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Leukotriene antagonists

Drug usage age/dose comments
Accolate (zafirkulast)
  • attenuate late response
  • age 12+ 20mg BID empty stomach
  • pregnancy category B
Less toxicity, but not impressive efficacy.
Singulair (montelukast)
  • adjunct in exercise-induced asthma
  • improves FEV1
  • 2-5 yrs: 4mg
  • 6-14 yrs: 5mg chewabel in evening
  • 15+ 10 mg in evening
  • pregnancy category B
No major interactions. Safety, age range, and dosing mean this is likely a "keeper", even though efficacy is limited.
Zyflo (zileuton)
  • exercise and aspirin induced asthma
  • immediate FEV1 improvement
  • age 12+ 600 mg QID
  • pregnancy C
Liver toxicity, drug interactions, lousy dosing schedule. This drug won't last long.

Chronic Cough




Pleural Effusion And Thoracentesis


typical target is in post. mediolat. area; 7-8th interspace.

TRAY contents (if not preset):CONSENT, vacuum bottles, anaerobic and aerobic culture media, #15 scalpel, gloves, valium or s/l ativan. Tubes: EDTA, blue, purple, and red tops, blood gas. Send for pH, LDH, protein, glucose, culture, gram stain, AFB, cytology, amylase, triglycerides, cell count and diff, gases (complement).

method 1:
method 2:


Differential Diagnosis

Always rule out PE and tb. Exudate: fluid/serum protein < 0.5, fluid LDH >200, fluid/serum LDS >0.6, fluid protein > 3.

Transudate (protein < 3mg/dl)
Exudate (protein > 3mg/dl)

Chest Tube Sclerosis

Give demerol/phenergan 1/2h prior to proceedure.

Need 21 gauge needle, 7.5 gloves, betadine wipes, 2 chest tube clamps and blue pagd. Clamp distal to the tube connector and inject the xylocaine, then the sclerosing solution (slowlthen the saline. Wait 1/2 hour then UNCLAMP.

need sclerosing solutions plus:

sclerosing solutions (one or the other):

Sleep Apnea Diagnostic Criteria (ref. #1177)

  1. home oximetry: >1% of time at O2 sat < 90% (screening)
  2. > 15 episodes of O2 sat < 4% below baseline (specific)
  3. indeterminant measures require further referral/sleep studies
  4. If normal test no further testing needed. If positive (as above) do PSG.

Ventilators and Oxygenation

DATED MATERIAL. See also: Critical Care Values and Cardiology. This stuff is so old I should probably delete it, but it's a useful starting point for me.

Oxygen transport and consumption


The response to decreased O2 delivery to tissues is to increase cardiac output (300%), increase venous O2 extraction (dec. SvO2 to 30% from 70%). A healthy person can compensate for a Hg as low as 1.6 without developing lactic acidosis (in theory).

Ventilator Management

Ventilator settings

(@2000 settings have changed to reduce ARDS incidence. See literature. These settings are 10 years old.)


  1. valium 5 mg and MS 4mg then Pavulon 4mg; may repeat same with Pavulon 8 mg.
  2. IV Haldol (flush line with saline first)
    Wait 20 minutes between doses, double the dose q20m until effective (max 40 mg qh)
  3. Pavulon: load with 0.05 to 0.1 mg/kg then give 0.02 to 0.05 q4h.

RDS Managment

Author: John G. Faughnan.  The views and opinions expressed in this page are strictly those of the page author. Pages are updated on an irregular schedule; suggestions/fixes are welcome but they may take weeks to years to be incorporated. Anyone may freely link to anything on this site and print any page; no permission is needed for citing, linking,  printing, or distributing printed copies.