BUMC Basics.pdf - Anesthesia Home

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Reglan. DO NOT prep a patient unless GI says that they were
able to get the patient on the schedule for the next day.
GI Prophylaxis
Generally not indicated unless patient is at high risk of GI
bleeding: high dose steroids, previous peptic ulcer disease,
heavy NSAID use, neurotrauma, etc. GI prophylaxis may put
patients at increased risk for C. difficile infection.
Nutrition
• TPN- there is a standard order sheet/order set. You
should become familiar with this order set and in general
write your own TPN. The dieticians are very good at
writing and are a very valuable resource.
• Tube feeds- enteral nutrition is always preferable to
TPN. There are a variety of formulas available at Baylor
(the Baylor EMR website has a list). Remember, Dobhoff
tubes are more comfortable for patients due to their small
size, but crushed meds don’t go down them very well, so
order your meds as suspensions.
Pancreatic Masses
If a patient has a pancreatic mass, and an FNA is indicated,
than it is best to call a gastroenterologist that does EUS/FNA
Pancreatitis
• Always assess severity — mild, moderate, severe — via
Ranson’s criteria or other criteria, and watch closely for
complications.
• If severe, then ICU treatment is needed.
• Treatment- IVF. If necrosis on CT, consider antibiotics
(controversial). Pancreatic necrosis can only be
determined on a CT with IV contrast (which may be
problematic as many patients with pancreatitis develop
AKI)
• Early tube feeds (gastric or duodenal) are controversial
• Always check a sonogram for stones. Consult surgery if
you suspect biliary pancreatitis because they usually need
a cholecystectomy before they leave the hospital. The