Monday July 5, 2010
How Passy-Muir Valve works
Monday, July 5, 2010
Sunday, July 4, 2010
Saturday, July 3, 2010
Saturday July 3, 2010
Stages of Decub ulcer
Stage I
This stage is characterized by a surface reddening of the skin. The skin is unbroken and the wound is superficial. This decubitus ulcer quickly fades when pressure is gone. Treatment consists of turning or alleviating pressure. Increased nutrition is part of prevention.
Stage II
This stage is characterized by a blister either broken or unbroken. A partial layer of the skin is now injured. Involvement is no longer superficial. The goal of care is to cover, protect, and clean the area.
Stage III
The wound extends through all of the layers of the skin. It is a primary site for a serious infection to occur. The goals and treatments of alleviating pressure and covering and protecting the wound still apply as well as an increased emphasis on nutrition and hydration.
Stage IV
A Stage IV wound extends through the skin and involves underlying muscle, tendons and bone. The diameter of the wound is not as important as the depth. This is very serious and can produce a life threatening infection. All of the goals of protecting, cleaning and alleviation of pressure on the area still apply. Nutrition and hydration is now critical. Without adequate nutrition, this wound will not heal. Anyone with a Stage IV wound requires medical care by someone skilled in wound care. Surgical removal of the necrotic or decayed tissue is often used on wounds of larger diameter.
Stages of Decub ulcer
Stage I
This stage is characterized by a surface reddening of the skin. The skin is unbroken and the wound is superficial. This decubitus ulcer quickly fades when pressure is gone. Treatment consists of turning or alleviating pressure. Increased nutrition is part of prevention.
Stage II
This stage is characterized by a blister either broken or unbroken. A partial layer of the skin is now injured. Involvement is no longer superficial. The goal of care is to cover, protect, and clean the area.
Stage III
The wound extends through all of the layers of the skin. It is a primary site for a serious infection to occur. The goals and treatments of alleviating pressure and covering and protecting the wound still apply as well as an increased emphasis on nutrition and hydration.
Stage IV
A Stage IV wound extends through the skin and involves underlying muscle, tendons and bone. The diameter of the wound is not as important as the depth. This is very serious and can produce a life threatening infection. All of the goals of protecting, cleaning and alleviation of pressure on the area still apply. Nutrition and hydration is now critical. Without adequate nutrition, this wound will not heal. Anyone with a Stage IV wound requires medical care by someone skilled in wound care. Surgical removal of the necrotic or decayed tissue is often used on wounds of larger diameter.
Friday, July 2, 2010
Friday July 2, 2010
Q: You confirmed propofol infusion syndrome in a patient on prolong high concentration infusion. Once you stop propofol how long does it take to recover from propofol associated lactic acidosis?
Answer: About 6 hours
Propofol infusion syndrome (PRIS) has been observed in patients receiving propofol at high dosages and for prolonged periods though reported with lower doses as well as short infusion time. It is said to be synergestic when given concomitantly with catecholamines or steroids in the setting of acute neurologic or inflammatory diseases.
Propofol infusion syndrome is said to occur in patients with genetic mitochondrial abnormalities.
MCQ on PRIS here (posted here earlier)
Q: You confirmed propofol infusion syndrome in a patient on prolong high concentration infusion. Once you stop propofol how long does it take to recover from propofol associated lactic acidosis?
Answer: About 6 hours
Propofol infusion syndrome (PRIS) has been observed in patients receiving propofol at high dosages and for prolonged periods though reported with lower doses as well as short infusion time. It is said to be synergestic when given concomitantly with catecholamines or steroids in the setting of acute neurologic or inflammatory diseases.
Propofol infusion syndrome is said to occur in patients with genetic mitochondrial abnormalities.
MCQ on PRIS here (posted here earlier)
Thursday, July 1, 2010
Thursday July 1, 2010
Q: 34 year old male with previous history of lung transplant is admitted to ICU with sepsis. Patient is recovering well but continue to have persistent ileus. Junior resident wrote for erythromycin to increase GI motility. What need to be watch in this patient?
Answer: Tacrolimus level
Tacrolimus has clinically major drug interactions with erythromycin, dilantin and rifampin. Erythromycin may increase Tacrolimus to toxic level. It is recommended that concurrent administration of erythromycin and tacrolimus be avoided. However, if concomitant therapy is necessary, tacrolimus concentrations should be monitored.
Other significant interactions Tacrolimus may have is with amphotericin, barbiturates, calcium channel blockers, itraconazole, ketoconazole, fluconazole, cyclosporine, and cimetidine.
Q: 34 year old male with previous history of lung transplant is admitted to ICU with sepsis. Patient is recovering well but continue to have persistent ileus. Junior resident wrote for erythromycin to increase GI motility. What need to be watch in this patient?
Answer: Tacrolimus level
Tacrolimus has clinically major drug interactions with erythromycin, dilantin and rifampin. Erythromycin may increase Tacrolimus to toxic level. It is recommended that concurrent administration of erythromycin and tacrolimus be avoided. However, if concomitant therapy is necessary, tacrolimus concentrations should be monitored.
Other significant interactions Tacrolimus may have is with amphotericin, barbiturates, calcium channel blockers, itraconazole, ketoconazole, fluconazole, cyclosporine, and cimetidine.
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