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