BUMC Basics.pdf - Anesthesia Home

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• Vasopressin — pressor of choice if not able to maintain
adequate blood pressure with blood product and fluid
resuscitation.
• NGT aspirate: If red blood then may indicate active GI
bleeding. If coffee ground, than probably UGIB within 1 to
2 days.
**A negative NGT lavage does not rule out an UGIB.
Large post-pyloric bleeds such as duodenal ulcers
commonly have negative aspirates. It is usually okay
to remove the NGT after the aspirate (unless you are
going to use it for medications or something else).
• Consult GI: Important things to tell them are
1. Patient name and location
2. Presentation
3. Co morbidities and medications (including any
NSAIDS)
4. Actively bleeding or not (results of lavage)
5. Significant labs: H&H, PT/INR
6. Resuscitation efforts (how much blood/FFP has
been given)
7. Hemodynamics
8. If a procedure is needed
9. Remember the definition of urgent endoscopy is
an endoscopy within 24 hours.
• Follow serial H&H Q6 hours for 1-2 days, then change to
Q 8-12 hrs
• Make sure to repeat INR 1-2 hours after FFP
• Vitamin K: Most cirrhotics who have significant jaundice
are also Vitamin K deficient so give Vitamin K 10 mg SC
daily x 3 days.
• Keep NPO
GENERAL HEPATOLOGY
Acute liver failure
▪ Basic definition: Jaundice, coagulopathy, and AMS
▪ Very complex, sick ICU patients. Acute liver failure can
progress very rapidly. Best managed on 4 west ICU (aka