BUMC Basics.pdf - Anesthesia Home

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- EEG silence x2 12 hours apart (pitfall – can be
confounded with medications on board, also at high
sensitivities, much artifact comes through)
- Cerebral angiography-Gold standard (no flow-no
brain. pitfall – costly, invasive, requires transporting
patient out of ICU setting to radiology, not readily
available)
5. Southwest Organ Transplant can come and talk to the
family about organ donation, but keep that separate
from the talking you do with the family.
NEUROMUSCULAR EMERGENCIES
Some patients will present with generalized weakness with
certain neurological conditions. This may result in bulbar
(facial) or respiratory weakness, and require close monitoring.
Patients with severe bulbar weakness are more likely to
require mechanical ventilation.
• The following conditions in particular should prompt
special attention: Guillain-Barre, Myasthenia Gravis
Exacerbation, Polymyositis
• Watch FVC and Negative Inspiratory Force (NIF)
frequently (approximately Q6 hours). NIF=Maximum
Inspiratory Pressure (MIP). You can write an order in the
chart to monitor NIF as above and this will be performed
by respiratory therapy.
• If FVC drops below 15 cc/kg, the patient will require
intubation and ventilation.
• NIF should be at least -25 cm H20. If NIF begins to
become more positive, this may indicate worsening
diaphragmatic weakness and require intubation.
• Also severe facial/bulbar weakness may make
performance of bedside spirometry difficult if not
impossible. Patients should be able to take a deep breath
and count out loud to at least 1 to 20 in a single breath. If
the time period is shorter, the patient may need to be
intubated.
• Follow ABG and if PaCO2 if creeping up, then have a
low threshold for intubation.