FDA approved for reversal in adult surgery cases, to speed recovery after case completion and is also used to follow neurologic status in neurologic catastrophe (e.g. Intracranial Hemorrhage) or Status Epilepticus
However emergency paralytic reversal is off-label use and may not be ideal as a patient who requires emergent Endotracheal Intubation still needs an airway
Can't Intubate but CAN ventilate scenarios may be treated with temporarily with BVM or LMA, and Can't Intubate, Can't Ventilate scenarios require emergency Cricothyrotomy
Innominate artery erosion is a rare but catastrophic complication presenting from bleeding at Tracheostomy site
Any significant bleeding, even if stopped, requires careful evaluation
Initial bleeding event may transiently stop, but herald masssive bleeding when clot is displaced
Emergent surgical intervention is needed, but temporizing maneuvers include hyperinflating Tracheostomy cuff ballon, and ET intubation from above and compressive inominate artery against Sternum with inserted finger
Uncommon, but life-threatening infection and abscess of the prevertebral space with risk of airway obstruction, local infection spread (e.g. mediastinitis, meningoencephalitis, Carotid Artery erosions)
DVT Prophylaxis for 10-14 days after knee replacement, 35 days after hip surgery
Also consider DVT Prophylaxis after hospital discharge if prior VTE, extremely limited mobility
Most other patients do not need DVT Prophylaxis after hospital discharge, and serious bleeding risk is typically higher than the DVT Risk
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This page was written by Scott Moses, MD, last revised on 11/4/2019 and last published on 11/5/2019.