Medical Management of Potential Donors
Reviewed and revised 25 June 2012
OVERVIEW
- specific measures to support different organ systems
CVS
- autonomic storm
- vasoplegia
- arrhythmias
- hypovolaemia (aim for neutral fluid balance)
- low cardiac output
- -> antihypertensives (esmolol, SNP)
- -> normalize electrolytes, volume status, temperature
- -> amiodarone, cardioversion
- -> atropine, adrenaline, isoprenaline, pacing, CPR
- -> MAP > 70
- -> noradrenaline
ELECTROLYTES
- DI: polyuria, hypernatraemia, hypovolaemia
- -> DDAVP 0.25-4mcg Q2-6 hrly or
- -> vasopressin 0.5-2.0U/hr
- hyperglycaemia
- -> insulin infusion
- Mg2+ and K+
- -> standard care
ENDOCRINE
- vasopressin 0.5-4U/hr
- tri-iodothyronine (T3) 4mcg IV bolus, then 3 mcg/hr
- methylprednisolone 15mg/kg single bolus
RESPIRATORY
- routine suctioning, positioning and turning
- lung protective ventilation
- humidification
- minimal fluid administration
HYPOTHERMIA
- keep warm
- warm fluids
HAEMATOLOGICAL
- anaemia, coagulopathy and SIRS response
- -> early removal
- -> supportive care
NUTRITION
- feed enterally
References and Links
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC