Helium has low density, which does 2 things. One, it lowers the reynold's number is more air travels laminar instead of turbulent. Two, it increases turbulent flow but doesn't work in the small airways where laminar flow predominates. It also decreases the work of breathing.
APGAR - appearance, pulse, grimace, activity, respiration
Myotonic dystrophy - muscles still contract after NMB and regional technique. Exaggerated responses to sux. Causes AV conduction problems.
Cerebral vasospasm after SAH - most common 1 week after SAH not 3 days. More likely with severity of SAH. Nimodipine not nifedipine is drug of choice. HHH therapy should be started after cerebral vasospasm occurs.
Apnea in neonates
Risk factors: decreased postconceptional age, decreased gestational age, hx of apnea, presence of anemia
Management: regional, avoiding opioids, longer term monitoring
Postop management: stimulate the baby, metylxanthine (caffieine, theophylline), CPAP, correction of underlying metabolic diorders, PPV
Avoid: Prostaglandin E1 which is used in ductal-dependent CHD but is associated with development of apnea
Herbal Medication
Garlic, ginseng, and ginkgo biloba inhibits platets (3G)
Ginseng also associated with hypoglycemia
St. John's wort is a MAOI, p450 inducer, decrease cyclosporin levels
Kava, Valerian are both GABA agonists and potentiate sedative medication
Antibiotic prophylaxis for
- prosthetic valve, prior IE, heart transplant w/ valvulopathy, partially fixed CHD
- for dental procedures, bronch biopsies, infected skin or tissue
- not for colonoscopy, bronch w/o biopsy, vaginal delivery, hysterectomy.
give ampicillin or ancef not gent or vanc
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