long procedures/studies (i.e. MRI). Flipside is it takes a while to wear off (45-60 min), and as all kids under sedation must be constantly monitored, you need a lot of nurses. Propofol is non-opiate non-barbituate sedative that offers no pain control. Fast on, fast off, safe in good hands.
-Ketamine/Propofol: Ketamine is an NMDA antagonist and disassociative anesthetic. It causes sedation without respiratory depression or airway loss-- people totally breathe on their own. Causes slight HTN/tachycardia. In adults can lead to hallucinations, but rarer in kids. Contraindicated in patients with ICP, IOP, psychosis, in critical condition. Good for stable, healthy patients undergoing short procedures.
4. Indications for intubation for sedation: facial trauma/malformations that may may emergent intubation difficult, severe lung disease, significant cardiovascular disease
5. The sound of a PDA in a newborn is not like that of older kids. Because of increased pulmonary resistance in neonates, there is only flow across the PDA during systole, resulting in more of a mid-systolic ejection murmur than the continuous machine-like murmur of older children.
6. Things that cause hyperkalemia: 
-Cell injury (burns, rhabdo, tumor lysis synd, ischemia, hemolysis)
-Acidosis, low insulin, DKA
-Transfusion of old blood 2/2 hemolysis. People who really need fresh blood: cardiac/cardiac surgery patients, renal failure)
-Muscle injury 2/2 tourniquet left on too long, or squeezing small feet for blood.
-Hyperosmolar state.
-RTA 4/hypoaldosterone
-Other: beta-blockers, digitalis (causes K to shift out), low Mg causes K wasting.
-not diet: you can't eat enough bananas to make yourself hyperkalemic.
7. When to treat K imbalances:
-In adults, who often have subpar cardiac health, you really want to keep their K above 4. Babies and kids (not teenagers) who have very healthy hearts can tolerate much lower levels of K (down to 2s). IV potassium is associated with some bad outcomes, so use it only if you really need to. Indications for K replenishment: K<2-2.5, K<3.5-4 with hypokalemic symptoms (cardiac symptoms, profound weakness or respiratory changes), someone with a history of cardiac disease. If you treat, give 0.5-1 mEq/kg (0.5 for no sx, 1 if +cardiac sx) top out at 40 mEq IV, 60 mEq PO. PO is better, if they can take it.
-Hyperkalemia is very dangerous! Someone can go from a normal EKG to ventricular arrhythmias very quickly, bypassing the peaked T waves and prolonged PR and QRS widening and such. Treat anyone with a K over 6, or close to 6 and trending up. Treat at even lower levels if they have symptoms.
-If you suspect K imbalances, recheck with an arterial stick.
8. Treatment for hyperkalemia: 
-Calcium to protect myocardium. 1 dose buys you 20 mins. Ca causes cutaneous burns, so try to give it in a central line. If you don't have time and all you have is a peripheral IV, CaGluconate is thought to have less of a burn effect. Dose: 50-100mg/kg. 100 if someone is in extremis. CaChloride: central line only, 10-20mg/kg. Max 2g.
-Kayexylate: slurry, give rectally with a catheter. At first, give with sorbitol (osmotic agent that will help pull things out). Works in 10 mins. You may need more than one dose-- if you need more than 2 doses, ask for kayexylate without sorbitol. It can be given PO (and should be in someone who is neutropenic and immunocompromised) but it tastes bad and your patients may not tolerate. If there is a g-tube or you suspect good cooperativity, PO is ok.
-Albuterol
-Insulin+Glucose: Insulin dose, 0.1uL/kg. Glucose: 2-5mL/kg of D10 or D25. If they are a big person (i.e. teenager, almost adult) you can give an amp of D50. Don't do that in a child. Check sugars q10-15 minutes.
-Sodium Bicarb, 1-2 mEq/kg. One amp is 50 mEq.
9. When your treatment is not working: K keeps rising, EKG changes keep progressing, then put in a quinton cathether and get ready to go to dialysis.
10. Things that cause hypokalemia: 
-Drugs: diuretics, aminoglycosides, amphotericin.
-Vomiting (via alkalosis), diarrhea
-Alkalosis, increased insulin,
-Hyperaldosterone
-Beta agonists,
-Plasmapharesis.