Surprisingly, ... “minor” surgical procedures were associated with high pain intensities....the most likely is that patients undergoing the(se) procedures that have the reputation of being less painful received inadequate pain relief” Anesthesiology April 2013
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Injury Mechanism Minimisation Strategy Volutrauma Non-homogenous lung injury Over-distension of normal alveolar units to trans- pulmonary pressures above ~30 cm H 2 O (that corresponds to approximate total lung volume) causes basement membrane stretch and stress on intracellular junctions. Avoid over-distending the “baby lung” of ARDS: (a) Maintain Plateau Airway pressure under 30 cm H20 (b) Use Tidal volumes 6ml/kg (4- 8ml/kg) Good evidence to support this strategy (ARDSNet) Barotrauma Increasing the trans-pulmonary pressures above 50 cm H 2 O will cause disruption of the basement membranes with classical barotrauma Biotrauma Mechanotransduction and tissue disruption leads to upregulation and release of chemokines and cytokines with subsequent WBC attraction and activation resulting in pulmonary and systemic inflammatory response and multi-organ dysfunction ...
The burn injuries affects multiple anatomical area with major physiologic consequences.... Below is the summary of the anatomical and physiological insults .... 1-Supraglottal Loss of airway patency due to mucosal oedema Loss of airway reflexes due to coma (e.g. blast Traumatic brain injury, intoxications such as carbon monoxide,) Tracheobronchial Bronchospasm resulting from inhaled irritants Mucosal oedema and endobronchial sloughing causing small airway occlusion, leading to intrapulmonary shunting. Pulmonary Parenchymal Pulmonary (alveolar) oedema and collapse leading to decreased compliance, and further intrapulmonary shunting. Loss of tracheobronchial epithelium and airway ciliary clearance contributing to tracheobronchitis and pneumonia. Barotrauma, ARDS, pleural effusions, Ventilator associated pneumonia, TRALI and tracheobronchitis may all result from Intensive Care resuscitation, and treatments o...
Adrenal Insufficiency Hyponatraemia Hyperkalaemia Non anion gap acidosis Hypoglycaemia Hypercalcaemia Refeeding Syndrome Hypophosphataemia Hypokalaemia Hypomagnesaemia Hyperglycaemia Tumour Lysis Syndrome Hyperphosphataemia Hyperkalaemia Hypocalcaemia Hyperuricaemia Metabolic acidosis Ethylene Glycol Toxicity High anion gap acidosis High osmolar gap Hypocalcaemia
ETCO2 aids the e valuation of the exhaled [CO 2 ], especially end-tidal CO 2 , which is the maximum partial pressure of CO 2 exhaled during a tidal breath (just prior to the beginning of inspiration) and is designated PetCO 2. it is highy used in the OR...less in ICU...lesser in other units... below are the main uses 1. Use as an adjunct to determine that tracheal rather than esophageal intubation has taken place (Low or absent cardiac output may negate its use for this indication.);colorimetric CO 2 detectors are adequate devices for this purpose. 2. Monitoring severity of pulmonary disease and evaluating response to therapy, especially therapy intended to improve the ratio of dead space to tidal volume (V D /V T ) and the matching of ventilation to perfusion (V/Q) ,and, possibly, to increase coronary blood flow 3. Continued monitoring of the integrity of the ventilatory circuit, including the artificial airway 4. Evaluation of the eff...
If you are interested in neuroanesthesia....click on the link below.... It is the best site to learn about neuroanatomy and neurology ... Click here
Peak Expiratory Flow Rate (PEFR) This is a simple method of measuring airway obstruction and it will detect moderate or severe disease. The simplicity of the method is its main advantage. It is measured using a standard Wright Peak Flow Meter or mini Wright Meter. The needle must always be reset to zero before PEF is measured. Normal values are related to the patient's height as follows: Height (cm) PEFR (L/min)* 120 215 130 260 140 300 150 350 160 400 170 450 180 500 * mean; 2 SD = ±100 An easy to remember approximation is: PEFR (L/min) = [Height (cm) - 80] x 5
Duration of Flow = Oxygen Tank Conversion Factor * Remaining Tank Pressure (psi) / Continuous Flow Rate (L/min) Oxygen Cylinder Conversion Factors • D Tank = 0.16 • E Tank = 0.28 • G Tank = 2.41 • H/K Tank = 3.14 • M tank = 1.56
It has been demonstrated that neuromuscular response to stimulation is greater if the negative electrode is placed distally. Remember ‘Positive is Proximal, Negative to Nerve’ References Fuchs-Buder T, Schreiber J, Meistelman C. Monitoring neuromuscular block: an update. Anaesthesia 2009; 64(S1): 82–9.