Union Memorial (Regional)

2025-06-26T13:11:30Z

Darreonschwartz: updated contact info, day-to-day workflow

=== About ===
Union Memorial (MedStar Health) is a regional anesthesia elective available to CA-3s who have completed their initial regional rotation downtown. You will work directly with attendings (some remote Hopkins grads) and interact with experienced CRNAs.

=== Getting Started ===

==== Site coordinators ====

* Joshua Dishon (Chair of Anesthesiology Department at Union Memorial)
* Nicole Allen (Administrator)

==== The Experience ====

* 2 week call-free rotation at major orthopedic surgery center
* Expect to get significant experience with both upper and lower extremity blocks. Arguably, the rotation rounds out blocks we do not perform as often at other sites. Most commonly:
** Total Shoulders: Interscalene (single-shot)
** General Hand: Infraclavicular, often with catheter placement (preferred over supraclavicular per general institutional preference)
** Total Knees: Post-op adductor catheters
** Miscellaneous Knee Procedures: Adductor/IPACK
** AKA/BKA: Fem/Sciatic catheters
**Other (less frequent): PECS catheters, TAP catheters

==== First Day ====

* Union Memorial Hospital is located at the Hopkins Homewood campus (201 E University Parkway)
* You'll park in Garage A first day and park in Garage B once you have your parking associated with your employee badge.
** If there is a parking attendant outside the garage that asks if you are a patient, just say yes otherwise they won't let you into the garage
* You'll confirm your Powerchart access, get scrubs/meal card, and meet with Dr. Dishon (Josh) who will take you around, expect to jump into a block as soon as opportunity arises
*There are three floors of ORs: Ground floor (hand +/- shoulders), 3rd floor (newer, knee/hip +/- shoulders), 4th floor (cardiothoracic and vascular [AKA's, BKA's, AVF's])
*Codes: Block cart (0531), 3rd floor staff lounge (2019)[[File:UMH Campus Map.png|thumb|Union Memorial Hospital Campus - Parking located off Calvert Street (turn onto 34th street).]]

==== Contact Info (please do not distribute) ====

* Nicole Mitchell (Admin Assistant) 410-554-6559
* Josh Dishon MD 443-904-2026
* Mark Jensen MD 585-953-9797
* Kerry Blaha MD 410-258-5758
* Tandi Mohammed MD 443-4447-5946
* Jane Radov MD 443-691-3000
* Rahul Guha MD 734-223-3061
* Marcelo Quezado MD 443-801-8889
* Sumanth Kuppalli MD 443-224-3500 

==== Block Recipes ====

* By and large, you will be using 0.5% ropivicaine for everything
** General volumes (more than you'll be used to):
*** Interscalene: 20 cc
*** Supraclavicular: 20-40 cc (I'm serious)
*** Infraclavicular: 30 cc
*** Adductor/Saphenous: 20 cc
*** Popliteal/Sciatic: 20 cc
**21G 100 mm block needle (exception: shorter needle for interscalene)
**Fent/Versed sedation universally
* For catheters, supplies include:
** PNC kit
** Vial(s) of 0.5% Ropivicaine
** Chloraprep, large/poptart Tegaderm, CHG Tegaderm dressing, sterile ultrasound probe cover (standard for all blocks, whether sterile or not), ultrasound gel, sterile gloves
*If two catheter sites, each pump is run with '''0.2%''' ropivicaine at 10 cc/hour intermittent bolus (PIB) without demand. Otherwise patients with single PNC (e.g. single adductor PNC) have PIB pumps programmed as 8/4/20/3 --> cc per hr / cc demand bolus / lockout interval in minutes / number of demands per hr.

==== Subsequent Days ====

* Arrive by 7:00 AM to catch attendings for any first start blocks (in room by 7:30 AM)
*Anticipate bouncing between floors for 1st case starts -> PACU catheters -> preop blocks
*'''Expect to feel like a medical student''' until you get to know attendings better
*Josh will often help connect you with attendings doing regional cases in the morning, but you will need to hover frequently
*Some attendings will get better about texting you when there is a block
* APS is a good opportunity for blocks/catheters on the floor. Dr. Jensen (Mark) runs APS service and is very good about keeping you in the loop, and proactive with creating block opportunities
*Fridays start with administrative meeting, thus case starts are at 8:30 AM
*Before going home, peek at the list of cases for the following day to figure out the best OR to show up to and when
**The anesthesia schedule is published separately and around 3 pm, so you'll likely have to ask someone if you want to know where specific attendings will be

=== Miscellaneous ===

* There is a full gym (free weights, machines, cardio) adjacent to the anesthesia offices in the 33rd Street Professional Building
* Nearby cafes for studying if preparing for ITE/Advanced:
** Bird in Hand (free wifi, outlets for laptop/phone, good food/beverage selection)

Ketamine

2022-07-15T00:50:10Z

Darreonschwartz: added pharmacokinetic data

{{Infobox drug reference
| trade_names = Ketalar
| image_file = Ketamine.svg
| image_caption =
| drug_class = Sedative hypnotic
| drug_class_color = sedative_hypnotic
| uses = Induction and maintenance of anesthesia, sedation, analgesia
| contraindications = * <3 months old
* Situations where elevated blood pressure or myocardial oxygen demand would be dangerous
* Schizophrenia
* Use controversial with elevated ICP or IOP
| routes = IV, IM, IN, PO, PR
| dosage = Induction of general anesthesia: 0.5-2 mg/kg IV
| dosage_calculation = ketamine
| mechanism = NMDA-receptor antagonism
| adverse_effects = Laryngospasm
Hypersalivation
Emesis
Emergence reaction
| time_onset = * IV: 15-30 seconds
* IM: 3-5 minutes
| duration = * IV: 5-10 minutes
* IM: 12-30 minutes (residual 0.5-2 hours)
* PO: 1-6+ hours
*Context-sensitive half-time: 40-55 minutes after 8 hours of continuous infusion
| metabolism = Liver (CYP3A4, CYP2B6)
| halflife_elimination = 2.5-3 hours
| protein_binding = 23-47%
| formula = C13H16ClNO
| molar_mass = 237.73 g/mol
}}

'''Ketamine''' is a dissociative anesthetic used for the induction of anesthesia, procedural sedation, and as an analgesic adjunct.

== Uses ==

== Contraindications ==

=== Absolute contraindications ===

=== Precautions ===

== Pharmacology ==

=== Pharmacodynamics ===

==== Mechanism of action ====

==== Adverse effects ====

=== Pharmacokinetics ===
Metabolized by hepatic microsomal enzymes to norketamine via ''N''-demethylation. Norketamine is then metabolized to hydroxynorketamine. Ultimately, hydroxynorketamine undergoes glucuronide conjugation and is excreted in the urine.

Norketamine has 33% of the potency of ketamine

The plasma disappearance of ketamine is traditionally described by a two-compartment model.

Elimination half-life: 2.5-2.8 hr

Clearance: 12-17 mL/kg/min

Vd at steady state: 3.1 L/kg

== Chemistry and formulation ==

== History ==

== References ==
Kamp J, Olofsen E, Henthorn TK, van Velzen M, Niesters M, Dahan A; Ketamine Pharmacokinetic Study Group. Ketamine Pharmacokinetics. Anesthesiology. 2020 Dec 1;133(6):1192-1213. doi: 10.1097/ALN.0000000000003577. PMID: 32997732.

Miller, Ronald D. Miller's Anesthesia. 7th ed. Philadelphia, PA: Churchill Livingstone/Elsevier, 2010.
[[Category:Drug reference]]
[[Category:General anesthetics]]
[[Category:Intravenous anesthetics]]
[[Category:Sedative hypnotics]]
[[Category:NMDA antagonists]]

WikiAnesthesia - User contributions [en]

Union Memorial (Regional)

Ketamine