critical care

lefort !

pearsonjohnf critical care, intubation, peri-op management, PONV , , , , ,

A nice rundown of Anesthetic considerations available at Continuing Education in Anesthesia, Critical Care and Pain (2014): http://ceaccp.oxfordjournals.org/content/early/2013/06/28/bjaceaccp.mkt027.full

A few of the key points:

  • Nasal intubation preferred, and smooth extubation is essential
  • Watch out for local anesthestic toxicity, and they use lots of epinephrine
  • PONV is critical to avoid – use copious anti-emetics and go for TIVA
  • Remifentanil helps smoothen anesthetic and smoothens extubation
  • P/O ICU is historical, blood loss is minimal
  • Severe malocclusion can be intubation difficult
  • Surgeons prefer induced hypotension to minimize bleeding, remi helps this
  • Know post-op if patient will have wired jaw (clippers at bedside in pacu)
Quite the jaw thrust
Quite the jaw thrust (from Elsevier, via article cited)

Renal Replacement Therapy – Considerations

pearsonjohnf critical care, peri-op management, Renal , , , ,

Indications for Renal Replacement Therapy (notes from TrueLearn)

-broad term : hemodialysis, peritoneal dialysis, hemofiltration, renal transplant
-CRRT is over 24hrs, best for HD unstable patients

Chronic Renal Failure indications
-fluid overload
-uremic symptoms
-ftt
-malnutrition
-GFR criteria

Indications in ICU patient
-oliguria/anuria
-pulmonary edema unresponsive to diuretics
-uncompensated metabolic acidosis (ph35, creatinine >400, hyperkalemia >6.5

Succ will raise K same as normal patient
watch fluid status and hemodynamics
avoid nephrotoxic agents (some a/b, nsaids)