WOUND VAC - leaking

[V] Wound care team - consulted
Take it off => Wet to dry dressing + cover it with Mepilex => Team will change in AM.

Diarrhea symptom control.

Test C. Diff first
(if it's watery stool)
If it's not or negative,

Then symptomatic control

1) Loperamide ( QTc prolongation )
2) Bismuth Salicylate ( anti secretory, absorbent)
3) Psyllium with high fiber diet => BULKING UP stool ; most benign treatment.

Post ablation regimen +- [ ]

Colchicine 0.6mg po q12hr

PPI 40mg po qday

Sucralfate 1g q6hr. (1hr before meal)

etc.

pain control

tylenol
percocet
fentanyl 50mcg IVP with sheath pull

Half dose of apixaban(Rivaroxaban, Dabigatran etc)
A 2.5
R 10
D 75

Hypofibrinogenemia. OHT rejection treatment [ ]

OHT

IVIG

Plasmapheresis



<Hypofibrinogenemia>
Plasma transfusion vs. Platelet transfusion vs. RBC transfusion.
- Type and Screen?
- What others can be screened?

Plasma products: (contains vs. pros and cons)

Cryoprecipitate => 1 UNIT is good enough (even with <60 of fibrinogen => will be upto >100)

Fresh Frozen Plasma
PCC
Fibrinogen

Palliative care - end of life measurement. dyspnea.

Morphine 2mg IV Qhr PRN
or
Fentanyl 25mcg IV Q15minutes PRN -> PCA(clinician push)

Haldol 1mg IV Qhr PRN

COVID-19[ ]

(1) Epidemiological concept

(2) Pathophysiology concept

(3) Clinical sign
; fever + URI(cough, sore throat) ~ LRI(pneumonia) ~ death.

= Testing indication(PUI);
fever 
and/or LRI symptom (CXR - infiltration ) = BUT it might not be found. 

AND

exposure(COVID 19 -confirmed or suspected ; or traveled outside; ) in 14days prior.
(confirmed, suspected, residence, potential - in the event..)

OR
unknown cause of LRI

(4) Dx. kit
; how long does it take? PCR kit. Where to get? How to run? 
= it will take 3-4 days to come back(NC)

; other respiratory pathogens, upper respiratory tract (nasopharyngeal and oropharyngeal swab) specimens and, if possible, lower respiratory tract specimens

(5) Tx.
- Precaution: airborne precaution(Standard, Droplet; mostly droplet though)
Contacting PUI; for sure
Current policy? => notify state, infectious disease(infection control) 
My policy?

DECISION to DISCONTINUE quarantine. 
Appropriate notification: When COVID-19 is suspected, infection control measures should be implemented and public health officials notified.

Discontinue: resolution of clinical signs and symptoms and negative results of reverse-transcription polymerase chain reaction (RT-PCR) testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on two sequential paired nasopharyngeal and throat specimens (ie, four specimens total, each handled separately), with each pair collected ≥24 hours apart [82].

Positive RT-PCR tests for SARS-CoV-2 were reported in four laboratory-confirmed COVID-19 patients after they had clinically improved and tested negative on two consecutive tests [83]. The clinical significance of this finding is uncertain; it is unknown whether these individuals continued to shed infectious virus.

- Conservative management.
- Chloroquine:

NTG work for esophageal spasm as well.

[Ped] [ ] Newborn reflex.