sedationstation

End of CVC is in the superior vena cava,ideally at the junction with RA,this position decrease the risk of tip thrombosis and dysarthmyias... Look for complications as pneumothorax  Pulmonary artery catheters: ideally 5 – 8 cm beyond the bifurcation of the main pulmonary artery in either the R or L pulmonary artery,not to extend beyond the pulmonary hilum on CXR. ET tube: neck extension and flexion can make a tube move up to 3 cm. In neutral position tube should be 2- 3 cm  above the carina...remember flexion =further ,extension=exit  Tracheostomy tube: Tube tip should be at the level of T3. Exclude complications of pneumothorax, pneumomediastinum and subcutaneous emphysema..tracheostomy tube dose not move with neck movement  Pleural tubes: check all side holes are within the thorax Intra-aortic balloon pump: ideal position of the tip is just distal to the origin of the L subclavian artery on TOE, or tip in 2 nd intercostal space just above the left ma...

During glidescope directed intubation the common factor associated with intraoral injuries such as palatopharyngeal, anterior tonsillar pillar or soft palate perforations, is blind advancement of the endotra- cheal tube.  Injuries have occurred despite apparent gentle technique and the lack of resistance encoun- tered by the operator. When upward force is applied to the GlideScope ® to achieve better laryngeal visualisa- tion, the tonsillar pillars and related structures may be stretched taut and become susceptible to perforation .1 This highlights the need for constant visual assessment of the tip of the endotracheal tube under direct vision during the initial oral- pharyngeal insertion, as well as during subsequent advancement of the tube on the GlideScope ® monitor.  In the interim, there may be a blind spot, depending on the patient’s oral anatomy .2 A strategy to overcome such problems is to advance the endotracheal tube rig...

A simple mnemonic to remember the hepatic metabolism of inhaled anesthetics is the so-called "Rule of 2's."  Halothane is roughly 20% metabolized,  enflurane 2%,  isoflurane 0.2%,  desflurane 0.02%,  sevoflurane roughly 4% (2%   x   2).  The hepatic metabolism of nitrous oxide is negligible.  Of the inhaled anesthetics that are now available clinically, sevoflurane undergoes the most hepatic metabolism.

The average American sodium intake, the recommended dietary intake, a liter of normal saline, and a can of Campbell's soup.

Myocardial infarction can also be classified as occurring in the setting of percutaneous coronary intervention (Type 4) and coronary artery bypass grafting (Type 5).  What are the diagnostic criteria in these settings? In the setting of percutaneous coronary interventions (PCI) and normal baseline troponins, myocardial ischemia may be classified as  myocardial necrosis  (BM > 99URL) or  MI  (BM > 3 × 99URL). ( BM = biomarkers and URL = upper reference limit).  There is a subtype of MI related to documented stent thrombosis.  In the setting of coronary artery bypass grafting (CABG) and normal baseline troponins, myocardial ischemia may be classified as  myocardial necrosis  (BM > 99URL) or  MI (BM > 5 × 99URL). In addition to biomarker criteria, MI must have one of the following: New pathological Q waves or new LBBB Angiographically documented new graft or native coronary artery occlusion Imagin...

In the pressure-volume loop below, cardiac work is best represented by:   the area of the curve  the slope of the line from points C to D  the distance of the line from points C to D  the slope of a line from points A to D .. .. ... .... ... .... .... .... In the pressure-volume loop below, cardiac work is best represented by:  the area of the curve Cardiac work is the product of pressure and volume and is linearly related to myocardial oxygen consumption. Cardiac work is best represented by the area of the curve of a pressure-volume loop.

The use of anesthetic agents can effect the response to carbon dioxide.  Sedative doses of opioids shift the curve to the right without a significant change in the slope of the curve. Large doses of opioids have a similar effect to that of inhalational agents causing a shift to the right and a downward sloping. This effect means that for a given rate of alveolar ventilation would occur at a much higher PaCO2 and increases occur at a much slower rate.  Miller: Miller's Anesthesia, 7th ed. Pg 584 – 585 Koeppen & Stanton: Berne and Levy Physiology, Updated Edition, 6th ed. Chapter 2

Pain Term Definition Analgesia Absence of pain in response to a stimulus that is normally painful Anesthesia dolorosa Pain in an area that is anesthetic Chronic pain Pain that outlasts an initial injury to tissues Dysesthesia An unpleasant abnormal evoked sensation Hyperalgesia An increased response to a stimulus that is normally painful Neuralgia Pain in the distribution of a nerve or nerves Somatic pain Pain carried by sensory fibers; discrete and intense Pain threshold The least experience of pain that a subject can recognize Pain tolerance level The greatest level of pain that a subject is prepared to tolerate Neuritis Inflammation of a nerve or nerves Visceral pain Pain carried by sympathetic fibers; diffuse, poorly localized Paresthesia Abnormal sensation that is not unpleasant

Elevated troponin is non specific ...troponin elevation doesn't mean always AMI... There are myriad causes for elevated troponin ... Chronic elevation like in HF patient or renal failure  Acute elevation could be due type 2 MI which essentially a demand supply phenomenon..fix the cause first ,and look If the patient needs further testing  The most important cause of elevated troponin is AMI type 1 ....here you got to activate ACS algorithms ... In practical approach ,what to do with a raised troponin: (a) Repeat the troponin level and assess for a rise and/or fall. (b) If there is no rise and/or fall, this is not AMI. Think about the patient: is this someone you expect to have a chronic troponin elevation or is this totally unexpected? (c) If the troponin is elevated and there is a rise and/or fall on serial testing, think about the clinical context. Is there an underlying condition causing a supply-demand imbalance? If so, this is most likely a type 2 AMI. Treat t...

Expect the Unexpected Neonatal Oral Mass Diagnosed at Birth Anesthesiology May 2013 A full-term, 3.5-kg neonate was transferred for management of a large, mobile intraoral mass. The infant demonstrated no signs of airway obstruction or respiratory  distress and had normal oxygen saturation without support. The child did not seem dysmorphic and the mass was isolated  to the anterior maxillary alveolar ridge, easily mobilized out of mouth. A prenatal ultrasound at 20 weeks did not identify any anomalies. Adequate ventilation was achieved after mobilizing the mass extraorally and achieving adequate mask seal. At this point, a mask induction with spontaneous ventilation was performed, followed by uneventful intubation. The mass was considered low risk for airway obstruction during induction  because it did not disturb the airway anatomy, and was easily mobilized out of the mouth. Epulis, or congential granular cell tumor, is a rare tumor of variable size and number ori...

   Portopulmonary hypertension (POPH) refers to the presence of pulmonary arterial hypertension (PAH) in patients with portal hypertension.    Among patients with portal hypertension, reported incidence rates of POPH range from 2 to 9%.    Long-term survival in cases of POPH is poor.    Pulmonary hypertension in patients with liver disease or portal hypertension can be due to multiple mechanisms: ►   hyperdynamic (high-flow) state ►   increased pulmonary venous congestion ►   vascular constriction or obstruction of the pulmonary arterial bed    Vascular obstruction to pulmonary arterial flow, reflected by increased pulmonary vascular resistance (PVR), is a key parameter that defines POPH