Patient #1   Charlie Fox is a 25-year-old male admitted to Parks Hall Hospital for a craniotomy and developed a post-op craniotomy infection (cerebrospinal fluid (CSF) shunt infection) positive for MRSA. Patient is having shunt drainage but is otherwise doing well and in no distress. The prescriber has ordered vancomycin to treat his infection and has consulted pharmacy for dosing and monitoring per hospital policy. Using the patient’s profile answer the following questions.    Patient information:   Weight – 80 kg  Height – 5’4’’  Allergies – NKDA   Problem list   TBI/SAH/SDH s/p decompressive craniotomy  Respiratory failure s/p trach Skull Fractures   Current Labs   BUN – 8mg/dL CO2 – 26 mmol/L SCr – 0.53 mg/dL Glucose 112 mg/dL  Cl – 99 mmol/L K – 3.9 mEq/L Na – 138 mEq/L  *Patient already received a loading dose, 1st maintenance dose is due tonight at 1800.  

According to the Presentation Skills PowerPoint, which is an example of a Strong Presentation Ending?

What type of monitoring will this patient need and when will we get level(s)? (If the first dose is due today at 1800, give an exact time and date)  *Patient already received a loading dose, 1st maintenance dose is due tonight at 1800.  

The #12 sticker is located on which entire organ?   IMG_2806.JPG

Based on this treatment indication what goal trough are we targeting? 

A patient is switched from PRVC to SIMV mode, rate of 10/min, VT 350 ml, fi02 0.40, PEEP 5 cmH20, Pressure Support 8 cmH20,  I-time is 1.0 second in which she had a comfortable work of breathing.  After the switch, here are the ventilator parameters:  PIP 36 cmH20, PPlat 20 cmH20, spon VT 200 ml’s, total RR 35/min, I:E 1:1, Ve 11.5 L.  Patient Assessment:  increased work of breathing with paradoxical respirations noted. Abg’s: pH 7.38, paC02 43 torr, pa02 65 torr,  HC03 22 meq/L, B.E. -What could you attribute this clinical picture to?

The #31 arrow is pointing to which structure? IMG_2820.JPG

The #15 arrow is pointing to which part of the organ? IMG_2808 (2).JPG

The #27 arrow is pointing to which organ? IMG_2816(1).JPG

The #22 sticker is pointing to which part of the organ? IMG_2813.JPG