Wednesday December 16, 2009
Q: What is the mechanism of action of Mannitol in control of Intracranial Hypertension (Increase ICP)?
A; Immediately after bolus administration Mannitol expands circulating volume by help of osmotic forces, decreases blood viscosity, resulting in reflex vasoconstriction and lowering of intracranial pressure. Its osmotic properties take effect in 15-30 minutes when it sets up an osmotic gradient and draws water out of neurons.
Wednesday, December 16, 2009
Tuesday, December 15, 2009
Tuesday December 15, 2009
Q: Does Phenytoin (Dilantin) get cleared by hemodialysis or hemoperfusion?
A; No (clinically insignificant removal)
Clinical significance:
- In Phenytoin toxicity/overdose, Hemodialysis or hemoperfusion are ineffective for enhancing elimination.
- Hemodialysis patients do not require extra dosing post dialysis though require frequent monitoring due to lower albumin level.
Monday, December 14, 2009
Monday December 14, 2009
Abnormal sleep and errors more common in ICU nurses
Intensive care unit (ICU) nurses are more likely than floor nurses to have abnormal sleep and to experience a drop in vigilance during their shift that could impair patient safety, according to study findings presented at the CHEST 2009 meeting in San Diego, California.
"Nurses working in the ICU tend to have abnormal sleep and tend to have a greater frequency of errors across the length of their shift," lead researcher Dr. Salim R. Surani said. "These findings could be explained on the basis of the ICU nurses having a more impaired sleep quality as seen by PSQI (Pittsburg Sleep Quality Index), and perhaps having a more demanding and intensive work schedule in the ICU as compared to the floor."
Dr. Surani and colleagues from Baylor College of Medicine, Houston assessed ICU and floor nurses using the psychomotor vigilance test (PVT)
Abnormal sleep and errors more common in ICU nurses
Intensive care unit (ICU) nurses are more likely than floor nurses to have abnormal sleep and to experience a drop in vigilance during their shift that could impair patient safety, according to study findings presented at the CHEST 2009 meeting in San Diego, California.
"Nurses working in the ICU tend to have abnormal sleep and tend to have a greater frequency of errors across the length of their shift," lead researcher Dr. Salim R. Surani said. "These findings could be explained on the basis of the ICU nurses having a more impaired sleep quality as seen by PSQI (Pittsburg Sleep Quality Index), and perhaps having a more demanding and intensive work schedule in the ICU as compared to the floor."
Dr. Surani and colleagues from Baylor College of Medicine, Houston assessed ICU and floor nurses using the psychomotor vigilance test (PVT)
- ICU nurses made more errors at both the beginning and end of their shift than did floor nurses.
- As their shifts progressed, the ICU nurses made more errors (p = 0.029), while floor nurses showed no change.
- ICU nurses had significantly worse PSQI scores than did floor nurses (p = 0.041).
- Scores on the Epworth and Stanford sleepiness scales, however, were similar in the two groups
Dr. Salim Surani is co-editor of this website and extensively published on 'sleep'.
Sunday, December 13, 2009
Saturday, December 12, 2009
Saturday December 12, 2009
The influence of white noise on sleep in subjects exposed to ICU noise
Background and purpose: There is disagreement in the literature about the importance of sleep disruption from intensive care unit (ICU) environmental noise. Previous reports have assumed that sleep disruption is produced by high-peak noise. This study aimed to determine whether peak noise or the change in noise level from baseline is more important in inducing sleep disruption. We hypothesized that white noise added to the environment would reduce arousals by reducing the magnitude of changing noise levels.
Patients and methods: Four subjects underwent polysomnography under three conditions: (1) baseline, (2) exposure to recorded ICU noise and (3) exposure to ICU noise and mixed-frequency white noise, while one additional subject completed the first two conditions. Baseline and peak noise levels were recorded for each arousal from sleep.
Results: A total of 1178 arousals were recorded during these studies. Compared to the baseline night (13.3±1.8arousals/h) the arousal index increased during the noise (48.4±7.6) but not the white noise/ICU noise night (15.7±4.5). The change in sound from baseline to peak, rather than the peak sound level, determined whether an arousal occurred and was the same for the ICU noise and white noise/ICU noise condition (17.7±0.4 versus 17.5±0.3DB, P=0.65).
Conclusions: Peak noise was not the main determinant of sleep disruption from ICU noise. Mixed frequency white noise increases arousal thresholds in normal individuals exposed to recorded ICU noise by reducing the difference between background noise and peak noise.
The influence of white noise on sleep in subjects exposed to ICU noise - Sleep Medicine, Volume 6, Issue 5, Pages 423-428 (September 2005)
The influence of white noise on sleep in subjects exposed to ICU noise
Background and purpose: There is disagreement in the literature about the importance of sleep disruption from intensive care unit (ICU) environmental noise. Previous reports have assumed that sleep disruption is produced by high-peak noise. This study aimed to determine whether peak noise or the change in noise level from baseline is more important in inducing sleep disruption. We hypothesized that white noise added to the environment would reduce arousals by reducing the magnitude of changing noise levels.
Patients and methods: Four subjects underwent polysomnography under three conditions: (1) baseline, (2) exposure to recorded ICU noise and (3) exposure to ICU noise and mixed-frequency white noise, while one additional subject completed the first two conditions. Baseline and peak noise levels were recorded for each arousal from sleep.
Results: A total of 1178 arousals were recorded during these studies. Compared to the baseline night (13.3±1.8arousals/h) the arousal index increased during the noise (48.4±7.6) but not the white noise/ICU noise night (15.7±4.5). The change in sound from baseline to peak, rather than the peak sound level, determined whether an arousal occurred and was the same for the ICU noise and white noise/ICU noise condition (17.7±0.4 versus 17.5±0.3DB, P=0.65).
Conclusions: Peak noise was not the main determinant of sleep disruption from ICU noise. Mixed frequency white noise increases arousal thresholds in normal individuals exposed to recorded ICU noise by reducing the difference between background noise and peak noise.
The influence of white noise on sleep in subjects exposed to ICU noise - Sleep Medicine, Volume 6, Issue 5, Pages 423-428 (September 2005)
Friday, December 11, 2009
Friday December 11, 2009
Q: What is the easy (and quick) way of knowing ideal body weight at bedside?
Answer: Ideal weight can be calculated as follows:
- Men = 106 lb for 5 feet in height plus 6 lb for each additional inch.
- Women = 100 lb for 5 feet in height plus 5 lb for each additional inch.
Nutrition Management in the ICU - CHEST May 1999 vol. 115 no. suppl 2 145S-148S
Thursday, December 10, 2009
Thursday December 10, 2009
Q: Name few treatment modalities in Status Asthmaticus if all conventional treatments including mechanical ventilation fails?
Answer:
Ketamine: has been shown to improve airway resistance, particularly the lower airways, as well as improve lung compliance. Dose: loading dose of 1 mg/kg (IV), followed by a continuous infusion of 1 mg/kg/hr for 2h. Peak airway pressure, PaCO2 and PaO2 should be monitored.
Deep anesthesia: such as with halothane or enflurane in combination with propofol or ketamine, may also be effective treatment as potent bronchodilators.
Nitric oxide: has also been used in isolated case reports.
Nebulized lidocaine: in combination with albuterol or levalbuterol is effective in helping the vocal cord dysfunction that may accompany status asthmaticus.
ECMO: Extracorporeal life support in patients with status asthmaticus when everything fails.
Reference: Click to get abstract
Use of ketamine in severe status asthmaticus in intensive care unit. Iran J Allergy Asthma Immunol. Dec 2003;2(4):175-80
Anaesthetic management in asthma. Minerva Anestesiol. Jun 2007;73(6):357-65.
Q: Name few treatment modalities in Status Asthmaticus if all conventional treatments including mechanical ventilation fails?
Answer:
Ketamine: has been shown to improve airway resistance, particularly the lower airways, as well as improve lung compliance. Dose: loading dose of 1 mg/kg (IV), followed by a continuous infusion of 1 mg/kg/hr for 2h. Peak airway pressure, PaCO2 and PaO2 should be monitored.
Deep anesthesia: such as with halothane or enflurane in combination with propofol or ketamine, may also be effective treatment as potent bronchodilators.
Nitric oxide: has also been used in isolated case reports.
Nebulized lidocaine: in combination with albuterol or levalbuterol is effective in helping the vocal cord dysfunction that may accompany status asthmaticus.
ECMO: Extracorporeal life support in patients with status asthmaticus when everything fails.
Reference: Click to get abstract
Use of ketamine in severe status asthmaticus in intensive care unit. Iran J Allergy Asthma Immunol. Dec 2003;2(4):175-80
Anaesthetic management in asthma. Minerva Anestesiol. Jun 2007;73(6):357-65.
Life-threatening status asthmaticus treated with inhaled nitric oxide - The Journal of Pediatrics, Volume 137, Issue 1, Pages 119-122
Emergency extracorporeal life support for asphyxic status asthmaticus. Respir Care. Nov 2007;52(11):1525-9.
Subscribe to:
Posts (Atom)