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Practice Guidelines for Preoperative Fasting

Infographic by Dr. Jesse Burk-Rafel
@jbrafel

> 8 hours - Heavy foods (fried/fatty) and
@jbrafel > 8 hours ... and meats > 6 hours ... formula > 4 hours ... coffee) 0-2 hours ... Liquids up to 2 hours
Normal urine output 
- 0.5 to 1.5 cc/kg/hour 
- A patient should be urinating at least
0.5 to 1.5 cc/kg/hour ... least every 6 hours ... < 300cc/m2/24 hours ... - < 0.5 cc/kg/hour ... - < 1.0 cc/kg/hour
Quick Guide: Methadone Starts in the Hospital
Day 1: max daily dose 40 mg methadone
First dose
• Check
Recheck Ramsay in 1 hour ... After 4 hours • ... After 4 hours • ... After 4 hours • ... After 4 hours •
Blood Pressure Targets in Hypertensive Crisis

Timeline:
1 hour: ↓ MAP by 25%, Maintain DBP ≥ 100 mmHg
2-6
Timeline: 1 hour ... 100 mmHg 2-6 hours ... DBP 100 mmHg 24 hours
3 Hour Time Lapse - Button Battery Ingestion Simulation - mp4 video version here: https://www.grepmed.com/images/14833

Swallowed button
3 Hour Time Lapse ... that occurs in 3 hours
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Types of hypersensitivity reactions

Type I - lgE-Mediated, Within I Hour (Anaphylaxis)
Type II - IgG or IgM
lgE-Mediated, Within I Hour ... IgM Cytotoxic, Hours
Important Blood Pressure Targets in the ED
Subarachnoid Hemorrhage: 
    SBP < 140 -
110: For 24 hours ... by 15% over 24 hours ... by 20% in first hour
Opioid Withdrawal Symptom Timeline
Stage l: Up to 8 hours 
Stage II: 8—24 hours 
Stage Ill: Up
Stage l: Up to 8 hours ... Stage II: 8—24 hours
Therapeutic Drug Level Monitoring 
Carbamazepine - Sample immediately before next dose (trough) 
Clozapine - Sample immediately
) or exactly 2 hours ... - Sample 8-24 hours ... trough level 2-4 hours ... Lithium - Sample 12 hours ... sample after 18 hours
Alcohol Withdrawal Timeline
Minor withdrawal (6 to 36 hours) - Tremulousness, mild anxiety, headache, diaphoresis, palpitations, gastrointestinal
withdrawal (6 to 36 hours ... Seizures (6 to 48 hours ... hallucinosis (12 to 48 hours ... tremens (48 to 96 hours