Based on its correlation with other systemic disorders like systemic lupus erythematosus, Reynaud's phenomenon is either classed as primary or secondary. Reynaud's syndrome is a persistent vasoconstriction of the distal extremities brought on by microvascular hyperresponsiveness to cold or stress. Avoiding colds, abstaining from inciting drugs, and using calcium-channel blockers—which prevent the smooth muscle excitation that is ultimately responsible for vasoconstriction—are the mainstays of treatment for primary Raynaud's. The possibility of macro-vascular disease should be ruled out in patients who arrive with critical limb ischemia. Anticoagulation, topical nitrates, intravenous prostaglandins, and phosphodiesterase inhibitors are used to treat critical ischemia when there isn't a fixable macrovascular problem. A cervical sympathectomy can be used to treat patients who develop amputation or continue to have critical limb ischemia. A cervical sympathectomy, which disables sympathetic signals to the affected upper extremity, can be used to treat patients who experience critical limb ischemia for an extended period of time or who eventually require amputation. Investigations into pharmacological or local sympathectomies have been recommended, but have not yet been adequately studied, given the substantial risk of long-term return of symptoms. Raynaud's is not a condition that requires intravenous nitrates, and a continuous infusion would be harmful without constant monitoring.
27% of the patient's body has been burned (9% on the arms, 9% on the upper back, and 9% on the lower back). Use the Parkland Formula (REMEMBER THIS!! ): 4 mL per kilogram per kilogram of body weight per percent burned. Replace fluid. Instead of using the time of admittance, use the time burnt to determine this.
After succinylcholine induction, the presence of an elevated end-tidal CO2 raises serious concerns for malignant hyperthermia. One of the initial symptoms of malignant hyperthermia is being displayed by this patient; additional early symptoms include tachycardia, muscle rigidity, tachypnea, and hyperkalemia. Myoglobinuria, fever, and eventually multi-organ failure are later symptoms. This response is the result of more than 30 distinct mutations. Dantrolene prevents the release of calcium from the sarcoplasmic reticulum, which interferes directly with muscle contraction.
Epidural hematoma is most likely given the history of a head injury, loss of consciousness, lucidity, and subsequent decompensation. It is recommended to evacuate the hematoma since the middle meningeal artery is the vessel that is most frequently implicated in epidural hematomas. Due to the blood's placement between the dura and skull, a biconvex-shaped hemorrhage is frequently seen on imaging (see below). Epidural hemorrhages can be deadly in up to 20% of cases. On imaging, subdural hematomas have a crescent form and hardly ever feature the typical "lucid period" of epidurals. Instead, patients experience progressively worsening pain and bewilderment. The subdural hematomas' bleeding is caused by the bridging veins.
Keep the tube suctioned while gauging the output. Hemothorax typically results in diminished ipsilateral breath sounds and muted percussion on that side. The pleural cavity of a typical adult male can retain 4 or more liters of blood, therefore exsanguination can happen even in the absence of any other outward signs of bleeding. The prompt return of 1500ml would have indicated OR. Indications for exploratory surgery include bleeding with instability after all other causes of bleeding have been ruled out, output >250 mL/hour x 4 hours, or 2500 mL/24 hours.
The MAC is the lowest amount of anesthetic vapor required to inhibit a physical response in 50% of patients to a common surgical stimulus. Less fat soluble, less powerful, yet faster onset with higher MAC. More lipid soluble, more powerful, but longer onset, when MAC is lower. This little anecdote can help you remember it: "When MAC is LOW he is FAT and SLOW." Common MAC values are as follows: Nitrous oxide (MAC): 104; Xenon (MAC): 72; Desflurane (6 MAC); Ethyl Ether (3 MAC); Sevoflurane (2 MAC); Enflurane (MAC); Isoflurane (MAC); Halothane (0.75 MAC); Chloroform (0.55)
RQ=CO2/O2 By causing an excess of calories and carbs to be turned into fat, overfeeding can extend intubation and mechanical ventilation in patients. A RQ>1.0 would arise from this. This process results in an increase in CO2 generation, which must be offset by an increase in the patient's respiratory effort. As a result, the respiratory system might become so worn out that weaning becomes challenging or even impossible. Since the body uses more oxygen when turning stored energy into sugar (by destroying glycogen and adipose tissues), starvation would result in an RQ 0.7.
