Sunday, October 10, 2010
Rules
- First of all, "Anything can go wrong WILL go wrong, at the WORST POSSIBLE TIME."
- Always recheck marking of ET tube for desaturating patients
- Rising pCO2 in spontaneously breathing patients/pt on PSV => decrease sedation first
- USG is your best friend for procedures (e.g. lines, pleural tap...)
- Remember bougie for endotracheal intubations, check mouth opening and ROM of neck beforehand, position well beforehand, insert the tube deep enough, always check breath sound yourself after intubation, protect patient's teeth during DL
- Stick higher for IJ lines at level of thyroid cartilages to avoid pneumothorax, manipulate to increase diameter of IJ vein (head down, limited head turning/extension, light palpation of carotid pulse)
- Do not blindly correct INR, platelet. Think before given pack cell/FFP/platelet concentrate
- Always check ionized Ca2+ level for post-TOTAL thyroidectomy patient
- O2 flow rate of NRM should > 6L/min
- No need to stop NG feeding just because of coffee ground aspirate
- Always check the patient's position while reading a CXR
- Offer comfort care (e.g. morphine infusion) earlier if indicated
- Use sulperazone as emprical abx for nosocomial infections in "The Unit"
- Know when to wait and when to start antibiotics
- Bronchospasm..."treat medically"...remember "second-line agents" e.g. MgSo4, IV salbutamol, adrenaline infusion, ketamine infusion...
- Remember Difficult Airway Algorithm: Awake Vs GA, Spontaneous ventilation Vs paralysis, Superglottic Vs Infraglottic. (always remember awake intubation under topical anesthesia +/- sedation for expected difficult airway)
- Filp Technique of airtraq insertion (like 180-degree turn while inserting oral airway)
# posted by Fat Hing @ 4:46 PM 
