TY  - CHAP
M1  - Book, Section
TI  - The Pharmacist’s Perspective
A1  - Dzierba, Amy L.
A1  - Barletta, Jeffrey F.
A2  - Lane-Fall, Meghan B
A2  - Shapiro, David S.
A2  - Kaplan, Lewis J.
PY  - 2024
T2  - After the ICU: Multidisciplinary Perspectives on Supporting Critical Illness Survivors
AB  - Patient  Care  VignetteA  76-year-old  woman  presents  to  the  emergency  department  (ED)  with  confusion,  lethargy,  fever,  cough,  and  shortness  of  breath.  Her  symptoms  have  progressively  worsened  over  the  past  3  days,  during  which  time  she  has  been  using  acetaminophen  (Tylenol)  and  over-the-counter  antihistamines.  Her  medical  history  is  significant  for  epilepsy  (though  she  has  been  seizure-free  for  20  years),  hypertension,  coronary  artery  disease,  diabetes  mellitus,  hypothyroidism,  and  end-stage  renal  disease.  She  undergoes  hemodialysis  three  times  weekly.In  the  ED,  she  had  low  blood  pressure  that  did  not  respond  to  intravenous  fluid.  She  also  had  a  low  oxygen  saturation  that  only  slightly  improved  with  100%  oxygen.  A  chest  X-ray  shows  pneumonia.  Shortly  thereafter,  she  was  working  so  hard  to  breathe  that  she  required  a  breathing  tube  to  be  placed  and  she  was  started  on  mechanical  ventilation.  Her  blood  pressure  fell  further,  and  she  required  an  infusion  of  a  vasopressor  to  raise  her  blood  pressure  to  a  safe  level.  Given  pneumonia,  she  was  also  administered  broad-spectrum  antibiotics.  ICU  care  was  required  for  septic  shock  related  to  pneumonia.The  ICU  pharmacist  helps  the  admitting  team  with  the  medication  reconciliation  process,  obtaining  the  patient’s  medication  list  from  her  outpatient  pharmacy.  The  patient’s  home  medications  include  divalproex,  levothyroxine,  metformin,  metoprolol,  lisinopril,  furosemide,  rosuvastatin,  calcium  acetate,  ferrous  sulfate,  and  a  daily  multivitamin.  The  patient’s  home  medications  are  not  initially  re-ordered,  as  each  one  needs  to  be  considered  in  light  of  septic  shock.  The  ICU  pharmacist  ensures  that  medications  that  may  decrease  her  blood  pressure  such  as  metoprolol,  lisinopril,  and  furosemide  are  not  initially  resumed.  Her  new  medications,  aside  from  antibiotics  and  a  vasopressor,  include  intravenous  fluid,  a  sedative  infusion,  a  gastric  acid–reducing  agent  for  stress  ulcer  prophylaxis,  subcutaneous  unfractionated  heparin  for  deep  venous  thrombosis  prophylaxis,  and  a  chlorhexidine  rinse  for  oral  care.  She  also  has  Tylenol  and  an  as-needed  dose  of  an  analgesic  for  pain  management.  
SN  - 
PB  - McGraw Hill
CY  - New York, NY
Y2  - 2024/10/04
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=1204537294
ER  -