1. To relax the bowels and let them heal after injury, make someone NPO, put in an NG tube to suction the stomach and give octreotide.
2. The anterior compartment is the most common common compartment affected in compartment syndrome because it is the smallest. It contains the anterior tibial artery and the deep peroneal nerve.
3. Catheter directed thrombolysis (CDT) with tPA results in less hemorraghic morbidity and less incidence of post-thrombosis syndrome (venous valve failure) compared to systemic tPA.
4. GI bleeding is a side effect of tPA. So hypothetically, if you see a lot of melena from your pt, their hct could have been crashing from 30 to 15 in a few hours, and they could code on the operating table in front of you, twice, and then require 8 units of blood in the ICU and end up with acute renal failure. Hypothetically speaking, of course.
5. CDT is an expensive, invasive procedure, usually reserved for arterial clots. Venous clots are usually managed with lovenox, unless it's in the IVC or causing ischemic symptoms.
6. Theoretically, CDT could result in the showering pieces of clot downstream; in the very least, there is tPA flowing with it downstream so it should break it up. Theoretically, this could result in further ischemia in downstream arteries (or in the case of venous clots, in iatrogenic PEs)
7. If someone has had a large ischemic injury and their pee is brown, think rhabdomyolysis.
8. Lovenox has better outcomes than coumadin in cancer patients on DVT prophylaxis. Something about anti-inflammatory properties.
9. Technique for CDT: put in wire -> advance-> put catheter over it-> inject dye/angiogram-> advance wire->advance catether-> repeat angiograms until you reach the clot -> put guidewire through the clot -> put catheter with holes through clot -> drip tPA through this catheter, max 36-48 hours.
10. Taxols and platinum agents are the cornerstones of treatment for ovarian cancer. So much that if someone is in ESRD and has ovarian cancer, you give them platinum agents anyways and dialyze it off afterwards. Taxotere (doxetaxel) has less peripheral neuropathy than taxol, which is important in young patients that you don't want to condemn to many decades of neuropathic symptoms. Unfortunately, it hits the hematocrit harder than other chemo agents, and it also causes thickening/detachment of nails, and darkening of palms/soles/blood vessels. It can also cause sudden onset severe edema, central and peripheral; treat with dexamethasone the day before, day of, and day after chemo to ameliorate/prevent this edema. On the flipside, Taxol has fewer of the systemic symptoms but causes bad peripheral neuropathy. In an older patient who already has neuropathy from diabetes and can't take the hematocrit drop, taxol may be a better choice.