Category Archives: Surgical ICU

Precedex does not cause respiratory depression

Dexmedetomidine (Precedex)

hp-precedexLogo

  • Sedation without respiratory depression
  • Ideal for use in the Intensive Care Unit.
  • Can be used for managing extubations.
  • No absolute contraindications
  • Compared to Versed (Midazolam), Precedex is associated with less delirium, tachycardia, and hypotension, but had more bradycardia
  • Agonist of alpha 2 adrenergic receptors in the brain
  • FDA reports that infusions greater than 24 hours in duration include ARDS, respiratory failure, and agitation

 

Skin and Soft Tissue Surgical Highlights – Notes

Skin and Soft Tissue – Surgical Issues

  • Various classification systems for necrotizing skin and soft tissue infections help in the study of the disease, doesn’t necessarily help in the care of the patient.
  • Dish water exudates and grey necrotic tissue are macroscopic findings of necrotizing soft tissue infection.
  • Along with early debridement, very broad spectrum IV antibiotics is the mainstay of necrotizing soft tissue infection.
  • Hyperbaric oxygen is not a proven therapy of necrotizing soft tissue infection.
  • Switching from castille soap to a once daily 2% chlorhexidine body wash reduces MRSA colonization rates of Surgical ICU patients.
  • MRSA (Methicillin Resistant Staphylococcus Aureus) is currently the leading pathogen of surgical site infection
  • Chloraprep (contains alcohol) use must be selective – beware of starting a fire on the surgical site.
  • After fasciotomies, negative wound therapy could be helpful for getting rid of edema and keeping wound clean and dry.
  • Negative pressure wound systems have been associated with complications of death and injuries.
  • Measuring compartment pressures, position of the head and trunk relative to the extremities is important when zeroing the transducer
  • When performing a Fasciiotomy – one approach anterolateral incision and then posteromedial incision
  • Calciphylaxis is associated with high calcium phosphorus product (Ca x P).
  • Infected Calciphylaxis lesions must be completely excised which is associated with a high mortality rate.
  • Pressure sores is a “never” event.
  • Smoking cessation is a mainstay of managing hidradenitis supperativa
  • Carbon dioxide laser excision is now being tried to treat moderate infections of¬†hidradenitis supperativa (not severe enough for hospitalization).
  • Biopsy of complex skin lesions is important for diagnosis
  • Pyoderma Gangrenosum – 50-70% will have systemic disease (like inflammatory bowel disease (UC / Crohn’s Disease).