After below the knee amputation?

[kigo]

Kaplan 2011-2012 CD argues that after below the knee amputation, the stump should be elevated by raising the foot of the bed postoperatively during the first 24hours. In the NCLEX rn thread that I downloaded from this site, the argument is the foot of bed shouldn't be raised during the first 24hrs but rather a pillow should be used to elevate the stump. What is what now?Thanks in advance for the help

[futurern34]

Saunders says elevate foot of bed to reduce edema for the 1st 24 hrs, after 24 hrs position prone. I think as long as we know to elevate we should be good. Go by your book. Just like after a myelogram the thread says water-based dye lay flat, oil-based elevate HOB or vice versa but you elevate for both. If air contrast is used lower HOB lower than trunk. According to Saunders pg 984. Hope this helps!

[kigo]

@Futurern34, thanks for the timely and very helpful response. I have just noted the thread is correct (it specifies for above knee, elevate with pillow & below knee raise foot of bed). Your observation on myelogram is critical...because I have also come across a source talking of flat position after air contrast.

Do you have an idea why in the thread they advocate use of Neostigmine/Atropine (anticholinergic) to reverse effect of pancuronium. Atropine makes sense but I think neostigmine is an anticholinesterase and thus would potentiate pancuronium.

[futurern34]

Sorry I don't. Don't even no what pancuronium is:bugeyes:, but will look it up tomorrow. Thanks.

[NewGoalRN]

I think:

Above knee amputation- elevate on pillow first 24hrs

Below knee amputation- elevate foot of bed first 24 hrs

[reginakrys]

Pancuronium is a muscle relaxant.

Neostigmine and Atropine have opposite effects. Neostigmine is an anticholinesterase, meaning it opposes or decreases the effect of the enzyme that breaks down acetylcholine, resulting in an increased level of ACh. Atropine, on the other hand, is an anticholinergic, so it blocks acetylcholine. Atropine is actually given to treat cholinergic crisis brought about by anticholinesterases.

Now, in relation to Pancuronium, I think Neostigmine would make sense if you're looking to reverse its effects. Neostigmine allows for muscular contraction to happen by increasing Ach.