BUMC Basics.pdf - Anesthesia Home

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30 STEMI: Complete occlusion of coronary artery by thrombus resulting in ST elevation on EKG. Progression — Stable plaque-unstable plaque-plaque rupture-UA/NSTEMI (partial occlusion)-microemboli-STEMI (complete occlusion) Orders — For ACS: Think MONA BASH (Morphine, Oxygen, Nitroglycerin, Aspirin, B-blocker, Statin, Heparin) Meds: 1. Morphine 2 to 4 mg IV Q4 hours prn chest pain 2. Oxygen per protocol to keep SpO2>92% 3. Nitroglycerin 0.4 mg SL Q3-5 minutes x 3 doses prn chest pain 4. ASA 325 mg PO Qday 5. BBlocker: Can use coreg 3.125 mg to 6.25 mg PO BID and increase as needed: write parameters on BP meds (hold for SBP
31 Unstable Angina/NSTEMI • Can use history, physical exam, and TIMI risk score to stratify. • TIMI risk score will help dictate conservative versus invasive strategy. **Get Cardiology on case soon if not admitted by a cardiologist! Tests — Chest X ray, EKG, Echo (non emergent) and cardiac enzymes (Troponin and CKMB) EKG: Will show ST depression, T wave inversion, or nonspecific changes. Treatment — Revolves around three keys: (1) anti-ischemic therapy, (2) antiplatelet therapy, and (3) anticoagulation. • Anti-Ischemic Therapy: Nitrates, Beta blockers (don’t use if hypotensive, wheezing, bradycardia), Calcium channel blockers (nondihydropyridines, if can’t use beta blockers), morphine, and oxygen. • Antiplatelet Therapy: ASA, Plavix (load with 300 or 600mg, don’t use if suspect going to CABG), GP IIB/IIIa inhibitors (pts with >3 TIMI risk score and positive cardiac enzymes) • Anticoagulation: UFH (bolus and wt. based titrate for aPTT of 50-70). Use bivalirudin if patient has heparin induced thrombocytopenia. Low Risk: Negative cardiac enzymes, no ST depression, TIMI score 3. Use GPIIb/IIIa and will need angiography with in 24-48 hours. STEMI • Immediately call cardiologist on call and activate cath lab. • Will have ST elevation in >2 leads with reciprocal changes or new onset of LBBB.
Page 1 and 2: BUMC BASICS
Page 3 and 4: • Status Epilepticus • Stroke m
Page 5 and 6: 5 Welcome to Baylor University Medi
Page 7 and 8: 7 Rounding on your patients: • Se
Page 9 and 10: 9 2. gloves only. During codes, if
Page 11 and 12: 11 • There is one resident and 3
Page 13 and 14: Chest pain 13 DDx to consider • M
Page 15 and 16: SOB DDx • Pneumonia • PE • An
Page 17 and 18: 17 • Heparin • Lidocaine • Ni
Page 19 and 20: 19 TPC (cont’d) Pager Cell Phone
Page 21 and 22: 21 Gen Surgery Neurologists Urgent
Page 23 and 24: 23 OBTAINING A CONSULT AT BAYLOR Ob
Page 25 and 26: 25 • Enter 2 initial zeros and th
Page 27 and 28: 27 • Albuterol/Atrovent nebulizer
Page 29: 29 CARDIOLOGY CCU IN GENERAL You ar
Page 33 and 34: 33 Post PCI Complications — In yo
Page 35 and 36: 35 function, elevated troponin T is
Page 37 and 38: 37 **0-1 point non-cardiogenic, 2 p
Page 39 and 40: 39 • Erythromycin • Phenothiazi
Page 41 and 42: 41 Therapy — Therapy is guided by
Page 43 and 44: 43 Nitroglycerine (Onset in 2-5 min
Page 45 and 46: 45 Treatment: • Vasovagal: Recogn
Page 47 and 48: 47 GI/HEPATOLOGY GI CONSULTS AND GR
Page 49 and 50: 49 hepatitis, obesity), then they p
Page 51 and 52: 51 timing and necessity of ERCP for
Page 53 and 54: 53 the liver transplant ICU) where
Page 55 and 56: 55 GI bleeding (**See above under G
Page 57 and 58: 57 • Barium Enema (clear liquids
Page 59 and 60: 59 Pseudomonas: • Piperacillin/Ta
Page 61 and 62: 61 • Neoplasm: Lymphoma, leukemia
Page 63 and 64: 63 mortality. It lowers mortality i
Page 65 and 66: Pneumonia (immunocompromised) (cont
Page 67 and 68: 67 BRAIN DEATH EXAM • Can order b
Page 69 and 70: 69 SEIZURES Can use BZD ativan IV o
Page 71 and 72: 71 3. Stop anticoagulants and rever
Page 73 and 74: 73 ONCOLOGY THE ACUTE LEUKEMIC “T
Page 75 and 76: Timeline*: 75 Day 0 (admit) — Bon
Page 77 and 78: 77 PALLIATIVE CARE AND CLINICAL ETH
Page 79 and 80: 79 release oxycodone, and hydromorp
Page 81 and 82:
81 • Institutional Ethics and Pal
Page 83 and 84:
83 PULMONARY ARDS Definition: Need
Page 85 and 86:
85 MECHANICAL VENITALTION Oxygen su
Page 87 and 88:
87 • Ineffective respiratory effo
Page 89 and 90:
89 - Daily sedation vacations at 07
Page 91 and 92:
91 • After 1 wk of intubation det
Page 93 and 94:
93 - Sustained changes in the heart
Page 95 and 96:
95 PULMONARY EMBOLUS (PE) Evaluatin
Page 97 and 98:
97 RADIOLOGY RADIOLOGY HINTS IF YOU
Page 99 and 100:
Superficial Abscess/Mass Abscess/Ma
Page 101 and 102:
101 RENAL ACID/BASE DISTURBANCES Qu
Page 103 and 104:
103 ACUTE KIDNEY INJURY Acute Kidne
Page 105 and 106:
105 Mg
Page 107 and 108:
107 CHRONIC KIDNEY DISEASE Stage GF
Page 109 and 110:
Hypovolemic Hyponatremia EABV low R
Page 111 and 112:
111 fluid pulled off and into the p
Page 113 and 114:
113 Colorectal Surgery, and Plastic
Page 115 and 116:
115 • Social work: Circle Social
Page 117 and 118:
Ear Health Antipyrine/Benzocaine ot
Page 119 and 120:
Magnesium Oxide 400mg tab Prenatal
Page 121 and 122:
121 DUEWALL’S FAVORITE MNEMONICS
Page 123:
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