Chest drains

If losses >10 ml/kg/hr in a postoperative patient, notify surgeon immediately. In the first two hours, losses may be up to 5 ml/kg/hr, thereafter it should be less than 2 ml/kg/hr. If losses exceeds these levels, check ACT, aPTT, PT, fibrinogen, platelets and TEG, and transfuse accordingly. If significant losses continue, notify surgeons. Insertion of…

Blood products

Pump blood Pump blood is the blood remaining in the bypass circuit on the completion of bypass. It is a mixture of the patient’s own blood, other fluids and any bank blood used to prime the bypass circuit. Unfiltered pump blood has a low Hct and contains large amounts of heparin and inflammatory cytokines. The…

Anticoagulation

UNFRACTIONATED HEPARIN (UFH) Indications: Low dose heparin infusions are used in the maintenance of central venous lines, arterial lines and the prevention and treatment of deep vein thromboses. Administration: Heparin can be administered by intravenous and subcutaneous routes. This protocol applies to the intravenous route only. Heparin is compatible with 5% dextrose, 0.9% NaCl and…

Weaning opioids and steroids

Withdrawal from drugs (principally opioids) prolongs hospital admissions and causes morbidity! Gradual weaning of drug dosing aims to prevent the onset of withdrawal abstinence syndromes: regime one: 10% reduction in original dose per day weaning over 10 days or regime two: 20% reduction in original dose per day weaning over 5 days regime three: 20%…

Muscle relaxation

Definition: Muscle relaxants block transmission at the neuromuscular junction (NMJ) by interfering with nicotinic cholinergic receptors (AChRs). They are large polar molecules with small volumes of distribution that are not orally bioavailable and do not cross the placenta or blood-brain barrier. They have no analgesic, anaesthetic or amnestic properties and so should never be given…

Intubation

Indication: to secure the airway: severe airway obstruction/inadequate protective reflexes (coma or prolonged seizures) to facilitate ventilation: hypoxaemic and/or hypercarbic respiratory failure Intubation should NOT be attempted by the inexperienced if more skilled personnel are available. Two doctors always present if possible! Assessment: how urgent is the intubation? anatomical abnormality, which would suggest difficult intubation?…