Procainamide is a type IA antiarrhythmic which prolongs repolarization via sodium channel blockade. This is achieved by slowing conduction through the ventricular His-Purkinje system thereby widening the QRS complex (and ultimately the QT interval).
Postoperative pulmonary complications (PPCs) come in a wide variety of flavors ranging from atelectasis and pulmonary congestion to respiratory failure and pneumonia. Not only do certain surgeries (upper abdominal and thoracic), age, case duration, and patient comorbidities (renal failure, longstanding respiratory disease, etc.) confer a higher incidence of PPCs, but…
Fluconazole (Diflucan) is an intravenous and oral antifungal medication that inhibits ergosterol synthesis (an important component of fungal cell membranes). As an intensivist, I most often use this medication to cover Candida albicans infections (especially symptomatic cystitis given fluconazole’s excellent urine penetration); however, it doesn’t cover C. krusei and has…
Here’s a free reference sheet (front and back) with “high-yield” information in critical care and perioperative medicine. I’m well-suited to pursue this educational endeavor, given my training as a physician who works in both settings, and I hope that many of you will benefit from the information. Now some details:
In pursuit of evidence-based rationales for my hatred of dopamine, I turned to PubMed and queried the database for “dopamine shock” filtered for meta-analyses, randomized controlled trials, and systematic reviews in adult patients since 2009. I then ventured into the PubMed black hole. :razz:
Pharmacokinetic models describe the rate of absorption, distribution, metabolism, and elimination of a particular drug. This can vary significantly based on properties of the drug itself, varying levels of metabolism in the context of organ impairment or enzyme polymorphisms, plasma protein binding, and other patient factors (ie, obesity).
Midodrine (ProAmantine) is an oral and intravenous prodrug. Its active metabolite, desglymidodrine, activates α-1 receptors to produce vaso and venoconstriction with resulting increase in blood pressure (BP). This medication has excellent oral bioavailability and is FDA approved for the treatment of symptomatic orthostatic hypotension. Since midodrine increases BP, it makes…
Desmopressin (DDAVP, antidiuretic hormone) is a synthetic analog of vasopressin that can be administered IV, IM, subQ, and orally. Compared to vasopressin (generally regarded as a potent vasoconstrictor), DDAVP has less efficacy as a pressor, a longer duration, and is a much more potent antidiuretic (hence its use for bedwetting)…
Nitric oxide is a molecule normally made by vascular endothelial cells to decrease vascular resistance in both the systemic and pulmonary circulations. Inhaled nitric oxide (iNO) is an (expensive) pulmonary dilator I frequently use in the OR and ICU settings for patients with acute right heart failure, refractory hypoxemia, pulmonary…
