This where the money is..often being quoted during the practice clinical cases--> actually the hotcases are like the extension of the written exam questions where we have to show clinical skills to elicit important findings. 'Go directly to where the money is' meaning that we have to direct our clinical examination and clinical findings to be able to formulate answer to the specific tasks given. Usually the questions consists of at least two parts and must remember the questions very well. Don't forget to answer all parts of the questions (the same rule for written)
Cases
1. ARDS
CAP : include the management of CAP, antibiotics and if the patient in shock
-always remember the specific treatment and general management of the patients
-in any clinical management, firstly we have to get the diagnosis and must have few differential diagnosis.
2. VAP
-definition
-possible organisms
-management
3. CRBSI
-definition
-management
4. management of severe TBI with high intracranial pressure
-regarding prognosis
-family meeting
-rescue therapy
Thiopentone:
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Thiopental has a long Context Sensitive Half Time (CSHT), meaning infusions saturate peripheral compartments (fat, muscle etc). When the infusion is stopped, the drug re-distributes from the peripheral tissues back into the blood, prolonging the effect.
Thiopental also exhibits zero order kinetics at higher doses. The rate of elimination becomes constant.
Thiopental also exhibits zero order kinetics at higher doses. The rate of elimination becomes constant.
Contraindications:
1. Acute intermittent porphyria
2. Barbiturate allergy
3. Patients with a low circulating blood volume, such as after haemorrhage, are prone to severe hypotension with thiopentone.
4. Patients with cardiac disease (particularly those with stenotic heart valve lesions) are at risk from the cardiovascular depressant effects of thiopentone. The drug must be carefully titrated against effect.
5. Patients with partial airway obstruction should not be given an intravenous anaesthetic agent in case total airway obstruction develops.
6. In severe asthma it is thought that thiopentone may occasionally cause bronchospasm.
1. Acute intermittent porphyria
2. Barbiturate allergy
3. Patients with a low circulating blood volume, such as after haemorrhage, are prone to severe hypotension with thiopentone.
4. Patients with cardiac disease (particularly those with stenotic heart valve lesions) are at risk from the cardiovascular depressant effects of thiopentone. The drug must be carefully titrated against effect.
5. Patients with partial airway obstruction should not be given an intravenous anaesthetic agent in case total airway obstruction develops.
6. In severe asthma it is thought that thiopentone may occasionally cause bronchospasm.
Metabolism. For many years it was thought that the short duration of action of thiopentone was due to its rapid metabolism. It is now known that thiopentone is metabolised quite slowly, and the rapid recovery is due to redistribution of the drug firstly into muscle and skin, and later into body fat stores.
Thiopentone is metabolised in the liver; less than 1% of the drug appears in the urine unchanged
Thiopentone is metabolised in the liver; less than 1% of the drug appears in the urine unchanged
