Posts
Showing posts from 2016
Cardiac Arrest. Shockable and Non-Shockable Rhythms.
- Get link
- Other Apps
Acute restoration of sinus rhythm. Cardiac arrest is a sudden stop in effective blood flow due to the failure of the heart to contract effectively. During cardiopulmonary resuscitation (CPR) it is obligatorily to recognize Shockable or Non-Shockable the heart rhythm. It is important to know when to use defibrillation.
Adrenaline (Epinephrine) in anaphylaxis case.
- Get link
- Other Apps
As an alpha-receptor agonist, it reverses peripheral vasodilation and reduces oedema. Its beta-receptor activity dilates the bronchial airways, increases the force of myocardial contraction, and suppresses histamine and leukotriene release. There are also beta-2 adrenergic receptors on mast cells that inhibit activation, and so early adrenaline attenuates the severity of IgE-mediated allergic reactions.
Etiologies and diagnosis of fever of unknown origin
- Get link
- Other Apps
Anaphylaxis algorithm.
- Get link
- Other Apps
Anaphylaxis is a severe, life-threatening, generalised or systemic hypersensitivity reaction. Incidence rate : 30 - 950 cases per 100,000 persons per year. It is important to note that, in many cases, no cause can be identified. A significant number of cases of anaphylaxis are idiopathic (non-IgE mediated). Anaphylaxis is likely when all of the following 3 criteria are met:
Motor Response of Upper Limb Nerves to Stimulation.
- Get link
- Other Apps
Peripheral Nerve Stimulation is the most common method used to identify nerves percutaneously. Pure ulnar/radial/median nerve stimulation can only be achieved at the axilla or below. Indicates motor supply of the nerve. Sensory stimulation can be achieved with some peripheral nerve stimulators. Patient cooperation is desirable but not essential—sedation or GA is possible, but the patient should not have received neuromuscular blocking drugs. Possible reduced potential for nerve damage, because there is no need for direct physical contact with the nerve (paresthesia). Usually comfortable for the patient.
Abbreviated mental test score
- Get link
- Other Apps
The abbreviated mental test score ( AMTS ) is used in medicine to assess for confusion and other cognitive impairment, although it has mainly been validated in the elderly. The following questions are put to the patient. Each question correctly answered scores one point. A score of 7-8 or less suggests cognitive impairment at the time of testing, although further and more formal tests are necessary to confirm a diagnosis of dementia, delirium or other causes of cognitive impairment.
TURP syndrome.
- Get link
- Other Apps
TURP (t ransurethral resection of the prostate) syndrome - it is a combination of fluid overload and hyponatremia, which occurs when large volumes of irrigation fluid are absorbed via open venous sinuses. The most commonly used irrigant is glycine 1.5% in water, which is hypotonic (osmolality 220 mosm/L). On average, patients absorb a total of 1–1.5 L, but absorption of up to 4–5 L can be possible.
Narcotic (Opioid) Overdose.
- Get link
- Other Apps
The global prevalence of opiate (heroin and opium) use was estimated at 0.4% of the population, or 12.8-20.2 million people ( the United Nations Office on Drug and Crime (UNODC) ). F rom 2004 to 2011 medical use of opioids increased 100%; use of codeine decreased 20% ( ARCOS ). Receptors and main effects of opioids:
ECG. Right Bundle Branch Block (RBBB)
- Get link
- Other Apps
In case of Right Bundle Branch Block a ctivation of right ventricle is delayed and spreads through the septum from the left side (left ventricle). Blockade location, both in complete and partial blocks, is usually proximal. Main causes: Pulmonary embolism Chronic obstructive lung disease. Ischaemic heart disease (myocardial infarction) Hypertensive heart disease Myocarditis Cardiomyopathy RBBB also can occur in normal individuals without underlying heart disease ECG criteria:
Preparations and Drugs, are safe to use in Malignant Hyperthermia-susceptible patients
- Get link
- Other Apps
About 20% of patients redevelop symptoms of Malignant Hyperthermia. The mean time until symptoms redeveloped was 13 hours, with a range of 2.5 to 72 hours. (data from the NAMHR) Dantrolene pretreatment is no longer indicated. Dantrolene pretreatment may cause mild weakness in normal patients and significant weakness in patients with muscle disorders. The gold standard for diagnosis is the caffeine-halothane contracture test (CHCT). The patient’s muscle is exposed to incremental doses of halothane and caffeine, and the muscle is evaluated for the degree of contracture. Using this test is very limited. Preparations for Malignant Hyperthermia-susceptible patients:
Why Central Venous Pressure is not an indicator of cardiac output
- Get link
- Other Apps
Indications and Contraindications for Transesophageal Echocardiography (TEE)
- Get link
- Other Apps
Transesophageal Echocardiography (TEE) is often performed by a cardiac anesthesiologist to evaluate, diagnose, and treat patients in the perioperative period. TEE is very useful during many cardiac surgical procedures (e.g., mitral valve repair, off-pump and on-pump CABG). It helps to detect and quantify the disease preoperatively as well as to assess the results of surgery immediately after the procedure. If the repair is found to be inadequate,
Transapical off-pump mitral valve repair with Neochord Implantation (TOP-MINI): step-by-step guide
- Get link
- Other Apps
The step-by-step standardization of TOP-MINI provides an effective tool among the available minimally invasive MVR techniques. This procedure is feasible and highly reproducible with significant clinical results. It does not require any structural change to the dynamics of the operating room or cardiac surgery team. The TOP-MINI procedure does indeed push the boundaries of minimally invasive MVR techniques to a new level.
Anesthetic Care for Cesarean Delivery
- Get link
- Other Apps
This article is based on "Practice Guidelines for Obstetric Anesthesia. An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology". The decision to use a particular anesthetic technique for cesarean delivery should be individualized, based on anesthetic, obstetric, or fetal risk factors (e.g., elective vs. emergency), the preferences of the patient, and the judgment of the anesthesiologist. Uterine displacement (usually left displacement) should be maintained until delivery regardless of the anesthetic technique used. ( effective approach to managing hypotension as it helps in directly relieving the aortocaval compression ) Consider selecting neuraxial techniques in preference to general anesthesia (GA) for most cesarean deliveries. ( higher Apgar scores at 1 and 5 min for epidural anesthesia when compared with GA. When spinal anest
Successful intubation position.
- Get link
- Other Apps
Optimal positioning for obese patients with a short neck (especially in obstetrics) is the main predictor of successful intubation. Potential difficulty in securing the airway in pregnant patients may be due to: airway edema a full dentition large breasts that can obstruct the handle of the laryngoscope in patients with short necks increased intra- abdominal pressure High risk of regurgitation of gastric contents and acid aspiration syndrome Rapid onset of hypoxaemia after induction ( FRC reduced by 20% ) Risk of bleeding from airway manipulation due to coagulopathy in pre-eclampsia.
Management of Laryngospasm.
- Get link
- Other Apps
Laryngospasm is the most common cause of post-extubation upper airway obstruction.This may present as mild inspiratory stridor or complete airway obstruction. It is more common in children undergoing upper airway surgery. Laryngospasm is most frequently caused by local irritation by blood or saliva and is likely to occur in patients during light planes of anaesthesia, when they are neither able to prevent this reflex nor generate an adequate cough. In children, the incidence can be reduced if they are left undisturbed in the lateral recovery position until they wake up. I.V. magnesium (15 mg kg −1 over 20 min) and lidocaine (1.5 mg kg −1 ) have been used to prevent laryngospasm. Table describes a management plan for established laryngospasm:
General Anesthesia in Young Children Not Associated with Significant Neurological Impairments, Study Suggests
- Get link
- Other Apps
CHICAGO – Children who are exposed to general anesthesia from birth to age 2 have developmental testing results in kindergarten that are similar to those of children who have not been exposed, according to a new study published in the October issue of Anesthesiology , the official medical journal of the American Society of Anesthesiologists (ASA).
CURB-65 score for assessment of severity of pneumonia.
- Get link
- Other Apps
Acute Kidney Injury. Causes and Differential Diagnosis.
- Get link
- Other Apps
Read also: Anesthetic agents and impaired renal function. Acute kidney injury (AKI) is defined as an abrupt or rapid loss in kidney filtration function, that develops within 7 days. Main groups of causes are: I PRERENAL Absolute decrease in effective blood volume Severe blood loss Volume depletion Severe burns Relative decrease in blood volume (ineffective arterial volume) Congestive heart failure Decompensated liver cirrhosis Arterial occlusion or stenosis of renal artery Hemodynamic form NSAIDs ACE inhibitor or angiotensin-II receptor antagonists in renal-artery stenosis or congesitve heart failure II INTRINSIC RENAL Vascular Vasculitis, malignant hypertension Acute glomerulonephritis Postinfectious glomeronephritis disease caused by antibody to glomerular basement membrane Acute tubular necrosis Acute interstitial nephritis Ischemic Nephrotoxic Exogenous: Antibiotics (gentamicin), Radio contrast agents, Cisp
HEART DRUGS EFFECTS: INOTROPIC, BATHMOTROPIC and others
- Get link
- Other Apps
Emergency Treatment for An Acute Malignant Hyperthermia Crisis
- Get link
- Other Apps
Malignant hyperthermia: Causes and Clinical Manifestations
- Get link
- Other Apps
TAVI Mortality Higher vs SAVR in Intermediate-Risk Patients: GARY Registry
- Get link
- Other Apps
Larry Hand NEW ORLEANS, LA — Among intermediate-surgical-risk patients with aortic stenosis in a German registry, adjusted mortality at 1 year was significantly higher for those undergoing transcatheter aortic valve implantation (TAVI) compared to surgical aortic-valve replacement (SAVR), in a study presented here at the American Heart Association (AHA) 2016 Scientific Sessions [1] .
Transcatheter aortic valve implantation (TAVI):Indications and Contraindications
- Get link
- Other Apps
This new approach for the treatment of symptomatic patients with severe aortic stenosis (AS) has been shown to be feasible and safe in patients at very high or prohibitive surgical risk. The following are indications for Aortic Valve Replacement (AVR) for severe Aortic Stenosis that apply to either surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI):
TAVR heart procedure for inoperable aortic stenosis.
- Get link
- Other Apps
Measures for reducing brain injury during cardiac surgery.
- Get link
- Other Apps
Brain injury is a major source of patient morbidity after cardiac surgery and is associated with prolonged hospitalization, excessive operative mortality, high hospital costs, and altered quality of life. Main reasons: cerebral embolism by air, fat, atheromatous debris, thrombus (micro- or macroemboli) 50% of strokes; hypoperfusion inflammatory processes evoked from CPB and/or ischemia/reperfusion injury; Clinical forms of brain injury and relative frequencies: Clinical manifestation Frequency Stroke Low risk patient ≤ 1% High risk patient 5% to 16% Encephalopathy 8.4% to 32% Neurocognitive dysfunction Hospital discharge 40% to 75% One Month after surgery 12% to 30% Recommendations for measures to protect brain injury during cardiac surgery: see more: Brain Protection in Cardiac Surgery
How to Recognize Type of Coronary Dominance.
- Get link
- Other Apps
There are three types of coronary dominance. It depends on what coronary artery supplies the posterior descending artery . It can be estimated angiographically. First, h ave a look at the coronary anatomy. P osterior descending artery is written in red color. "RIGHT-DOMINANT" (70% of population): posterior descending artery is supplied by the right coronary artery ; "LEFT-DOMINANT" (10% of population): posterior descending artery is supplied by the circumflex artery , a branch of the left artery; "CO-DOMINANT" (20% of population): posterior descending artery is supplied by both the right coronary artery and the circumflex artery. Dominance has important implications in myocardial ischaemia and infarction. The tissue separating the right and left ventricles of your heart (the interventricular septum) receives blood predominantly from the left coronary artery, but the exact breakdown of blood source is deter
Steps for successful insertion of a laryngeal mask.
- Get link
- Other Apps
The laryngeal mask airway (LMA) is an acceptable alternative to mask anesthesia in the operating room. It is often used for short procedures when endotracheal intubation is not necessary. Here some important steps for successful insertion of LMA (click to enlarge) : Relative contraindications for the LMA: patients with pharyngeal pathology (eg, abscess) pharyngeal obstruction full stomachs (eg, pregnancy,hiatal hernia) low pulmonary compliance (eg, restrictive airways disease) requiring peak inspiratory pressures greater than 30 cm H2O.
Sevoflurane. Features, Organ Effects and Contraindications.
- Get link
- Other Apps
Look into the patients eyes
- Get link
- Other Apps
Do not ignore physical examination of your patient. It's interesting. For example, today's case: about 70 years old male, CABG procedure. What symptom do you see? Answer is under the spoiler ) ANSWER : Arcus senilis (or arcus senilis corneae) is a white, grey, or blue opaque ring in the corneal margin (peripheral corneal opacity), or white ring in front of the periphery of the iris. It is present at birth but then fades; however, it is quite commonly present in the elderly. It can also appear earlier in life as a result of hypercholesterolemia So it is sign of diffuse atherosclerosis .
Risk factors for postoperative pulmonary complications.
- Get link
- Other Apps
Table of risk factors for postoperative pulmonary complications. Click to enlarge: ASA, American Society of Anesthesiologists. 1. Within each evidence category, risk factors are listed according to strength of evidence, with the first factor listed having the strongest evidence. 2. Subsequent evidence indicates that this is a probable risk factor. Data from Smetana GW, Lawrence VA, Cornell JE, et al: Preoperative pulmonary risk stratifi cation for noncardiothoracic surgery: systematic review for the American College of Physicians, Ann Intern Med 2006;144(8):581-595.