Monthly Archives: March 2014

Obstructive Sleep Apnea

Excessive Daytime Sleepiness Scale

Constipation

1. Senna 17.2mg (2×8.6 tabs) PO q12, then q6
2. Bisacodyl 10mg PO q12 (max 30mg/day) or 10mg PR q12 (max 30mg/day)
3. Magnesium Citrate 1 bottle daily/q12 (be careful in people with renal failure as this has a lot of Mg)
4. Tap water enema x3
5. Lactulose 20mg q6 hrs till BM
6. Miralax 17g dissolved in 4-8 oz of beverage once
7. Fleets enema (again, not to use in renal failure) x 1 or 2
8. Relistor can be used as a last resort for opioid related constipation

DIC

Disseminated Intravascular Coagulation Scoring System

dicscore ISTH Scoring System

 

TREATMENT:

  • no specific treatment other than that directed against predisposing condition
  • bleeding – replace platelets and coagulation factors
    • cryoprecipitate 10 units = fibrinogen 2.5 g  –> but this rarely helps, consumption of platelets and coagulation proteins can aggravate thrombosis
  • heparin is ineffective in retarding microvascular thrombosis (due to depletion of antithrombin III)
    • give heparin with AT-III? – 90-120 units load then 90-120 units daily x 4 days (no evidence for improvement in mortality)

 

Reference

Marino, Paul L, and Kenneth M Sutin. The ICU Book. Philadelphia: Lippincott Williams & Wilkins, 2007. Print.