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6. Deutsch DG, Bergert Rd. Evaluation of a benchtop capillary gas chromatography-mass spectrometer for clinical toxicology. Clin Chem 1985; 31: 741-6. Cough TA, Baker PB. Identification of major drugs of abuse using chromatography. J Chromatogr Sci 198220: 289-329. 8 Kabra PM, Koo HY, Marton U. Hypnotics and sedatives. 1n Marten U, Kabra PM, eds. Liquid chromatography in clinical analysis. Clifton, NJ: Humana Press, 1981; 223-41. 9. Newton B, Foery R. Retention indices and dual capillary gas chromatography for rapid identification of sedative hypnotic drugs in emergency toxicology. J Anal Toxicol 1984; 8: 129-34. Brogurz M, Wijsbeck J, Franke JP, Zeum RA. Applicability of capillary gas chromatography to systemic toxicological analysisoccurrence of concentration-dependent retention behavior. J Anal Toxicol 1983; 7: 188-92. Wallace JE, Hall LR, Harris SC. Determination of certain other barbiturates by capillary gas-liquid chromatography. J Anal Toncol 1983; 7178-80. 12. Cailleux A, Thrcant A, Premel-Cabic A, Allain P. Identification and quantitation of neutral and basic drugs in blood by gas chromatography and mass spectrometry. J Chromatogr Sci.
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Each dose should be administered by slow intravenous infusion over a one-hour period. In patients with renal impairment, Zpvirax should be administered with caution since the drug is excreted by the kidneys. The following modifications in dosage are suggested: Creatinine Clearance 25-50 mL min 10-25 mL min 0 anuric ; - 10 mL min Dosage The recommended dose 5 or 10 mg kg ; every 12 hours The recommended dose 5 or 10 mg kg ; every 24 hours The recommended dose should be halved 2.5 or 5 mg kg ; every 24 hours and after dialysis.
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UTILITY OF BRONCHOSCOPY IN MECHANICALLY VENTIALTED PATIENTS WHO DEVELOPED HEMOPTYSIS IN THE INTENSIVE CARE UNIT Maya Juarez BS * Petey Laohaburanakit MD Ken Y. Yoneda MD U.C. Davis School of Medicine, Sacramento, CA PURPOSE: The etiology of hemoptysis in mechanically ventilated ICU patients includes a wide spectrum of disorders. We evaluate the utility of fiberoptic bronchoscopy when used to identify and diagnose the bleeding source and potentially achieve hemostasis in such patients. METHODS: A retrospective review of medical records of ICU patients who developed hemoptysis while on mechanical ventilation at a tertiary-care, 700-bed teaching hospital. All bronchoscopies done from April 1998 to December 2003 were reviewed. RESULTS: Seventy-one bedside fiberoptic bronchoscopies were performed in 56 ICU patients on mechanical ventilation. Mean age was 55 years, 35 were male. The amount of hemoptysis ranged from persistent blood-streaked sputum to massive. The bleeding source was localized during 66.2% n 47 ; of all bronchoscopies, although additional diagnostics radiology, repeat bronchoscopy, etc ; after bronchoscopy were required in 23% n 16 ; of cases. Bronchoscopic findings were consistent with the final consensus etiology of hemoptysis in 77% of cases n 55 ; . Only in 42% n 30 ; of cases was the clinical impression prior to bronchoscopy consistent with the final diagnosis of the cause for hemoptysis. Etiologies of hemoptysis included: pneumonia, coagulopathy, suction trauma, pulmonary edema, trauma, neoplasm, pulmonary embolism, and granulation tissue. Diagnostic samples taken during 23 bronchoscopies yielded positive results in 17 cases.Patients underwent at least one therapeutic intervention after 51% of bronchoscopies anticoagulation discontinued, antibiotics changed, transfusion, etc ; . Bronchoscopic interventions were performed in 8 cases 11% ; , including deployment of fogarty balloon, application of neosynephrine, repositioning of endotracheal tube, and removal of blood clots. Minor complications were evident in 3 4% ; cases within 24 hours after bronchoscopy: transient desaturation once, transient hypotension twice. The transient hypotension resolved spontaneously, while the desaturation required slight endotracheal tube repositioning. CONCLUSION: Localization of the source of hemoptysis and determination or confirmation of the etiology of hemoptysis is frequently achieved bronchoscopically, although intraoperative treatment is seldom done and alesse and zovirax, for instance, zovirax uses.
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