Pheochromocytoma - triad of headache, tachycardia, diaphoresis. Diagnosis involves 24 hour urine metanephrines and catecholamines. Treatment involves 10-14 days alpha blockade (phenoxybenzamine) and 2-3 days of beta blockade before surgery. CCB and metyrosine (inhibits catecholamine production) are alternatives. Surgery involves complete adrenalectomy if singular or cortical-sparing adrenalectomy if bilateral. Postop complications including hypotension (fluid replete) and hypoglycemia (catecholamine -> insulni resistance, give glucose infusion). If new suspicion during surgery, give phentolamine (non-selective alpha agonist).
Massive Transfusion: 50% of blood replaced in 12-24 hours. Usual ratio is 1:1:1 of FFP:platelets:pRBCs. Citrate toxicity includes hypocalcemia and metabolic alkalosis. Beware in pts with poor hepatic clearance.
TRALI: ALI/ARDS within 6 hours of transfusion. Accompanied by hypotension, fever, exudative pulmonary edema, but no hemolysis. Contrast with hemolytic rx vs TACO vs anaphylaxis. Treatment is supportive care with possible vent support.
