PULMONARY/CRITICAL CARE TIDBITS

 

Risk factors for peri-op pulmonary complications (hypoxemia. bronchospasm, atelectasis, respiratory failure, pneumonia, ARDS)

Risk factor

Relative Risk

Age > 70

7.46

Age 50-69

4.14

Major abdominal surgery

3.90

Emergency surgery

3.49

COPD

3.13

Age 30-49

2.29

General anesthesia > 180 min

1.52

 

ASA classification

Class

Description

Mortality

1

no disease

0-0.4%

2

disease without functional impairment

0.5-2%

3

disease with functional impairment

5-10%

4

severe, life-threatening disease

75%

5

moribund

 

 

Brain death

  1. Rule out hypothermia, drug intoxication, NMJ blockade
  2. Absent brainstem reflexes
  3. Apnea test
    1. pCO2 40 60 mmHg
    2. preoxygenation with 10L/min or 10cmH2O CPAP
  4. Confirmatory tests (brain scan) indicated only if apnea test cannot be done or BS reflexes cannot be assessed

 

Subarachnoid hemorrhage complications

1. Rebleed

 

maintain SBP < 150 unless repaired

2. Vasospasm

45-70%, most likely days 4-6 but up to 14. Risk factors: 1) aneurism, 2) more blood in SA space, 3) antifibrinolytics, 4) hyperglycemia

-nimodipine, nicardipine

-volume expansion

-tiridazad

-HHT

-angioplasty/papaverine

3. Volume/osmolar disturbances

-cerebral salt wasting (nl serum UA compared with low in SIADH)

 

 

4. Seizure

 

 

5. Cardiac

-arrhythmia (VT, torsades)

-CK leak, contraction band necrosis

 

6. Pulmonary edema

neurogenic