BUMC Basics.pdf - Anesthesia Home

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66 NEUROLOGY ALTERED MENTAL STATUS Patient states: • Confused: disoriented but calm • Delerium:disoriented but agitated • Lethargic: Drifts off to sleep • Coma:Unarousable and unresponsive Etiology: MOVE STUPID • Metabolic (hypothyroid, hyperthyroid, hepatic encephalopathy) • Oxygen (Hypoxia from PNA, pulm edema, etc) • Vascular (TIA, CVA, Subdural hematoma, TTP) • Electrolytes (Specifically Na, Ca) • Seizure • Trauma • Uremia • Porphyria • Infection (sepsis/meningitis) • Drugs/Toxins Immediate ER cocktail (if history unobtainable): Thiamine IV (always give before glucose), D50, Narcan. Flumazenil only if BZD OD certain. Immediate assessment — Intubate if indicated. Vitals, Exam, ABG, DFS, O2 sat, EKG, utox Initial labs — CBC, CMP, serum osmolar gap, Acetaminophen level, Salicylate level, appropriate med levels if suspected, serum ETOH, TSH, Blood cultures x 2, UA and urine cx Consider additional diagnostic studies — CT Head (non-contrast), CXR, LP, EEG, additional infectious work-up if indicated
67 BRAIN DEATH EXAM • Can order brain death exam order set and it guides you through the following: • Brain death is a clinical diagnosis • Need to exclude the presence of exogenous/endogenous toxins • Patient can’t be hypothermic: Need to warm them up to declare them brain dead • Exam has 3 components (need to have all of the following): 1) Coma 2) Absent brain stem reflexes 3) Apnea test 1. Coma: Needs to be at least 6 hours if patient has a structural lesion and 24 hours if patient has anoxic brain injury 2. Brain stem reflexes: - Absent motor response - Pupils are midposition or dilated (4-9 mm), absent light reflex, doll’s eye maneuver - Absent corneal reflex - Absent oculovestibular reflexes (30-60 cc ice water in ear canal results in no movement; in normal person, fast beat is described by COWS: cold opposite, warm same, in coma, a response would be seen if eye slowly moves toward ear irrigated with cold water) - Absent jaw jerk - Absent gag reflex - Absent cough with tracheal suctioning - Absent sucking or rooting reflex If all brain stem reflexes are absent, proceed to 3. Apnea test: Pre-oxygenate at 100% FiO2 x 5-10 minutes. Would like pCO2 to be around 40 to begin with if possible. Then, disconnect from ventilator support for 8-10 minutes (deliver O2 at 8-10L/min, a small canula is placed down the ET tube) and watch for respirations. A positive test is absence of any respiratory response and a post test ABG with PaCO2 >60 or 20 mmHg greater than baseline. 4. Confirmatory testing (Not mandatory): - Brain flow study: nuclear scan to evaluate for cerebral blood flow (no flow when ICP exceeds SBP)bedside (pitfall – does not evaluate posterior circulation)
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BUMC BASICS
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• Status Epilepticus • Stroke m
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5 Welcome to Baylor University Medi
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7 Rounding on your patients: • Se
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9 2. gloves only. During codes, if
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11 • There is one resident and 3
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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 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: Pneumonia (immunocompromised) (cont
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
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Ear Health Antipyrine/Benzocaine ot
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Magnesium Oxide 400mg tab Prenatal
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121 DUEWALL’S FAVORITE MNEMONICS
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