First week with ST and then JL Flashcards
CG
C
81
Garcia
CG
full
mixed metabolic encephalopathy - septic/inflammatory + uremia
C
81
Garcia
admitted to ICU with multifactorial metabolic encephaopathy with obtundation on 1/2
admitted to ward for a week earlier for pancreitis
-arrest call GCS 3 + obstructing, did not require intubation
-prev choleccystomy
-non urgent MRCP
CRRT feb 1-3
for non ureng MRI, CTB NAD
-
resolved
#rhinovirus with superimposed bacterial infection, 10 days of ceftriaxone finished feb 2
#severe oesophitis on 31/1 scoped
-on PPI BD
RG
R
73
Graff
RG
full
lest sided rib fractures
R
73
Graff
transferred from bali as complex trauma, falling from 3m
-thoracotomy and rib fixation in bali
?emphysematous cystitis on progress CT
?gas intramural
%transfer from a foreign hospital
social
alzeimer, nursing home
Monday
not ready for extubation
JH
J
26
Hogarth
JH
full
J
26
Hogarth
admitted 2/5 with polysubstance overdose
BG of self harm and previous overdoses
Issues
9g pregabalin, possible 1g cocaine
-found comatose and cyanosised, intubated in ED
-urine positive benzo, opiates, cocaine
-paracetamol negative
Seizure
-required 2.5mg midaz
AKI
Febrile
plan
assess neurology
mental health
monitor renal function
cultures if febirle
chase cultures
Monday
extubated, awaiting psych review
KG
K
29
Gillott
KG
full
large splenic hypodensity
K
29
Gillott
CRS and hipec 31/1 for pseudomyxoma pertonei
ward cleared
persistent fevers
on augmentin
-splenic infarct
-requires asplenia prophlyaixsis
Monday
went to ward
RB
R
56
Brennan
RB
full
toxic shock syndrome
R
56
Brennan
VV ECMO from ecmo, on it for 3 days
-necrosis all limbs
-on fluconazole for like2 weeks, president positive cultures
on heparin TDS
pain
regular panadol, methadone, amitripline, PRN tapentdol, hydromorphone, ketamine
Monday
wife was upset we went back to fluconazole
in PM wife lost her shit that we called aps, 10/10 pain
vascular and plastic will not give plans
decreased diazepam to TDS
tuesday
plan to cut out mane quetaipine
Wednesday
meeting with APS, increased hydromorphone frequency, prn ketamine
a little drowsy in the morning,
cuff down 3 hours
no speaking valve
on fluconazole
hypercalemic, sent vit D and pth
decreased apperients
?needs echo
wean diazepam on friday
IC
I
64
Cameron
IC
full
seizure
I
64
Cameron
admitted 5/2 for reduced LOC after seizure on the ward
BG ethol cirhossis, parkinsons
given midaz, kepra
Monday
ward cleared
AE
A
33
Eutick
AE
A
33
Eutick
phenobarbitone overdose
monday
was ward cleared for days
spiked some fevers, grew something in urine and we started keflex
VL
V
58
Lane
VL
full
V
58
Lane
admittted 2/2 post CRS + hipec for ovarian cancer and peritoneal mets
Monday
plan for epidural out on tuesday
MR
M
Ruas
83
MR
full
hypoxic resp failure
M
Ruas
83
admitted 5/2 with T1RF on recent right mandibulectomy
#cardiac and resp
#new AF
AKI
candiemia
hypernatremia
not for cpr
Monday
ward cleared
ceased tazocin and kept fluconazole
on nasal prongs
decresad metoprolol to 25mg BD
tuesday
AA
A
Akin
37
AA
full
A Akin
37
Admitted with alcoholic pancreatisis on 4/2 for inotropic support
BG of nono ischemic dilated cardiomyopathy and alcohol abuse
issues
pancreatis
-lipase 8000, features on CT
-on m
AKI
-Cr 400 on baseline 120
nono ischemic dilated cardiomyopathy
-for echo
EtOH dependence
-high dose thiamine
Flozin
plan
norad
AWS
thiamine
monitor for withdrawal
monitor ketones
Monday
if filter clots leave off CRRT
DZ
D
Zappia
61
DZ
full
D Zappia
61
admitted DBD split liver transplant for ethanol cirrhosis
sig BG hepatopulmonary syndrome
post op
no intraoperative complications
-immunosupression as per liver team, tacro, mathlpred
-augmentin
ethanol missue,
-related to childhood trauma
-quite 2021,
LFT derangement
-transaminiitis picture
Monday started ketamine
RK
R
Kerin
85
RK
full
R
Kerin
85
admitted post gastroscopy complicated by aspiration
aspiration on induction in context of gastropscy
#vap e.coli
UGIB, from sphincterotomy + apixaban
#vasoplegic shock state
#delerium
Monday cleared for ward
JP
J
pearse
68
JP
full
UGIB
J
pearse
68
transfer from coffs with UGIB
BG of hep C, ethanol depdnence
#decomsstated cirrhosis
#encephalopathy
monday
not appropriate yet
IA
i
acret
19
IA
full
i
acret
19
transfer from ST george ICU on 2/2
Issues
#fulminant liver failure due to paracetamol overdose
-on tazocin and fluconazole for prophlayxsis
-on NAC
#oligoanuric AKI on dialysis
#anaemia
#chronic malnutrition due to anorexia
Monday
given plaeletes, 5 cryo and 2 ffp
end tidal not correlating (? dead space)
tuesday
pretty stable day
bio mom was passed out
jess lanes intubation drugs
really likes 2-3 of midaz
followed by 250 of fentanyl
, then 100 of rocuronium
but if its rapid sequence she used sux
and she likes standing back
SVT and shock
so this happened with jess lane
patient was on max metaraminol
get anart line in asap
pads on
record
adenosine 6mg
then adenosine 12mg
nothing happened, so we decided to intubate
patient con
stuart duffins advice on intubation
he likes hooking up norad, prime the line, set it at 5 and see its effect
eveyrthing you need for intubation with jess lane
suction
oxygen
adjuncts: bougie, lma, guedell
plan/positioning
monitoring
equipment: ETT (check the tube) and CMAC, BvM
drugs, midaz, fentanyl, rocuronisum, metaraminol, adrenaline
pump set
co2 attachment needs to be plugged in!!
norad line is super useful
what is carti
google
CAR T-cell therapy. A type of treatment in which a patient’s T cells (a type of immune cell) are changed in the laboratory so they will bind to cancer cells and kill them.
Cytokine release syndrome (CRS)
google
Cytokine release syndrome (CRS) is an acute systemic inflammatory syndrome characterized by fever and multiple organ dysfunction that is associated with chimeric antigen receptor (CAR)-T cell therapy, therapeutic antibodies, and haploidentical allogeneic transplantation
Diabetes insipidus
uptodate
the causes of arginine vasopressin deficiency (avp-d), previously called central diabetes insipidus
include idiopathic (most common), familial, congential, neurosx, trauma, primary and secondary cancers, hypoxic encephalopathy, infiltrative disorders, post-SVT, and anorexia nervosa
treatment: desmopressin
diagnosis on PubMed
Central diabetes insipidus is diagnosed when there is evidence of plasma hyperosmolality (greater than 300 mosm/l), urine hyperosmolality (less than 300 mosm/l or urine/plasma osmolality less than 1), polyuria (urinary volume greater than 4 mL/kg/hr to 5 mL/kg/hr for two consecutive hours after surgery).
a high serum sodium >146 points towards DI, while a low normal sodium indicatesprimary polydipsia
similarly a high plasma osmolality >300 is typically seen in DI
siadh
intubation drugs for totaro i picked up a lifehouse shift
he said dont bag patient because he didn’t want the stomach filled with air
he said midaz, ketamine 100 and sux 200
then he said scrap the midaz, just give ketamine 100 and then sux 300 (which I believe was an error and only gave 200 because that’s all I had)
my anaesthetic plans
this is my own opinion
if their sympathetic drive is not keeping their blood pressure up, go with this because high fentnayl will kill sympathetic drive
midaz 1-3
fentanyl 250
either roc 100 or sux 100
or if they really need their sympathetic drive go with this
low fentanyl or low midaz
ketamine 2mg/kg
either roc 100 or sux 100
