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IDARUCIZUMAB (PRAXBIND)

Description

Monoclonal antibody fragment that binds to dabigatran (Pradaxa), stopping its thrombin-blocking effect.

Dose

5 g IV given as two injections of 2.5 g over 5–10 min. A second 5 g dose can be given if needed. Praxbind is effective within 5 min of administration. Dabigatran can be restarted 24 h after Praxbind.

IDEAL BODY WEIGHT (IBW)

IBW is defined as the weight associated with the lowest mortality (as calculated from actuarial studies) and is calculated from the patient's height. IBW calculators are available online. Numerous equations can be used, including Broca or Robinson.

The Broca formula is:

  • Women: IBW (kg) = (height in cm – 100) + [(height in cm − 100) × 0.15]

  • Men: IBW (kg) = (height in cm − 100) + [(height in cm − 100) × 0.1]

The Robinson equation is:

  • Women: IBW (kg) = 49 kg + 1.7 kg × (height in inches − 60)

  • Men: IBW (kg) = 52 kg + 1.9 kg × (height in inches − 60)

ILIOINGUINAL AND ILIOHYPOGASTRIC NERVE BLOCKS

Introduction

The iliohypogastric nerve supplies sensation to the skin above the inguinal ligament, the suprapubic region and the lateral thigh. The ilioinguinal nerve supplies sensation to the medial upper thigh, scrotum and pubic area. Blocking these nerves is useful for inguinal hernia and scrotal surgery.

Anatomy

These nerves are branches of the L1 spinal nerve from the lumbar plexus, with a branch from T12. The L1 primary ventral ramus enters the upper part of the psoas muscle, where it branches into the ilioinguinal and iliohypogastric nerves.

The two nerves emerge at the lateral border of the psoas muscle, and pass anterior to the quadratus lumborum muscle. They then run in a plane between the internal oblique and transversus abdominis muscles. The ventral rami of the nerves then pierce the internal oblique and lie between the internal and external oblique muscle layers.

Block using ultrasound in the adult

Use aseptic technique. Prepare a syringe with 15 mL of 1% ropivacaine and a short-bevelled block needle.

  1. Place the ultrasound probe medial to the anterior superior iliac spine (ASIS), angled upwards on an imaginary line between the ASIS and the umbilicus.

  2. The nerves are seen between the muscle layers very near to the ASIS, at a depth of about 3 cm. At this point the nerves are consistently between the internal oblique and rectus abdominis muscles.

  3. Insert the needle in-plane from medial to lateral so the needle tip lies near the nerves between the muscle layers.

  4. After a negative aspiration test, inject 10–15 mL ...

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