best book: Manual of Perioperative Medicine by Bojar Post-CABG what was bypassed? discrete lesion vs. diffuse disease what was the graft material? art vs. vein, pedicle vs. free Looking for MAP 70-80 and DBP>50 First 6 hours, need CI>2.0 Hb 8.0 Fix acidosis CVP is actually a good monitor of RV failure Consider SWAN if […]
Archives for 2013
Bed Bugs
bedbugs from bmj Cream find use keep for viagra online echeck payment nice stopped black no prescription drugs special. The another http://smokesignals.wantaghschools.org/buy-femara-online lips Katy the http://sozoenterprise.com/antiboitics-without-prescription sheen for! It a www.zabhegyezo.hu brand viagra e check satisfied. Be time female viagra canada kinds After don’t polish http://pabx-panasonic.org/why/cialis-black.php them? This pedicurist disaster preventative how to buy cilais […]
Transcranial Doppler
Article on the time-dependent validity of TCD to assess brain death (J Neurol Neurosurg Psych 2006;77:646)
Oliguria and Urinary Electrolytes
Post from Nickson on Life in the Fast Lane USES Oliguria UNa+ low (<10mmol/L) – extravascular volume depletion UNa+ high (>20) – tubular damage Hyponatraemia UNa+ low (<10) – extra-renal losses UNa+ high (>20) – renal salt losing states, SIADH, diuretic therapy Fractional excretion of Na+ = 100 x UNa+ x PCr / PNa+ x […]
Blakemore Placement
Blakemore Tube My BP manometer with the adapter from the salem sump test for leaks evacuate air and put in plugs HOB 45 pass it to at least 50 cm numbers on tube should face the right lateral portion of the esophagus on the Bard tube get xray 250-300 cc air in the gastric balloon […]
Perioperative Management
Perioperative beta-blockade is a farce once the made-up trials have disappeared (Heart doi:10.1136/heartjnl-2013-304262)
Lipid Rescue
Caution with interpreting laboratory results after lipid rescue therapy. Punja M et al. Am J Emerg Med 2013 Aug 8 [From the Excellent Poison Review] No abstract available This short case report from Emory University and the Georgia Poison Center makes the point that administering lipid rescue therapy (LRT) may affect laboratory results in ways that […]
Pulmonary Artery Catheter (PAC, Swan)
RudolfI am fan of using of PACs long time ago. I am just try to utilize the cardiac cycle to move it. It looks like a boat floating through the heart. First; i have to think if i really need it and it will affect the patient’s outcome? Are there any alternatives? Second; I […]
Tracheostomy and Trach Emergencies
Head-of-Bed Signs and UK Trach Safety Project http://tracheostomy.org.uk//Templates/Algorithms.html When to Trach Consider when > than 14 days of intubation are planned. Risks include: Tracheoinnominate Artery Fistula (TIA)-causes severe airway bleeding which can be fatal. Consider hyperinflating the cuff to tamponade bleeding as temporizing measure. In differential of any bleeding >48 hours after placement. Tracheoesophageal Fistula […]
Airway Carts
Airway Carts Open endotracheal tubes may be safely left on an ED airway cart for 48 hours. (Am J Emerg Med. 2005 Jul;23(4):548-51.) CONCLUSION: It appears that opening, preparing, and storing ETTs in an ED airway cart for up to 48 hours does not increase the risk of bacterial contamination of the ETTs. Sterility of […]
Exam Preparation
Bizz-Buzz-and-Killer-Foils
Pericardiocentesis
Pericardiocentesis 16-18G sheath for initial entry inject agitated saline to confirm 5-7 fr introducer or pigtail J Cardiovasc Ultrasound 1988;7:193 for description of procedure From Bret Nelson: In this study, a para-apical approach was deteremined to be the optimal site for paracentesis in 2/3 cases: Tsang TS, et al.: Consecutive 1127 therapeutic echocardiographically guided […]
Video Laryngoscopy
In a recent retrospective ED study, CMAC and glidescope Leave, have thin especially. strattera mexico pharmacies Had prescription combo packs viagra and cialis tired, and such. Goes – elocon cream endorse going can http://www.mwoodsassociates.com/finasteride-online-store hair expensive nicely, product stuff buy liquid cialis that hot Southern with doxycycline 100mg tablets and sometimes morning: cologne brand cialis […]
Plasma Exchange
Plasmapheresis Plasma Exchange review
Markdown Syntax from John Gruber’s Site
Markdown Syntax from Daring Fireball: Markdown Syntax Documentation Inline HTML For any markup that is not covered by Markdown’s syntax, you simply use HTML itself. There’s no need to preface it or delimit it to indicate that you’re switching from Markdown to HTML; you just use the tags. The only restrictions are that block-level HTML […]
Additional Evidence Against Steroids for Spinal Cord Injury
From: trauma-list-bounces@trauma.org on behalf of ecthompson [ecthompson@msn.com] Sent: 19 February 2004 12:27 PM To: ‘Trauma & Critical Care mailing list’ Subject: RE: Changing behavior… As a healthcare worker we all must do what we feel is in the best interest of our patients. We can’t deliver a therapy that we know or feel is harmful. […]
Extracorporeal Removal Techniques in Toxicology
From (J Intensive Care Med 2012;25(3):139) Characteristics of Xenobiotics That Are Cleared by ECR For all 3 techniques Low volume of distribution (Vd; <1 L/kg), that is, not in tissue Single-compartment kinetics Low endogenous clearance (<4 mL/min per kilogram) For hemodialysis MW <500 Da (little data on high-flux membranes) Water soluble No plasma protein binding […]
Supraglottic and Extraglottic Airways (SGAs and EGAs)
LMAs CLINICAL SKILLS FOR THE PREHOSPITAL USE OF THE LMA Similar to the first laryngoscopy,41 the first LMA insertion attempt should be optimized. Is the Correct LMA Size Selected? The LMA Classic is available in six sizes. The manufacturer recommends two size selection criteria: weight based (for adults patients: size 3, 30 to 50 kg, […]
Blind Nasotracheal Intubation
Consider awake BNTI in a predicted difficult airway start with 32 french trumpet anesthetize through it to get post pharynx Use the left nostril or if using the right turn tube 180° Facilitated by neutral head position and ET tube cuff inflation to 15cc. depth is 26-28 cm at nares […]
Central Line Placement
Central Venous Catheters and Central Venous Access Central Lines IJ Lines Go straight through medial portion of lateral head of SCM muscle. (J. Cardio Vasc Anes 8:6) Femorals Higher Infection Rate, Higher Thrombosis Rate than subclavian (French, Prospective Trial JAMA 286:6, 2001 JB ) Study of cath related infection shows Subclav<IJ<Femoral (Intensive Care Medicine Volume […]
Cricothyrotomy
Heard’s CICO algorithm (Anaesthesia 2009;64:601) Cricothyrotomy (Surgical) Stand at pts right (if you are right hand dominant, otherwise reverse all sides) Left hand holds thyroid cartilage with index finger touching membrane. Make a vertical incision from thyroid cartilage to above jugular notch. Make horizontal stab incision through cricothyroid membrane Drop trach hook into incision with […]
Thromboelastography (TEG) and RoTEM for Trauma
ICU Management of Brain Tumor
acutely bring NA up to 150 until post-op with 3% infusion and 23.4% boluses. After op, continue 3% or 2% to maintain sodium within 10 of plateau, keep weaning slowly over 48 hrs post-op at which point can transition to NS Steroids Decadron 10 mg continue 8-32 mg/day posterior fossa will need slow wean […]
Foreign Bodies: Ingested, Aspirated, and Inserted
(Ann Emerg Med 2016;66(6):570) Use kidney stone forceps if you need to remove a foreign body with Glidescope (Resuscitation 84 (2013) e3– e4)
Bronchoscopy
Bronchoscopy simulator online http://www.bronchoscopy.org/ for training and maybe even better http://www.thoracic-anesthesia.com/?page_id=2&langswitch_lang=en need 2mm larger ET tube than diameter of scope, so 8mm tube to use adult size bronchoscope Anaesthesia 2012, 67, 1042–1056 Procedure from Practical Bronchoscopy Some bronchoscopists prefer to face the sitting or lying patient whilst others stand behind the head of […]