Monday, January 24, 2011

Quit Smoking Calculator

Quit Smoking Calculator

Quit Smoking Calculator calculates the total amount saved based on how much money is spent daily on smoking cigarettes. Enter the average paid per day for smoking for the year. Then, enter the average return in an investment. The default value is 5%, a good mutual fund's return. Then, put in the total years saved. For example, if a 30 year old quits smoking, enter 35 for the number of years till retirement. The yearly savings will be calculated, and that will be added to the investment every year. The interest will be compounded till the final savings is calculated.

Tuesday, January 18, 2011

Diagnostic Paracentesis

Diagnostic paracentesis is a simple bed side procedure. The basic items needed are a 60 cc syringe, 10 cc syringe, chloraprep, 18 gauge needle, 22 gauge needle, sterile gloves, ultrasound, lidocaine bottle, cap, and mask. Find a safe area to draw peritoneal fluid on the abdomen. The left lower quadrant or right lower quadrant can be used. The largest risk of a diagnostic paracentesis is bowel perforation with the sharp needles. The left lower quadrant is preferred by some since the cecum is prominent in the right lower quadrant. After finding an appropriate area with the ultrasound, sterilize the area and inject with lidocaine. Inject a wheal superficially with a 10 cc syringe and 22 gauge needle. Then inject perpendicularly deeper into the tissue beyond the muscle layers. Always apply negative pressure before injecting to avoid hitting a vein. The needle should advance into the peritoneum and ascites should be aspirated. Inject the lidocaine into the peritoneal area and inject along the pathway as the needle is pulled out. Use the 18 gauge and 60 cc syringe to aspirate the ascites along the anesthetized pathway. Obtain 60 ccs of fluid. Diagnostic paracentesis fluid should be sent for the following tests: cell count and differential, culture, albumin, and total protein. The most important initial test is cell count and differential. If the product of WBC count and segment percentage is greater than 250, then the patient has spontaneous bacterial peritonitis and needs to be treated with intravenous antibiotics. One option is Ceftriaxone. Cultures will provide specific microbe identification and antibiotic sensitivity. Albumin and protein can also help to identify the etiology of ascites, usually differentiating cardiac from hepatic sources. A diagnostic paracentesis is often important and mandatory for all patients admitted with ascites. 

FE Urea Calculator

Fractional Excretion of Urea =

((Urine Urea/Plasma Urea)*100
(Urine Creatinine/Plasma Creatinine))

FE Urea is used to determine the type of renal failure in patients using diuretics, since the FeNa calculation can be inaccurate. Fractional excretion of urine less than 35% is consistent with a pre-renal acute renal failure.

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Monday, January 03, 2011