Anesthesiology and Intensive Care

  Assessing Patient Readiness for Extubation

 Chris Nickson Spontaneous breathing trials (SBT) are used to identify patients who are likely to fail liberation from mechanical ventilation SBT is “the defacto litmus test for determining readiness to breathe without a ventilator” Ideally, during an SBT we want to observe the patient under  conditions of respiratory load that would simulate those following extubation

Cuff Leak Test    Chris Nickson OVERVIEW The cuff leak test is used to predict risk of post-extubation stridor in intubated patients Use and interpretation of the test needs to take into account the overall context of the patient’s condition and the management implications does not exclude obstruction due to supraglottic structures being splinted apart while the ETT is in situ PROCEDURE Suction endotracheal and oral secretions and set the ventilator in the assist control mode with the patient receiving volume-cycled ventilation With the cuff inflated, record displayed inspiratory and expiratory tidal volumes to see whether these are similar Deflate the cuff Directly record the expiratory tidal volume over the next six breathing cycles as the expiratory tidal volume will reach a plateau value after a few cycles Average the three lowest values The difference between the inspiratory tidal volume (measured before the cuff was deflated) and the averaged expiratory tidal volume (after cuf

  LASIK surgery: Is it right for you? LASIK eye surgery may mean no more corrective lenses. But it's not right for everybody. Learn whether you're a good candidate and what to consider as you weigh your decision. By Mayo Clinic Staff If you're tired of wearing eyeglasses or contact lenses, you may wonder whether LASIK surgery is right for you. LASIK is a type of refractive eye surgery. In general, most people who have laser-assisted in-situ keratomileusis (LASIK) eye surgery achieve 20/25 vision or better, which works well for most activities. But most people still eventually need glasses for driving at night or reading as they get older. LASIK surgery has a good track record. Complications that result in a loss of vision are rare, and most people are satisfied with the results. Certain side effects, particularly dry eyes and temporary visual disturbances, are fairly common. But these usually clear up after a few weeks or months, and very few people consider them to be a lo

CHOOSING ANTIBIOTICS There are some general guidelines that can be used in determining the appropriate antibiotic. Penicillins act against gram- positive and