How would you approach this case?

A little similar to thread below but would like you opinions! Learning a lot from these boards even after residency! Alone at night, patient brought in from nursing home,, 75 yo M 70kg ESRD, HTN, A fib on eliquis, DM, CAD LAD stent 10 yrs ago, CHF EF 10% on coreg, mod MR, mod TR , dementia, severe pHTN, reduced RV function w severely elevated CVP, fell, now w slowly expanding thigh hematoma needs to be drained. No detailed info/cath regarding CAD. Vitals normal/stable after 2 unit... How would you approach this case?
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Anesthesiology Source Type: forums

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Geriatric patients are at high risk of falls secondary to imbalance, weakness, higher prevalence of dementia, and medical co-morbidities frequently resulting in fracture. Mobility is critical to optimize healing and minimize loss of bone and muscle mass following fracture. However, the most common reason why many patients are unable to participate is poorly controlled pain [1]. Geriatric patients are at high risk of developing post-operative delirium which is multifactorial in etiology, including anesthetic agents, poly-pharmacy, being in unfamiliar surroundings, and pain medications [2 –6].
Source: Injury - Category: Orthopaedics Authors: Source Type: research
Publication date: Available online 5 September 2019Source: Alzheimer's &DementiaAuthor(s): Juraj Sprung, Phillip J. Schulte, David S. Knopman, Michelle M. Mielke, Ronald C. Petersen, Toby N. Weingarten, David P. Martin, Andrew C. Hanson, Darrell R. Schroeder, David O. WarnerAbstractIntroductionOur aim was to examine whether surgery with regional anesthesia (RA) is associated with accelerated long-term cognitive decline comparable with that previously reported after general anesthesia (GA).MethodsLongitudinal cognitive function was analyzed in a cohort of 1819 older adults. Models assessed the rate of change in global a...
Source: Alzheimer's and Dementia: The Journal of the Alzheimer's Association - Category: Geriatrics Source Type: research
Conclusions: POD patients were older and had more comorbidities. POD patients had lower QoR scores at T24 suggesting an adverse impact of delirium in postoperative quality of recovery. POD patients stayed for long in the PACU and at hospital.
Source: Saudi Journal of Anaesthesia - Category: Anesthesiology Authors: Source Type: research
(BMJ. 2018;363:k4109) Vascular dysfunction plays an important role in the pathophysiology of preeclampsia, and women with a history of preeclampsia face an increased risk of other cardiovascular disorders after pregnancy, including hypertension and stroke. Given these associations, women with preeclampsia might also be at increased risk of developing dementia. Previous studies that have investigated the association between hypertensive disorders of pregnancy and dementia later in life have had limitations such as being underpowered and dependent on self-reported information. This current study used a large register-based ...
Source: Obstetric Anesthesia Digest - Category: Anesthesiology Tags: Epidemiologic Reports Surveys Source Type: research
CONCLUSIONS: Frailty and cognitive screening protocols are feasible and provide information for perioperative care planning. Challenges to clinical adaptation include staff training, missing data, and additional administration time. These challenges appear minimal relative to the benefits of identifying frailty and cognitive impairment in a group at risk for negative postoperative cognitive outcome. PMID: 31425227 [PubMed - in process]
Source: Anesthesia and Analgesia - Category: Anesthesiology Authors: Tags: Anesth Analg Source Type: research
Abstract Chronic cerebral hypoperfusion (CCH) is associated with cognitive decline in aging, Alzheimer's disease and vascular dementia. Neural oscillations and their interactions support brain communication and involve in cognitive function. Although arginine vasopressin (AVP) has been linked to spatial learning and memory, the effects of AVP on CCH in terms of the hippocampal neural network is unknown. Here we investigated the dynamics of neural oscillations in the hippocampus in a rat model of permanent bilateral carotid arteries occlusion (two-vessel occlusion, 2VO) under urethane-anesthesia. Hypertonic saline ...
Source: Brain Research Bulletin - Category: Neurology Authors: Tags: Brain Res Bull Source Type: research
ConclusionA higher incidence of early SSI was found when hip fracture surgery was performed under non-laminar flow conditions but this difference was not statistically significant. Larger studies may change this outcome.
Source: Journal of Orthopaedics - Category: Orthopaedics Source Type: research
CONCLUSIONS: Intra-operative single-dose LIA can effectively reduce postoperative pain, morphine demand, and morphine consumption. Therefore, the use of LIA is recommended during TKA. PMID: 31395787 [PubMed - as supplied by publisher]
Source: Hong Kong Med J - Category: General Medicine Authors: Tags: Hong Kong Med J Source Type: research
CONCLUSION Compared with overnight fasting, pre-operative carbohydrate loading did not significantly enhance peri-operative well being or recovery in patients undergoing day-case cholecystectomy. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT03757208.
Source: European Journal of Anaesthesiology - Category: Anesthesiology Tags: Fluids Source Type: research
Conclusions: Both 2-[18F]A85380 and [18F]Nifene were successfully employed in PET/CT mouse brain imaging for the kinetic study of α4β2Rs nicotine receptor, making this study the first to use 2-[18F]A85380 in mouse models. The selectivity of the synthesized probes is consistent with other publications showing the distribution of the α4β2 nicotine receptor in the brain of human and mice. With an understanding of the differences in probe kinetics, we will be able to better study the precise mechanism of nicotine receptor upregulation and the displaceable binding of nicotine and varenicline, which has imp...
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Basic Science (Neurosciences) Posters Source Type: research
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