Pentobarb coma – BIS should be 10-20 and SR (suppression ratio) should be 70-80
Consider lev albuterol
Should give vaccines after coiling of spleen or before if possible
No calcium channel blockers post MI definitely and post op in general
Toradol inhibits spine healing
Don’t do endoscopes with patients in supine position
don’t ambulate patients with known dvt’s. wait 2-3 days until clots get stuck.
dvt’s even with filter get heparin as much as possible for post phlebitic syndrome and to retard new clot formation
diffuse alveolar hemorrhage – secondary to chemo, goodpasture’s, wegener’s, thrombocytopenia
Imuran causes myasthenic type syndrome and thrombocytopenia
use silver impregnated VAC’s only 2-3 times.
when using VAC’s use dermabond on skin edges so no sucker bites. also use skin sealant.
when think you might have PEG tube bleed, pull up balloon and blow it up to try to tamponade
When taking down adhesions from a hernia, know that vessels in the omentum do not have lots of musculature in the walls and don’t respond well to bovie. they should be tied or ligated. They can temporarily stop bleeding and fall down in the abdomen when you are doing it open and then the patient is hypotensive in the PACU
When taking down adhesions laparoscopically when fixing hernias, typically don’t do alot of bovie so that you don’t get delayed bowel injury.
antibiotics in sepsis need to be given in the first hour.
put in neil’s stuff about sedation and alcohol withdrawal – should be given po if possible. IV haldol and ativan is cleared rapidly from the system.
do haldol vs risperadol write-up. rispiradol has fewer extrapyramidal side effects but is not reliably sedating.
Neil thinks best antidelirium drugs in unit is haldol and prolixn
Neil thinks seraquel is okay in old people if low doses – can cause hypotension
zyprexa olanzapine has fairly significant anticholinergic effects – dry mouth, constipation, delirium. also causes metabolic syndrome over several months
lack of loss of consciousness does not rule out significant brain pathology.
check FVC in rib fractures
For lung transplants – lung recruitment 30 of peep for 30 seconds, mucormyst and solucortef. Transplant lungs if PaO2 > 300, kerlex is placed down pharnyx, lung transplant surgeons still want tv of 12ml/kg,
consider pulsatile preservation of kidneys’
To combat DI in brain death, ddavp and vasopressin gtt, if urine is > 250 cc/hr then replace with .2 NA
T4 maintains aerobic metabolism and is done in transplant donors. It replaces myocardial energy stores, decreases serum lactate, and reduces inotropic support.
transplant surgeons want urine > 100 cc/hr and cvp of 6-8
abdominal transplant surgeons love norepi and cardiac transplant surgeons hate norepi
no po cathartics in bowel obstruction
gross blood in the foley requires a CT cystourethrogram, not just CT with delayed cuts. In kids even microscopic blood requires CT cystourethrogram.
fluconazole can cause thrombocytopenia
linezolid hard on bone marrow, give quinpristin as alternate
duramorph does not kick for 3 hours, sometimes have to give narcotics but no PCA, at 18-24 hours get peak respiratory depression with duramorph
no haldol or reglan in parkinson’s
drug fevers tend to be continuous
treat staph aureus for 14 days
treat staph epi for 7 days
clinda binds toxin of strep A and also kills anaerobic
diabetic wounds get strep a and gram neg
ivda get staph and strep A
Collagen ADP test and collagen epi test for platelet function in trauma bay when patient on aspirin
freshwater submersion gets antibiotics
military does not use stryker needles anymore, put something on compartment syndrome in the book
if have bad heart and coming off balloon pump, can afterload reduce with captopril if kidney function is not bad
check IgG after growth hormone secreting tumors resected
watch for DI after pituitary adenoma resected – manifests as polyuria and decreased urine specific gravity
for cosyntropyn test – dexamethasone does not affect, hydrocortisone does affect so must wait 24 hours.
subarachnoid hemorrhage goes down sulce, intraparencymal bleed looks like smudge, subdural crosses suture line, epidural does not cross suture line.