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