BUMC Basics.pdf - Anesthesia Home

Fever
14
DDx to consider
• Infection (pneumonia, UTI, etc.)
• PE
• Drug fever
• DVT
• Fungal infection
Things to do
• Take history to try to find source (cough, dysuria, etc.)
• Look through chart to see what has been done (previous
blood cultures, etc.)
• Perform focused physical exam, esp. vital signs
• Do CXR, Blood cultures, Urine culture, sputum culture (if
indicated)
• Start abx only if patient looks ill with broad spectrum
• Refer to cross cover sheet or progress notes for
preference of what to advance antibiotics to if already on
abx (esp neutropenic fever)
Hypotension
DDx
• Sepsis
• Cardiogenic shock
• Adrenal insufficiency
• Hemorrhagic shock
• Volume depletion (overdiuresed)
• Medication
Things to do:
• Try fluid bolus of 1 L NS (less if CHF/3 rd spacing)
• Assess cause
• If septic: volume resuscitate; check cultures; broad abx;
start pressors (levophed) if needed to keep MAP>65
• If Cardiogenic shock: Assess why. Start dopamine or
dobutamine if needed
• If concern for adrenal insufficiency, start stress dose
steroids: Solumedrol 50 mg IV Q6 is a good start
• If hemorrhagic shock: Volume resuscitate with NS and
Blood. Check Hemostasis profile and give platelets/FFP
as needed. If in DIC, give cryo. Determine source of
bleeding and then stat consult for
GI/Surgery/Neurosurgery/etc.
• Hold BP meds, diuretics or reduce if needed