BUMC Basics.pdf - Anesthesia Home

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92 -If you extubate and hear stridor with poor respiration then consider edema and acutely give racemic Epi nebs prn stridor, keep HOB elevated to 90°, and give solumedrol 60 mg IV Q6 hours x 48 hours • Vocal Cord Dysfunction (VCD) - This is a long term complication: Need ENT evaluation Weaning MV When pts are clinically improved, assess the following criteria for extubation: • Original condition requiring intubation has been reversed or improved • During sedation vacation, patients are awake and alert • Hemodynamically Stable (HR60mm, no evidence of myocardial ischemia) while on minimum to no vasopressor support and no sedation • Stable Oxygenation (PaO2>60mm and O2Sat>92%) while on minimum non-toxic oxygenation settings (PEEP
93 - Sustained changes in the heart rate of 20 percent in either direction - A systolic blood pressure greater than 180 mm Hg or less than 90 mm Hg - Increased anxiety - Diaphoresis If pts pass SBT then write orders: • Check Cuff Leak Test prior to extubation (Patients without a cuff leak are at increased risk for post-extubation stridor) • Respiratory to Extubate (How is it done? HOB elevated to 90°, pull ETT, suction, listen for stridor, suction, then Face Mask/NC) • Place pt on 6L NC and then proceed w/ O2 Protocol • Incentive Spirometry (IS) Q2hrs while awake • Med Nebs: IPPB A/A nebs Q4 hours x 48 hours (Intermittent Positive Pressure Breathing (IPPB)) which is mainly used to treat atelectasis after surgery or postextubation to improve inspiratory capacity • Consider BiPAP if patient is high risk for re-intubation as post-extubation BiPAP has been shown to decrease reintubation • Swallow Study and Advance Diet as tolerated if passes • PT/OT If pts fail SBT then assess cause (see below) and retry SBT Qday if you feel patient is still clinically prepared. F Fluid overload: Diurese as able A Airway resistance: Check if ET tube is too small or obstructed I Infection: Treat as indicated L Lying down, bad V/Q mismatch: Elevate head of bed T Thyroid, toxicity of drugs: check TFT’s, check med list O Oxygen: Increase FiO2 as patient is taken off ventilator W Wheezing: treat with nebs/steroids as needed E Electrolyte disturbances: Correct K, Mg, Phos, Calcium A Anti-inflammatory needed?: Consider steroids in asthma/COPD N Neuromuscular disease, neuro status compromised
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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
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SOB DDx • Pneumonia • PE • An
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17 • Heparin • Lidocaine • Ni
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19 TPC (cont’d) Pager Cell Phone
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21 Gen Surgery Neurologists Urgent
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23 OBTAINING A CONSULT AT BAYLOR Ob
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25 • Enter 2 initial zeros and th
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27 • Albuterol/Atrovent nebulizer
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29 CARDIOLOGY CCU IN GENERAL You ar
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31 Unstable Angina/NSTEMI • Can u
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33 Post PCI Complications — In yo
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35 function, elevated troponin T is
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37 **0-1 point non-cardiogenic, 2 p
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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 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: 91 • After 1 wk of intubation det
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
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: 123
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