Reversal of neuromuscular blockade is sometimes used to assist in extubating a patient postoperatively. Generally, a train-of-four test is performed and if there are 1 or more twitches present, reversal is effected using neostigmine. Neostigmine is an acetylcholinesterase inhibitor that functionally acts to increase acetylcholine in the neuromuscular junction. Care must be taken when using Continue Reading
When anesthesiologists or intensive care physicians are determining suitability for reversing neuromuscular blockade, a train-of-four or “twitch” test is performed. This is done by causing a small electrical current to pass through an easily observed muscle and noting the number of times the muscles twitches, roughly corresponding to the percentage of neuromuscular receptors still blocked Continue Reading
Succinylcholine (aka “sux”) is a depolarizing muscle relaxant that produces the tell-tale fasciculations at onset of action. It is commonly used in intubation and has a fast onset of action of 30-60 seconds and a short duration of action of 10-15 minutes. Practitioners must be familiar with the possible adverse effects of this drug. These Continue Reading
Unfortunately for a condition with such serious sequelae, the risk profile of cerebral edema in diabetic ketoacidosis (CEDKA) is lacking. It is known that mortality is increased in cases where CEDKA is seen on first presentation of DKA, in the first 24 hours after presentation for DKA, and in patients who have a long-standing history Continue Reading
Vitamin deficiency questions often end up on board exams. A quick review of the most tested information is below: Vitamin Cellular Mechanism Deficiency Syndrome Vitamin A Photoreceptors, glycoprotein synthesis Keratomalacia, xerophthalmia Vitamin C Synthesis of collagen, Scurvy Vitamin D Calcium and phosphorus absorption, bone mineralization Rickets, osteomalacia, increased risk of some malignancies Vitamin K Prothrombin/coagulation Continue Reading
Refeeding syndrome occurs when a previously starved patient receives an abrupt onset of full or near full caloric requirements. Consideration of this syndrome is not infrequent in the critically ill patients in the ICU setting. Refeeding syndrome first began to get significant attention of the medical community after deaths occurred when World War II concentration Continue Reading
Every medical student in the last fifty years has been tested at least once on the basics of nutrient deficiency. At the risk of being overly pedantic: Nutrient Cellular mechanism Deficiency Biotin Fatty Acid Synthesis Alopecia, dermatosis, dry skin Chromium Improves glucose tolerance Hyperglycemia Copper Enzyme cofactor, hematopoiesis, bone formation Refractory iron repletion, hypochromic anemia Continue Reading
Virtually all patients who admitted to an intensive care unit for an extended period receive screening “nutrition labs” to assess nutritional and feeding status. When using these values to make changes in feeding regimens, the half-life of the substance must be considered to insure sufficient time has elapsed for the result to be a true Continue Reading
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