BUMC Basics.pdf - Anesthesia Home

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Liver transplant 56 Liver transplant evaluation (LTE) ▪ Can only be initiated by a hepatologist. ▪ Standardized 3 page order set which includes an extensive battery of imaging studies, labs, and consults. The evaluation usually takes 2-3 days minimum to complete. The liver transplant coordinator calls the consults (Psychiatry, etc.) as the transplant service often has consultants that they prefer to use. ▪ Be careful what you tell families and patients about their candidacy for transplant. Remember that the decision to transplant a patient is a committee decision. In general always defer this to the hepatologist. Patients and families are sometimes under the impression that they are being sent to Baylor for a liver transplant. It is important to tell the patient and family that a liver transplant evaluation is required first. ▪ Once a patient is transplanted, it is usually okay to sign off as the transplant surgery team will completely manage the patient. General liver patient guidelines • Avoid benzodiazepines and narcotics as they can precipitate encephalopathy • Tramadol is a good choice for pain management: 50 mg PO q12 hours prn pain • Insomnia is very prevalent. It is best to use Trazodone for insomnia. Do not use Ambien, Lunesta, etc. if possible. • If agitation is a significant problem, then low dose IM Zyprexa or Haldol is a possible treatment that can be used. • Always notify the liver transplant service if a patient that is on the liver transplant list is hospitalized. GI STUDIES Study Orders • Abdominal US (NPO 6hrs prior) • Barium Swallow (NPO 1hr prior) • Upper GI (NPO after MN) • SBFT (NPO after MN and one glass of water qhr from noon to 1900)
57 • Barium Enema (clear liquids 1d prior, NPO after MN, one glass of water qhr from noon to 1900, MgCitrate at 8pm, Dulcolax at 11pm, Dulcolax at 7am) • HIDA (NPO after MN) • Other notes: - CT abdomen/pelvis- always use oral contract (Gastrografin). Use IV contrast if possible. - Plain X-rays: KUBs and acute obstructive series are always best done in radiology rather than as portables. Endoscopy Orders • Colonoscopy, etc: Clear Liquid Diet day before then NPO except meds (except antiplatelets and iron) after MN and Nulytely 250cc PO Q10min until all 4L consumed starting at 1800 • EGD, etc: just NPO except meds for 6hrs prioir or after MN • Permits on chart for colonoscopy, endoscopy, and anesthesia • To GI lab on call • If pt is still passing stool in am the give fleet enema x1 • Have functioning IV (not heplock). The best way to do this is just to order IV fluids to start 4-6 hours before the procedure. • Patient to resume diet when alert ~1hr (for capsule can resume liquid/diet 2/4hrs after swallow • Benefits: 1/20 r/o cancer vs Risks: 1/500 r/o significant bleed, 1/2000 r/o perforation
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 and 54: 53 the liver transplant ICU) where
Page 55: 55 GI bleeding (**See above under G
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
Page 123:
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