TOW interesting cases

patient with incarcerated inguinal hernia- presented with IO, delayed presentation. A chit. had SVT in ED -aborted with 6+12mg.

if adenosine works: AVRT or AVNRT (AVRT-?broad complex). if not: AT, does not work with blocking node
post induction: BP crashed. ?hypovolemia despite 3L of fluid in ED. SVT again- K on ABG 2.4. Hb 8.5.
a lot of hesitation but finally given adenosine- 12mg- sinus pause, 2nd degree heart block-then sinus rhythm-then flutter then sinus

Mg in ED 0.78- wanted to give Mg but concerns of the other anaesthetist was hypotension. Patient was already on norad. Mg in SICU = 0.4!!!! should have given coz she had recurrent runs of AF and SVt again.

message: A chit or not: consider optimising K and Hb first
Mg: probably can give but not as bolus!

should consider Albumin instead of voluven in AKI
should consider FFP if a lot of fluid was given

TBI : if dura sinus tears- can bleed torrentially
respect the neuro case: can bleed++, might not be controllable
if prox tibia fracture: high chance of compartment syndrome

G-CSF in neutropenia secondary to sepsis: no harm but not necessary helpful

APRV: NEEDS SPONT VENT
hfov: NEED PARALYSIS and secretions difficult to control

Radio-imaging contrast- allergy and nephropathy

steroid prophylaxis for patients at risk of contrast reactions:

PO pred 30mg 12 hrs and 2 hrs before

if urgent: as soon as scan confirmed : IV hydrocortisone 200mg
IV benadryl 50mg (slow bolus or IM or PO)- not faster than 25mg/min

contrast nephropathy : PO acetylcysteine: bioavailability of glutathione higher. STart 600mg BD on day before until day after scan.
If scan decided stat: IV acetylcysteine
bolus 150mg/kg in 500ml NS 30-60min before scan then 50mg/kg in 500ml over 4hours after scan

IV risk of hypersensitivity