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Showing posts from May, 2014

Metabolic acidosis

Anion gap acidosis “MUDPILES” Non anion gap acidosis Methanol Renal Tubular Acidosis Uremia Diarrhea Diabetic Ketoacidosis Carbonic anhydrase inhibition Paraldehyde Ureteral Diversions/Fistulas INH toxicity Sodium chloride administration Lactic acidosis Early Renal failure Ethylene glycol   Salicylate poisoning  

EKG ...what u look for

EKG MASTER CLASS 2014: INTERPRETATION OF AN EKG:  What do you look for in an EKG? 1. VALIDITY : Name on EKG Indication for EKG Mirroring of Lead I and Lead aVR “R” Wave progression in precordial Leads  2. RHYTHM: Sinus or not, P present or not If P present sinus origin P or not  P married to QRS or not 3. RATE: Regular or not If irregular, pattern Same rate or variable rate 4. AXIS: Vertical axis normal. Left or right or intermittent Horizontal axis same as before or now more clockwise or less  5. INTERVAL: PR normal, short or long  RR constant or increasing QT normal or long 6. HYPERTROPHY: P waves tall, wide, bifid or normal Voltage criteria for RVH and LVH met or not 7. CONDUCTION : Normal QRS duration in V1 –V2 or not Normal QRS duration in V5-V6 or not Axis & hypertrophy compatible or not ,else should look for Hemi block .  8. PERFUSION: Ischemia or not (T Inversion) Injury or not ( ST depression) Infarction or not (ST elevation or q) Infarction ol...

Post discharge nausea vomiting

Postdischarge Nausea and Vomiting As the number of surgeries performed on an outpatient basis  continues to grow, there is increasing interest in using  antiemetic agents to prevent and treat postdischarge nausea  and vomiting (PDNV).  Because outpatient procedures are  typically less invasive and shorter in duration than inpatient  procedures, the relatively lower exposure to emetogenic inha lational anesthetics and opioids predicts a relatively lower  incidence of PONV in the PACU.  However, a study in 2170  ambulatory patients in the United States found that the inci dence of nausea and vomiting after discharge from the hospi tal was 37%, even after intraoperative prophylaxis with  ondansetron or dexamethasone.  PDNV is particularly a  concern because it occurs when patients no longer have access  to fast-acting intravenous rescue treatment, and PDNV limits  their ability to tolerate oral antiemetics. Ideal antieme...

Dexamethsone ..ponv interesting facts

Studies in animal models suggest that dexa methasone acts on the glucocorticoid receptor-rich bilateral   nucleus tractus solitarius (i.e., the vomiting center), but not  the area postrema. However, like other   intravenous drugs containing phosphate esters, dexametha sone has been associated with perineal burning and itching  when injected in awake patients. Apepitant inhibits   CYP 3A4 activity. this doubles  the plasma concentration of dexamethasone. Given that dexamethasone has high (80%) oral bioavailability,  and that aprepitant also increases the peak plasma concentra tion and half-life of dexamethasone, aprepitant’s inhibition of  CYP 3A4 activity probably plays alarger rolein systemic rather   than first-pass clearance of dexamethasone. Therefore doses  of dexamethasone that are coadministered with aprepitant  should be reduced by half to maintain dexamethasone plasma  concentrations that are similar to regimens withou...

Transdermal fentanyl ,,,the good and bad

The transdermal formulation offers the following advantages : Does not require oral intake (especially useful in patients with dysphagia and NPO status) Does not depend on GI absorption Improved patient compliance Less frequent dosing Long steady state with less peaks and troughs Intravenous access is not required Transdermal administration is not associated with patient discomfort The disadvantages of the transdermal route include : Lack of efficacy for breakthrough pain given long steady state Difficulty delivering high doses Requires subcutaneous fat making it ineffective in cachectic patients Pharmacokinetics and pharmacodynamics are affected by body temperature (and blood flow to the skin) - Higher levels than expected may be absorbed during a febrile episode.