Long QT, does anyone care?
Took care of a patient recently with long QT and history of postop nausea. She specifically told me not to give her Zofran because of her asymptomatic history just seen on ekg. Admittedly this is not something I’ve been generally concerned with in the past although I am familiar with the black box warning on Zofran. But the reality is every drug just about that we use for nausea has been associated with increasing QT interval and you have to give these patients something. Any thoughts? (Source: Student Doctor Network)
Source: Student Doctor Network - November 10, 2019 Category: Universities & Medical Training Authors: caligas Tags: Anesthesiology Source Type: forums
Intrathecal AND epidural morphine for C/S
A colleague of mine inserted CSE with Bupi + 0.2mg Morphine intrathecal. Then this same colleague gave 3mg morphine through epidural right at the end of case. Attending flipped out when he found out. Wanted MICU consult, etc. Patient fine but experienced vomiting in PACU despite zofran, dex etc. thoughts? (Source: Student Doctor Network)
Source: Student Doctor Network - November 15, 2017 Category: Universities & Medical Training Authors: User21218 Source Type: forums
How do you guys sort through which EMR drug interactions are legit?
I always click through zofran for SSRI patients (the most common one), but I get worried how cavalier I've become. The other day I gave diflucan to a woman on aripiprazole and some other AP....she didn't die, but I feel like we get alarm fatigue with the bull**** interaction checks. Is there a list of "real deal" med interactions? (Source: Student Doctor Network)
Source: Student Doctor Network - August 21, 2017 Category: Universities & Medical Training Authors: witzelsucht Source Type: forums
What is your standard cocktaIl? Timing of drugs? Dose? What's your cocktail for patients with prior PONV? Are you following the SAMBA guidelines? I do ondansetron 4mg, only towards the end. If prior PONV, or high risk, I toss dexamethasone 4mg at the end also. If patients still have PONV in pacu I add another dose of ondansetron 4mg, benadryl 50mg and metoclopramide 10mg. I'm not precisely following the SAMBA guidelines but seems to work. We don't have any of the newer antiemetics. (Source: Student Doctor Network)
Source: Student Doctor Network - November 6, 2016 Category: Universities & Medical Training Authors: urge Source Type: forums
Scary case - variceal bleed and possible intubation
So, we had a case today - GI bleed, likely (actually confirmed by GI) to be a variceal based on presentation of a lady w distended abd, etoh hx, scleral icterus. Found in our ER bathroom with a pint of blood in a bucket, bright red. HR 150, SBP 90. So I did the usual - reglan 10 iv, zofran 4 iv, octreotide and protonix boluses and drips. IVF x2L, uncrossmatched blood x 2u, ceftriaxone 1g iv. Also, we got our airway cart ready and I had the OR bring down the glidescope. Also 2 canisters of suction ready and plugged in. FFP ordered also. PH was 7.5, hgb was 7.7, inr was 2.0. Now - my question was when to intubate and ho...
Source: Student Doctor Network Forums - August 20, 2013 Category: Universities & Medical Training Authors: pinipig523 Tags: Emergency Medicine Source Type: forums