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Lessons

A collection of random things I’ve learned through my training

Transexamic Acid

Tranexamic acid (“TXA”, Cyklokapron) is an analog of the amino acid lysine that works as an antifibrinolytic by binding lysine receptor sites on plasminogen to competitively inhibit its conversion to plasmin - the enzyme responsible for…
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Isoproterenol

Isoproterenol (Isuprel) is a nonselective beta adrenergic agonist structurally very similar to epinephrine which I use most commonly in the electrophysiology (EP) lab to induce tachyarrhythmias for the electrophysiologist to map out and…
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Diphenhydramine

Diphenhydramine (Benadryl) is a first generation antihistamine which blocks H1 histamine receptors. Unlike many second generation antihistamines, first generation medications like diphenhydramine cross the blood-brain barrier and inhibit…
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Propofol

Propofol (Diprivan) is perhaps the most well known intravenous hypnotic used in perioperative and intensive care medicine. This "milk of amnesia" is prepared in a lecithin-based (purified egg yolk) emulsion. Similar to many other IV…
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Bispectral Index (BIS) Monitor

The bispectral index (BIS) monitor is a noninvasive derivative of the electroencephalogram (EEG) used to assess the depth of anesthesia to help prevent intraoperative awareness - a rare (~ 0.1% of general anesthetics) but serious…
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Heparin

Heparin is a naturally occurring, negatively charged carbohydrate consisting of molecules with different lengths (unfractionated). It potentiates the activity of antithrombin (AT) III which inactivates thrombin and factor Xa based on the…
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The Lethal Triad In Trauma

The lethal triad in trauma - acidosis, hypothermia, and coagulopathy - defines much of what I do in the ICU and cardiothoracic ORs. It’s important to appreciate the interplay between these three derangements, anticipate problems, and…
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Atropine

Atropine is an anticholinergic (specifically an antimuscarinic) that works by inhibiting the parasympathetic nervous system. It can be administered IV, IM, SC, and even down an endotracheal tube! Since atropine crosses the blood-brain…
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Albumin

Albumin is the most abundant globular plasma protein, an important transport protein, and the primary determinant of oncotic pressure (the colloid osmotic pressure that opposes hydrostatic pressure in determining transcapillary flow). The…
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