Management

Question 1

CI-AKI prevention (radiology 2020)

ทำเฉพาะใน AKI หรือ GFR < 30 without dialysis

Answer 1

1. Iden risk: CKD, DM, nephrotoxic agent, hypotension, hypovolemia
2. If GFR < 30 consult specialist
3. Stop nephrotoxic drugs 24-48 hr before and 48 hr after
4. NSS 1 ml/kg/hr 1 hr before and 12 hr after contrast (IPD)
5. NSS 3 ml/kg 1 hr before and 1-1.5 ml/kg 3-6 hr after (goal > 6 ml/kg after contrast) (OPD)
6. Lowest possible contrast media dose

Question 2

Indication remain intubation post-op (4 topics)

Answer 2

Consider 4 topics

• airway protection (drowsy?)
• airway patency (mass, edema)
• pulmonary toilet
• need for positive pressure (ex ARDS)

Question 3

Intraop monitoring in major hepatectomy 5 items

Answer 3

Standard + cardiac output
Temperature
Coagulation
Glucose
Neuromuscular blockihg

Question 4

PEEP setting in COPD with auto-PEEP

Answer 4

• Measure intrinsic PEEP (paralyze&raquo_space; expiratory pause)

- Set PEEP = 80% intrinsic PEEP

Question 5

Indacation for Rt DLT

Answer 5

1. Distorted anatomy of Lt main bronchus

2. Surgery involve Lt main bronchus

Question 6

Indication OLV

Answer 6

1. Prevent lung contamination (blood, pus)
2. Bronchopleural fistula, bronchial trauma, bleb/bullae/cyst
3. Unilateral lung lavage
4. VATS

Question 7

I/C for IV NaHCO3

Answer 7

1. Severe hyperkalemia

2. arrhythmia from TCA overdose

Question 8

3 negative effects of Iv NaHCO3

Answer 8

1. CO2 production (7.5%NaHCO3 50 ml = CO2 1 L to be exhaled)
2. Osmotic load from Na&raquo_space; volume overload
3. Overshoot metabolic alkalosis