Anesthesiology and Intensive Care

 A sigh maneuver, or a large tidal volume (Vt), has been suggested for reversing atelectasis; however, atelectasis is not uniformly reduced by a Vt increase or sigh up to airway pressure (Paw) of 20 cm H2O. 

Start reading here:  50+ IV Therapy Tips and Tricks: How to Hit the Vein in One Shot Starting an IV to a pediatric patient is extra challenging as their veins are smaller and are sometimes distressed when they see a needle. Hopefully, these IV tips for pediatric patients can help you:

  By  Matt Vera, BSN, R.N. We have all had our bitter experiences in a hospital; sometimes for simple accidents, sometimes for  infection  or fevers or even for some minor  surgery . But no matter what the reason may be, almost all of us would instantly agree that the factor that brought us back to good health, more than the medications, was nursing. Truly, hospitals would be much grimmer if it weren’t for the nursing staff looking after the ailing patients. We mean, if it weren’t for nursing, the only medical attention you will ever get is when the group of  doctors  comes around for rounds inspecting you like an odd specimen. So definitely nursing has transformed the way in which people heal, here we take a closer look at how it has helped hospitals to become a better place.

  A number of local anesthetic formulations are available for topical anesthesia , lidocaine, dibucaine, tetracaine, and benzocaine being the drugs used most commonly. In general, these preparations provide effective but relatively short durations of analgesia when applied to mucous membranes or abraded skin. Their efficacy is determined by drug form, melting point, concentration, and skin permeability. Lidocaine and tetracaine sprays are commonly used for endotracheal anesthesia before intubation or for mucosal analgesia for bronchoscopy or esophagoscopy.

   Obstructive sleep apnea (OSA) syndrome is an often overlooked cause of airway obstruction in the PACU, given that most patients are actually not obese and the vast majority of patients are undiagnosed at the time of surgery.

Control bleeding in ED/ICU/OR/Interventional Suite. Assess SpO2 and ventilation with view to early intubation . Review clinical condition and consider activation of massive transfusion protocol (MTP).  Insert large caliber central venous catheter (CVC) or two wide bore peripheral IV lines.  Reverse any anticoagulation therapy. 

Abdominal compartment syndrome results from intra-abdominal hypertension with organ dysfunction after major abdominal trauma and surgery (primary syndrome), although other patients may develop the syndrome without surgery, for example, during massive fluid resuscitation following major trauma or burns (secondary syndrome). The syndrome results from massive edema of abdominal organs produced by shock-induced inflammatory mediators, excessive fluid resuscitation, surgical manipulation, and closure of the abdominal fascia. The significant cardiac, pulmonary, renal, gastrointestinal, hepatic, and CNS dysfunctions caused by this syndrome result in a high mortality rate. 

 Heparin-Induced Thrombotic Thrombocytopenia Syndrome (HITTS) is a prothrombotic disorder caused by IgG mediated antibodies to complexes of platelet factor 4 (PF4) and heparin.

  One of the most promising indications for acupuncture is to prevent postoperative nausea and vomiting ( PONV ). PONV results in patient dissatisfaction, delayed discharge, unanticipated hospital admission, and the use of resources. Drugs have been the mainstay of management, however these have limited effectiveness, are associated with adverse effects, and can be costly. Acupuncture prevents PONV compared with sham acupuncture or no treatment.In two early controlled trials, acupuncture prevented PONV in the pediatric population; however, one literature review of 10 research studies examining the use of acupressure and acupuncture in adults concluded that it is not effective in preventing and managing PONV . Other clinical studies have found that acupuncture prevents PONV and results in a greater degree of adult patient satisfaction. For many of the trials in both adults and children, the PONV acupuncture point was P6 or PC6 (i.e., Nei guan or Pericardium 6). The P6 acupuncture point