sedationstation

The surgical stress response has three key components: Sympathetic nervous system activation Endocrine response with pituitary  hormone  secretion and insulin resistance Immunologic and hematologic changes including cytokine production, acute phase reaction, neutrophil leukocytosis, and lymphocyte proliferation

Intra-abdominal hypertension  (defined as a sustained  urinary bladder pressure   > 12 mm Hg ) may be an under-recognized problem in the ICU, especially in patients after abdominal surgery or who have gone massive volume resuscitation with blood and/or fluids (think hemorrhage, burns and sepsis). When high abdominal pressures ( > 20 mm Hg  sustained) cause organ failure and/or shock, it’s called abdominal compartment syndrome. Below are the strategies to cope with this complication.. improving abdominal wall compliance through sedation, analgesia, and pharmacologic paralysis; evacuating intraluminal contents through nasogastric and rectal decompression; correcting positive fluid balance through the use of hypertonic fluids, colloids, and careful diuresis; supporting organ function with vasopressors and judicious goal-directed fluid resuscitation to maintain an abdominal perfusion pressure (APP) ≥ 60 mm Hg (calculated as mean arterial pressure − IAP);...

In article published recently in critical care medicine  Paul Marik, Mark Flemmer, and Wendy Harrison  argued against the IDSA and CDC recommendation against the femoral line placement and they mentioned that there are no RCTs that support the CDC and IDSA claim of femoral line higher risk of infection..and below are the bottom lines... The chosen site should depend on the expertise and skill of the operator and the risks associated with placement. In emergencies or in high-risk patients (like a demented, agitated patient) femoral placement may be best. All catheters that are placed under non-sterile or emergency circumstances should be removed and resited within 2 days. Ultrasound should be used for catheters placed in the internal jugular and femoral site to reduce the risk of complications from placement. Avoid the subclavian site in patients with advanced renal failure to preserve the arm veins and subclavian vein for future fistula placement. Avoid the femoral vein...

Back in the med school we learned that not all murmurs are pathological ... Some are related to hyperkinetic circulation like in febrile patients,or Thyrotoxicosis ...some murmurs are normal in Peds...and so on... So the question which murmurs is 100 % sure is pathological : Here is the answer Pathological murmurs  All holosystolic (or late systolic) murmurs are pathologic. & All diastolic murmurs are pathologic. & All continuous murmurs are pathologic Easy....

The three agents commonly encountered in anaesthesia that raise intraocular pressure are ketamine, suxamethonium and metoclopramide .  Oral benzodiazepines and intravenous midazolam have no effect, whereas intravenous diazepam reduces intraocular pressure. Atracurium has no effect on intraocular pressure while other non-depolarizing muscle relaxants reduce it. Opioids, volatile anaesthetic agents and induction agents (except ketamine) reduce intraocular pressure.  Knowledge of these factors is of particular relevance to providing anaesthesia for ophtalmic surgery involving traumatic or surgical disruption of globe integrity where a rise in intraocular pressure may cause extrusion of globe contents and significant patient detriment. Reference Raw D, Mostafa S. Drugs and the eye. Contin Educ Anaesth Crit Care Pain 2001; 1(6):161-5

Neonates are at risk of developing hypoglycemia, particularly neonates of diabetic mothers.  Hypoglycemia is defined by a plasma glucose concentration less than 40 mg/dL in the preterm neonate, less than 50 mg/dL for the term neonate younger than 3 days old, and less than 60 mg/dL in the term neonate older than 3 days of age.  Neonates are at risk of hypoglycemia secondary to their poorly developed system for the maintenance of adequate plasma glucose concentrations. In addition, patients receiving total parenteral nutrition with high dextrose concentrations are at risk for hypoglycemia if the infusion is interrupted. Also, patients with poor nutritional status or liver disease often have inadequate hepatic glycogen stores and are also at risk.  Preterm neonates also are at risk of developing hypocalcemia.  Hypocalcemia in the neonate is defined by a plasma ionized calcium concentration less than about 1.1 mEq/dL.  Fetuses develop their calcium ...

The following is a brief description of the Raj test: when nerve stimulation is being used to locate a nerve, a twitch is observed when the needle tip is close to the neural target. Ideally, the twitch is required to persist at a current of 0.5 mA. The clinician then injects a small volume of local anesthetic or normal saline through the needle. I f the needle tip is in the correct location, the muscle twitch immediately disappears. Until very recently the disappearance of the twitch was thought to be caused by physical displacement of the nerve by the injectate. We recently learned that this mechanism is best explained in electrical terms and is not entirely a result of the physical dis- placement of the nerve. In a porcine model, the injection of 0.9% sodium chloride solution (NaCl) abolished the motor response, and a subsequent injection of 5% dextrose reestablished a motor response during peripheral nerve stimulation. An accompanying  in v...