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
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