BUMC Basics.pdf - Anesthesia Home

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54 Stage 1: Mild confusion, decreased attention, irritability, reversed sleep pattern Stage 2: Drowsiness, personality changes, intermittent disorientation, asterixis Stage 3: Gross disorientation, marked confusion, slurred speech Stage 4: Frank coma The grading/staging of HE can be difficult. The presence of asterixis is a fairly reliable indicator of at least stage II HE. ** Always look for what precipitated the HE. Common etiologies: Infection, bleeding, electrolyte abnormality, dehydration. • Kristalose (same as Lactulose but tastes better and comes as packets of crystals): a good starting does is 20- 30 g po TID, then titrate to 3-4 BM/day • Rifaxamin: 400 mg PO TID- this is very expensive, and so it can be difficult to continue as an outpatient • For your patients with Stage III/IV HE or refractory HE: Kristalose 30-60 grams every hour until BM. Lactulose enema: 200 g of lactulose in 800-1000 mL water Ascites-volume overload Large volume paracentesis is greater than >2L If the patient’s serum albumin is less than 3 g/dL, then give 8 to 10 g of albumin per liter of ascites removed. All albumin at Baylor is “sodium poor” so no need to specify “sodium poor albumin- SPA”. Albumin comes in 25 g vials, so it is best to round to the next highest 25 g interval. Usually best to hang the albumin as you are about to do the tap. • Diagnostic paracentesis - SBP, etc. - Send for: cell count/diff, albumin, total protein - Inoculate culture bottles at bedside with 10 mL of ascitic fluid in each bottle (increases yield) - SBP if >250 PMNs • Coagulopathy is not a contraindication to paracentesis. In general, we do not give FFP or platelets prior to a paracentesis unless the patient has a severe coagulopathy
55 GI bleeding (**See above under GI Bleeding; in addition, think about the following) • All cirrhotics with GI bleeding should get prophylactic antibiotics to prevent SBP. Good options include a 3rd or 4th generation cephalosporin or quinolone. Antibiotics should be continued for 5 days. • Fluid resuscitate- central line preferred. If not, then ensure a 18-20G IV in each arm If INR>2, then give at least 4Units FFP • Give platelets if
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 and 30: 29 CARDIOLOGY CCU IN GENERAL You ar
Page 31 and 32: 31 Unstable Angina/NSTEMI • Can u
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: 53 the liver transplant ICU) where
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
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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
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