In this 158th episode we return with another keywords episode with Dr. Gillian Isaac. We discuss hepatic disease for the advanced exam and PACU care for the basic exam.
CME: https://earnc.me/rEmBIA
Show Notes by Dr. Brian Park
Random recs:
Cloud Atlas: https://www.amazon.com/Cloud-Atlas-Novel-Liam-Callanan/dp/0385336950
Wolf Hall: https://www.amazon.com/s?k=wolf+hall+by+hilary+mantel&i=stripbooks&crid=2F978D2O2UCW&sprefix=wolf+hall%2Cstripbooks%2C135&ref=nb_sb_ss_i_1_9
Bottle of Lies: https://www.amazon.com/Bottle-Lies-Inside-Story-Generic-ebook/dp/B07JG49BQW/ref=sr_1_1?keywords=bottle+of+lies&qid=1581089047&s=books&sr=1-1
Thanks to Brian Robinson for pointing out: reversal of rocuronium with Sugammadex can occasionally cause severe bronchospasm, especially in higher doses, and this was one of the reasons its release was delayed in the U.S.
Although most sugammadex hypersensitivity reactions cause mild symptoms such as sneezing, nausea, rash, and urticaria, there is a small but finite risk of anaphylaxis with potentially life-threatening symptoms such as airway edema, bronchospasm, and cardiovascular collapse.
www.apsf.org › article › sugammadex-the-anaphylactic-risk
The second question is incorrect. Factor VIII is one of the only clotting factors that is not synthesized in the liver. Factor VIII is made in the vascular endothelium and is actually markedly elevated in end stage liver disease. This occurs as a compensatory mechanism for the coagulopathy that results from the decreased synthesis of most other clotting factors. It also helps explain how cirrhotic patients can paradoxically be both coagulopathic and pro-thrombotic.
Thanks Joe, you are absolutely right. We saw “factor” and didn’t read carefully enough to focus on factor VIII which, as you say, is elevated markedly in liver disease. I am uploading a corrected version as we speak. Good catch!
In your show notes could you post links to your random recommendations?
Many thanks
Done!