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14.02.05 ICU notes

Clotting
  • Extrinsic pathway - Tissue factor / Factors IX + X
    • PT
    • PT ratio / INR
    • For monitoring warfarin
  • Intrinsic pathway - Surface contact / Factor XII
    • APTT
    • For monitoring heparin


Clonidine

  • Centrally acting α2 adrenergic agonist
    • => Sympatholytic
  • Useful ITU drug
    • Mildly sedating
    • Anti-hypertensive
  • Other indications:
    • ADHD
    • Anxiety/panic disorder
    • Pain
    • Withdrawal symptoms (narcotics, alcohol, nicotine, dexmedetomidine)
    • Stree
    • Sleep disorders
    • PTSD
    • Restless legs syndrome
    • Rosacea flushing/redness
    • Diabetic neuropathy
    • Migraine
    • Hot flushes


Rosacea subtypes

  • Erythematotelangiectatic rosacea
    • Permanent redness (erythema) with a tendency to flush and blush easily
    • It is also common to have small widened blood vessels visible near the surface of the skin (telangiectasias) and possibly intense burning, stinging, and/or itching sensations
    • People with this ETR type often have sensitive skin
    • Skin can also become very dry and flaky
    • In addition to the face, symptoms can also appear on the ears, neck, chest, upper back, and scalp
  • Papulopustular rosacea
    • Some permanent redness with red bumps (papules) with some pus filled (pustules) (can last 1–4 days or longer; extremely varied syptoms)
    • This subtype can be easily confused with acne
  • Phymatous rosacea
    • This subtype is most commonly associated with rhinophyma, an enlargement of the nose
    • Symptoms include thickening skin, irregular surface nodularities, and enlargement
    • Phymatous rosacea can also affect the chin (gnathophyma), forehead (metophyma), cheeks, eyelids (blepharophyma), and ears (otophyma)
    • Small blood vessels visible near the surface of the skin (telangiectasias) may be present
  • Ocular rosacea
    • Red (due to telangiectasias), dry, irritated or gritty, eyes and eyelids.
    • Watery eyes
    • Eyelids often develop cysts
    • Some other symptoms include foreign body sensations, itching, burning, stinging, and sensitivity to light
    • Eyes can become more susceptible to infection
    • About half of the people with subtypes 1-3 also have eye symptoms
    • Blurry vision and loss of vision can occur


Notes
  • Milrinone in heart failure
    • Phosphodiesterase 3 inhibitor
    • Increases cardiac contractility
    • Vasodilates => Reduced afterload
  • VATS
  • AVRs often disrupt the primary conduction pathways => Complete heart block
    • Always put pacing wires in
  • Rolandic infarcts
  • Can give treatment dose dalteparin for 45 days in renal impairment
  • Beta-blockers are not contra-indicated in patients with lower extremity arterial disease (LEAD)
    • But use with caution
  • PDA = posterior descending artery
    • If the PDA (a.k.a. posterior interventricular artery) is supplied by the right coronary artery (RCA), then the coronary circulation can be classified as "right-dominant".
    • If the PDA is supplied by the circumflex artery (CX), a branch of the left artery, then the coronary circulation can be classified as "left-dominant".
    • If the PDA is supplied by both the right coronary artery (RCA) and the circumflex artery, then the coronary circulation can be classified as "co-dominant".
  • Only a few patients with heparin-induced antibodies develop heparin-induced thrombocytopenia (HIT)
    • Heparin-PF4-IgG antibodies can identify patients at risk of developing life-threatening HIT
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