sedationstation

The traditional text book of anesthesia tells us about the the interaction between aminoglycoside and the non depolarizing muscle relaxants... It is true ...the aminoglycoside prolong the action of muscle relaxants..... But it is not only o for aminoglycoside .....Colistin also... You may not be be familiar with Colistin...it highly used in many areas (Lebanon one of these countries).. Here is the Colistin issue and its implications on anesthesia practice..(report from the anesthesia safety news letter) Colistin, otherwise known as Polymyxin E, is a drug seeing a resurgence in use against multi-drug-resistant Gram negative bacteria, in particular Acinetobacter, E-coli, Klebsiella , and P. aeruginosa .  This drug, initially developed in the 1950s, was supplanted by the aminoglycosides because of the concern for significant nephrotoxicity and neurotoxicity associated with Polymyxin E. Of particular concern to anesthesiologists is the neuromuscular blockade due to ...

Rethinking Opioid Prescribing to Protect Patient Safety and Public Health. Alexander GC et al.  JAMA  2012 Nov 13;308:1865-1866. The authors of this “Viewpoint” piece begin by noting that the rates of death and complication from prescription drug abuse have been increasing astronomically: The annual number of fatal drug overdoses in the United States now surpasses the annual number of motor vehicle deaths, and overdose deaths attributable to prescription opioids — nearly 15000 in 2008 — exceed those attributable to cocaine and heroin combined. This marked increase has coincided with “ Pain as the 5th Vital Sign ” campaign, a push  that  some have suspected  was encouraged and supported by pharmaceutical companies as a marketing tool. The authors recommend “changes to clinical guidelines to treat chronic pain that are less reliant on opioids”. This would involve re-evaluation of the role of opioids in treating chronic pain: Grater cli...

Next time you get endocrine question.... Check endobible.com A very interesting site to help you answering these  questions.....

Identify the antihypertensive agent: 1. Rapid acting systemic and coronary artery vasodilator with minimal effects on cardiac conductivity or inotropy. Well studied in pregnancy. Caution in patients with left ventricular failure, liver cirrhosis 2. Predominantly dilates the venous system. Useful in patients with cardiac ischemia, pulmonary edema, or congestive heart failure. Caution in patients with right ventricular failure 3. Drug of choice in eclampsia, pre-eclampsia, and aortic dissection. Contraindicated in patients with congestive heart failure and heart block   4. Decreases peripheral vascular resistance and increases collateral coronary blood flow in an uncontrolled and unpredictable manner and may result in serious complications. Drug of choice during pregnancy 5. Direct arterial vasodilator that increases cardiac output and heart rate (Reflex response). Patient may develop lupus like syndrome. Not to be used as first line in the ED 6. Arterial vasodilator that...

EtCO 2 can be measured by colorimetry and capnography. Colorimetric devices provide continuous, semi-quantitative EtCO2 monitoring. A typical device has the following three color ranges: Purple—EtCO 2 is less than 0.5% Tan—EtCO 2 is 0.5–2% Yellow—EtCO 2 is greater than 2% Normal EtCO 2 is greater than 4%; hence, the device should turn yellow when the endotracheal tube is inserted in patients with intact circulation.(1) False positives may occur when the device is contaminated with acidic substances, such as gastric acid, lidocaine or epinephrine. The device will not provide an accurate reading if it is expired or if the tube is clogged with secretions. 1- Galvagno SM, Kodali BS. Critical monitoring issues outside the operating room. Anesthesiology Clin . 2009;27(1):141–156

The Eastern Association for the Surgery of Trauma recently released an update of their practice guideline for screening for blunt cardiac injury.  Although the bulk of the guideline remains the same, a few areas have been updated to reflect advances since its original 1998 release. Here is a quick summary of the new guidelines. Level 1 (best data): If blunt cardiac injury is suspected, an EKG should be obtained (no change) Level 2 (good  data ): If a new arrhythmia is seen on EKG, admit for monitoring. If not new, compare with an old EKG to determine need for admission. (updated) If the EKG is normal and troponin I is normal, BCI is ruled out. If the EKG is normal and troponin I is abnormal, admit for monitoring. (new) If the patient is unstable or the arrhythmia persists, obtain a cardiac echo. (updated) Sternal fracture is not predictive of BCI (moved from level 3) CPK should not be obtained (modified and moved from level 3) Nuclear medicine studies should ...

Delirium in the Critically Ill Delirium has been shown to be an independent predictor of mortality and can occur in up to 75% of critically ill patients. Whether preventing or treating delirium in the critically ill patient, consider the following: Minimize the use of anticholinergic medications (i.e. diphenhydramine, chlorpromazine) Ensure pain is adequately controlled (avoid meperidine and tramadol) Be careful with sedative medications; consider bolus dosing and daily interruption of continuous infusions Additional measures to treat delirious patients include reducing sensory deprivation, promoting normal sleep-wake cycles, early physical rehabilitation, and treating psychosis