The document provides information on pediatric resuscitation. It discusses:
1) Poor survival rates of 4-13% for out-of-hospital pediatric cardiac arrest, though in-hospital is higher at 27%. Early prevention through recognition of respiratory distress or shock can improve outcomes.
2) A systematic approach following the pediatric chain of survival - assessing airway, breathing, circulation, disability, and exposure.
3) Key differences in pediatric resuscitation including airway anatomy and techniques for opening and maintaining the airway. Emphasis is placed on high-quality chest compressions and minimizing interruptions during CPR.
The document discusses preoperative assessment of obstetric patients and rapid sequence induction. It outlines that preoperative assessment is important to identify high-risk patients, minimize risks by planning care, and determine urgency of procedures. All obstetric patients requiring anesthesia should undergo assessment. Rapid sequence induction involves rapid intravenous induction and application of cricoid pressure followed immediately by intubation to minimize aspiration risk. Cricoid pressure application and controversies surrounding its use are also discussed.
The document discusses Pap smear, CTG, urine dip test, and gram staining procedures including definitions, indications, preparations, equipment, nursing processes, and considerations for each test. It provides details on how to perform a Pap smear and CTG, what each test is used to detect, and factors nurses should consider when administering the tests.
This document summarizes data from an airway committee meeting regarding intubation outcomes at a hospital (RCH). The key points are:
1) Intubation data from 582 cases over 3 years was reviewed and complications increased significantly with more than one intubation attempt.
2) International studies also found increased complications with more than one attempt, supporting the committee's findings.
3) The committee made recommendations to improve outcomes, such as developing difficult airway protocols, checklists for intubation, and identifying difficult airway patients.
4) Future areas for improvement included more education and establishing airway experts to handle difficult cases. Standardizing equipment and procedures was also recommended.
Spirometry for Primary Care Physician OfficeRandy Clare
Step by step description of how to collect spirometry tests for Asthma and COPD. Quality control tips supported by literature with links to NIH, NIOSH and the Mayo Clinic. This is a presentation that I use to discuss hand held spirometry products from Carefusion. Micro Loop, Micro Lab, Micro 1 and Pulmolife
This document provides an overview of initial assessment and management of trauma patients in remote environments. It discusses the primary survey using CABCDE to rapidly identify life threats, including controlling hemorrhage, maintaining the airway, and assessing breathing and circulation. It also covers the secondary survey, prolonged field care, definitive care, and obtaining a thorough history including mechanism of injury to help predict injuries. The systematic approach outlined aims to stabilize patients and prepare them for evacuation.
1. The document outlines pre-operative care and considerations for patients undergoing surgery. It discusses the pre-operative consultation, investigations, patient history and risk factors, airway examination, ASA classification, and prophylaxis against complications like DVT.
2. Pre-operative investigations that should be performed for all patients include a full blood count, urea and electrolytes test, electrocardiogram for patients over 40, and chest x-ray for patients over 30. Additional tests may be needed depending on medical history or procedure.
3. Risk factors for complications like DVT are identified as age over 40, obesity, previous DVT/PE, immobility, and certain medical conditions. Prophylaxis
The document provides information on pediatric resuscitation. It discusses:
1) Poor survival rates of 4-13% for out-of-hospital pediatric cardiac arrest, though in-hospital is higher at 27%. Early prevention through recognition of respiratory distress or shock can improve outcomes.
2) A systematic approach following the pediatric chain of survival - assessing airway, breathing, circulation, disability, and exposure.
3) Key differences in pediatric resuscitation including airway anatomy and techniques for opening and maintaining the airway. Emphasis is placed on high-quality chest compressions and minimizing interruptions during CPR.
The document discusses preoperative assessment of obstetric patients and rapid sequence induction. It outlines that preoperative assessment is important to identify high-risk patients, minimize risks by planning care, and determine urgency of procedures. All obstetric patients requiring anesthesia should undergo assessment. Rapid sequence induction involves rapid intravenous induction and application of cricoid pressure followed immediately by intubation to minimize aspiration risk. Cricoid pressure application and controversies surrounding its use are also discussed.
The document discusses Pap smear, CTG, urine dip test, and gram staining procedures including definitions, indications, preparations, equipment, nursing processes, and considerations for each test. It provides details on how to perform a Pap smear and CTG, what each test is used to detect, and factors nurses should consider when administering the tests.
This document summarizes data from an airway committee meeting regarding intubation outcomes at a hospital (RCH). The key points are:
1) Intubation data from 582 cases over 3 years was reviewed and complications increased significantly with more than one intubation attempt.
2) International studies also found increased complications with more than one attempt, supporting the committee's findings.
3) The committee made recommendations to improve outcomes, such as developing difficult airway protocols, checklists for intubation, and identifying difficult airway patients.
4) Future areas for improvement included more education and establishing airway experts to handle difficult cases. Standardizing equipment and procedures was also recommended.
Spirometry for Primary Care Physician OfficeRandy Clare
Step by step description of how to collect spirometry tests for Asthma and COPD. Quality control tips supported by literature with links to NIH, NIOSH and the Mayo Clinic. This is a presentation that I use to discuss hand held spirometry products from Carefusion. Micro Loop, Micro Lab, Micro 1 and Pulmolife
This document provides an overview of initial assessment and management of trauma patients in remote environments. It discusses the primary survey using CABCDE to rapidly identify life threats, including controlling hemorrhage, maintaining the airway, and assessing breathing and circulation. It also covers the secondary survey, prolonged field care, definitive care, and obtaining a thorough history including mechanism of injury to help predict injuries. The systematic approach outlined aims to stabilize patients and prepare them for evacuation.
1. The document outlines pre-operative care and considerations for patients undergoing surgery. It discusses the pre-operative consultation, investigations, patient history and risk factors, airway examination, ASA classification, and prophylaxis against complications like DVT.
2. Pre-operative investigations that should be performed for all patients include a full blood count, urea and electrolytes test, electrocardiogram for patients over 40, and chest x-ray for patients over 30. Additional tests may be needed depending on medical history or procedure.
3. Risk factors for complications like DVT are identified as age over 40, obesity, previous DVT/PE, immobility, and certain medical conditions. Prophylaxis
Spirometry is a common pulmonary function test that measures breath volume and flow. It can be used to detect lung disease, monitor occupational exposures, and assess medication effects. This document provides an overview of how to properly perform and interpret spirometry tests, including ensuring patient preparation and positioning, using correct technique, assessing test quality, and comparing results to reference values to determine if lungs are normal or abnormal. Quality is important for obtaining accurate and reproducible results.
The document provides guidance on assessing and managing suspected COVID-19 patients using the ABCDE approach. It outlines how to assess the airway, breathing, circulation, disability, and exposure of patients and what interventions may be needed for each. Key points covered include performing risk assessments, applying infection control measures, assessing vital signs and symptoms related to ABCDE, and providing oxygen therapy, IV fluids, or other supportive treatments as needed. The document emphasizes reassessing patients after any interventions and the importance of effective handover communication if transfer to a higher level of care is needed.
Capnography: Discover Patient Safety Secrets Right Under Your NoseChristina Mason
This document discusses the importance and benefits of capnography monitoring in healthcare. Capnography provides immediate and accurate information about a patient's ventilation status and response to interventions in a noninvasive way. It can be used for patients of all ages and in many clinical situations, such as procedural sedation, opioid administration, assessing ventilation during cardiac arrest or CPR, and guiding ventilator management. The document recommends capnography monitoring as it can help detect complications early, guide treatment, and improve patient outcomes and safety.
This document discusses the partogram, a tool for recording the progress of labor. It explains that the partogram graphs cervical dilation, fetal descent, and uterine contractions on a chart to allow healthcare providers to monitor labor and identify complications early. The document outlines the components recorded on a partogram, including fetal heart rate, amniotic fluid, maternal vital signs, and medications. It describes how to interpret the alert and action lines plotted on the partogram to determine if labor is progressing normally or requires intervention. The partogram is an important tool that facilitates continuity of care during labor and allows early detection of problems like prolonged or obstructed labor.
The document provides guidance on evaluating and treating polytrauma patients. It outlines the goals of trauma resuscitation which include identifying life-threatening injuries. The Advanced Trauma Life Support (ATLS) approach is recommended as a safe standardized method, beginning with the primary survey of ABCDE (airway, breathing, circulation, disability, exposure). Key assessments include mechanism of injury, vital signs, neurological status, and bleeding control. A thorough secondary survey then involves a full head-to-toe examination. Guidance is given on managing specific injuries such as abdominal trauma, with operative intervention prioritized for unstable patients or those with signs of internal bleeding.
An infection control nurse informed the PICU consultant that two patients have been found to have MDR Acinetobacter infections. This may constitute an Acinetobacter outbreak. The consultant should confirm it is an outbreak by investigating patients and the environment, calculating the attack rate, and comparing it to the background rate. If confirmed, treatment and prevention measures should be implemented, including isolation, cohorting, strict sterilization and disinfection procedures.
This document discusses abdominal trauma, including its causes, signs and symptoms, diagnostic tests, and management. It notes that abdominal trauma peaks among 15-30 year olds and is most often caused by motor vehicle accidents or falls. Diagnostic tests include FAST scan, CT scan, DPL, and laparoscopy. Treatment depends on whether the trauma is blunt or penetrating and involves stabilizing the patient, identifying internal injuries, and treating those injuries either operatively or non-operatively. Nursing management focuses on monitoring for shock, sepsis, and other complications.
This document discusses awake tracheal intubation in the emergency department. It provides a brief history of awake intubation and outlines its benefits over rapid sequence intubation, including maintaining protective airway reflexes and avoiding risks of induction agents. The document also summarizes guidelines for patient selection, preparation, equipment, and outcomes of awake intubation. Key considerations include thorough airway assessment, use of cognitive aids, positioning to optimize oxygenation, and video laryngoscopy as an effective tool.
869 peak expiratory flow rate measurements final (2)nadahsalih
This document provides guidelines for measuring peak expiratory flow rate (PEFR) in clinical practice. It outlines who is allowed to perform PEFR measurements, the proper technique for patients, and the procedure staff should follow. PEFR is an objective measure of lung function used to monitor patients with asthma or chronic obstructive pulmonary disease. Serial measurements allow clinicians to track a patient's condition and response to treatment over time. The guidelines aim to promote accurate and reproducible PEFR readings.
This document discusses prenatal screening and diagnosis of fetal anomalies. It describes various risks that can affect every fetus, including chromosomal anomalies, structural anomalies, growth disorders, placental problems, infections, and liquor problems. Screening tests are recommended to triage mothers into high-risk and low-risk categories, prevent maternal complications, and screen the fetus for chromosomal and structural defects to decide the optimal time and mode of delivery. Approximately 3% of viable fetuses would be born with a severe anomaly, and prenatal diagnosis has reduced the incidence of severe defects at birth by diagnosing many early in the first trimester.
This document summarizes guidelines for managing the unanticipated difficult airway. It outlines a 4-plan approach:
Plan A is the initial intubation attempt. Plan B is secondary intubation methods if Plan A fails, such as video laryngoscopy or supraglottic airway devices. Plan C focuses on oxygenation and ventilation if intubation still cannot be achieved.
Plan D describes rescue techniques for "can't intubate, can't ventilate" situations. It recommends cannula cricothyroidotomy as first-line over surgical cricothyroidotomy, as studies show anaesthetists have lower success rates with scalpel techniques than surgeons. Proper training and familiar equipment are
This document discusses evidence and recommendations for improving airway management to prevent errors. It notes that evidence for current practices is limited. Data on airway errors comes from case reports, expert opinions, and rare cohort studies. Two key sources of data are the American Society of Anesthesiologists’ Closed Claim Project and the NHS Litigation Authority closed litigation database in the UK. The document recommends practices like using capnography for all intubations, developing intubation checklists, recognizing difficult airway risks and having backup plans, training staff, and conducting regular audits to improve airway management in emergency departments, intensive care units, and other clinical settings.
1) Balanced anesthesia aims to achieve loss of consciousness, memory, pain, and muscle tone. It involves preoperative, intraoperative, and postoperative management.
2) Preoperative management includes obtaining history, performing examination, ordering relevant investigations, and administering premedication. Key parts of examination focus on cardiovascular, respiratory, airway, and neurological systems.
3) Intraoperative management consists of monitoring, positioning the patient, selecting anesthesia technique, inducing and maintaining anesthesia, administering fluids, and performing extubation and recovery.
4) Postoperative management involves transferring the patient, providing pain management, and addressing any complications.
Two years before surgery, the surgeon must prepare themselves through skills training, observing other surgeons, and ensuring the operating room (OR) and team are ready. One week before, the surgeon confirms the indication for surgery, reviews contraindications and counsels the patient. The day before, the patient receives instructions and the surgeon ensures the OR and team are prepared. On the day of surgery, the surgeon obtains consent, checks equipment and the anesthetized patient is brought to the OR. Special considerations are discussed for obese, pregnant and high risk patients.
This document discusses respiratory disorders in newborns. It begins by defining respiratory distress and noting that it affects 4-7% of neonates and is responsible for 30-40% of NICU admissions, with higher rates in preterm infants. The main causes of respiratory distress are discussed as transient tachypnea of the newborn, respiratory distress syndrome, pneumonia, meconium aspiration syndrome and persistent pulmonary hypertension of the newborn. Diagnosis involves assessing respiratory rate, retractions, oxygen saturation and chest x-rays. Management involves supportive care, surfactant replacement therapy and managing complications.
The document summarizes the key changes to first aid guidelines published jointly by the American Red Cross and American Heart Association in 2005 based on a review of scientific evidence and expert consensus. Some of the major changes included recommendations around controlling external bleeding, treating wounds, burns, and frostbite. The guidelines aimed to provide medically sound, evidence-based assessments and interventions for first aid while avoiding delays in activating emergency medical services when needed. The development process involved an international collaborative effort to achieve scientific consensus on first aid practices.
This document discusses guidelines for imaging pregnant women to minimize radiation risk to the fetus. It provides that for most extra-abdominal exams, the fetal radiation dose is less than 0.1 mSv and risks are only increased above 150 mSv. Exams of the abdomen/pelvis can deliver up to 25 mGy but rarely exceed risks. Proper screening and documentation of pregnancy status is important. Guidelines recommend explicit questioning and documentation of last menstrual period and fetal risks/benefits should be considered before higher dose exams. Increased awareness through signage is suggested.
This document discusses interval colorectal cancer (CRC) diagnosed after a colonoscopy that did not detect cancer. It provides background on CRC screening and defines interval CRC. It examines the scope of the problem and explanations for interval CRC, including missed lesions, new lesions, and incompletely resected lesions. It discusses approaches to prevent interval CRC, such as improving bowel preparation, cecal intubation rates, adenoma detection rates, and adherence to surveillance recommendations. Future directions discussed include improved technologies, training and quality assurance programs.
Acute appendicitis is one of the most common conditions treated in the emergency room all over the world. And it has come a long way from the first described it to present, where a number of studies are reported in the topic. Claudius Amyandin 1735 is credited with performing the first Appendectomy whilein 1886 Reginald Fitz first described the clinical features and pathologic abnormalities of appendicitis.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Spirometry is a common pulmonary function test that measures breath volume and flow. It can be used to detect lung disease, monitor occupational exposures, and assess medication effects. This document provides an overview of how to properly perform and interpret spirometry tests, including ensuring patient preparation and positioning, using correct technique, assessing test quality, and comparing results to reference values to determine if lungs are normal or abnormal. Quality is important for obtaining accurate and reproducible results.
The document provides guidance on assessing and managing suspected COVID-19 patients using the ABCDE approach. It outlines how to assess the airway, breathing, circulation, disability, and exposure of patients and what interventions may be needed for each. Key points covered include performing risk assessments, applying infection control measures, assessing vital signs and symptoms related to ABCDE, and providing oxygen therapy, IV fluids, or other supportive treatments as needed. The document emphasizes reassessing patients after any interventions and the importance of effective handover communication if transfer to a higher level of care is needed.
Capnography: Discover Patient Safety Secrets Right Under Your NoseChristina Mason
This document discusses the importance and benefits of capnography monitoring in healthcare. Capnography provides immediate and accurate information about a patient's ventilation status and response to interventions in a noninvasive way. It can be used for patients of all ages and in many clinical situations, such as procedural sedation, opioid administration, assessing ventilation during cardiac arrest or CPR, and guiding ventilator management. The document recommends capnography monitoring as it can help detect complications early, guide treatment, and improve patient outcomes and safety.
This document discusses the partogram, a tool for recording the progress of labor. It explains that the partogram graphs cervical dilation, fetal descent, and uterine contractions on a chart to allow healthcare providers to monitor labor and identify complications early. The document outlines the components recorded on a partogram, including fetal heart rate, amniotic fluid, maternal vital signs, and medications. It describes how to interpret the alert and action lines plotted on the partogram to determine if labor is progressing normally or requires intervention. The partogram is an important tool that facilitates continuity of care during labor and allows early detection of problems like prolonged or obstructed labor.
The document provides guidance on evaluating and treating polytrauma patients. It outlines the goals of trauma resuscitation which include identifying life-threatening injuries. The Advanced Trauma Life Support (ATLS) approach is recommended as a safe standardized method, beginning with the primary survey of ABCDE (airway, breathing, circulation, disability, exposure). Key assessments include mechanism of injury, vital signs, neurological status, and bleeding control. A thorough secondary survey then involves a full head-to-toe examination. Guidance is given on managing specific injuries such as abdominal trauma, with operative intervention prioritized for unstable patients or those with signs of internal bleeding.
An infection control nurse informed the PICU consultant that two patients have been found to have MDR Acinetobacter infections. This may constitute an Acinetobacter outbreak. The consultant should confirm it is an outbreak by investigating patients and the environment, calculating the attack rate, and comparing it to the background rate. If confirmed, treatment and prevention measures should be implemented, including isolation, cohorting, strict sterilization and disinfection procedures.
This document discusses abdominal trauma, including its causes, signs and symptoms, diagnostic tests, and management. It notes that abdominal trauma peaks among 15-30 year olds and is most often caused by motor vehicle accidents or falls. Diagnostic tests include FAST scan, CT scan, DPL, and laparoscopy. Treatment depends on whether the trauma is blunt or penetrating and involves stabilizing the patient, identifying internal injuries, and treating those injuries either operatively or non-operatively. Nursing management focuses on monitoring for shock, sepsis, and other complications.
This document discusses awake tracheal intubation in the emergency department. It provides a brief history of awake intubation and outlines its benefits over rapid sequence intubation, including maintaining protective airway reflexes and avoiding risks of induction agents. The document also summarizes guidelines for patient selection, preparation, equipment, and outcomes of awake intubation. Key considerations include thorough airway assessment, use of cognitive aids, positioning to optimize oxygenation, and video laryngoscopy as an effective tool.
869 peak expiratory flow rate measurements final (2)nadahsalih
This document provides guidelines for measuring peak expiratory flow rate (PEFR) in clinical practice. It outlines who is allowed to perform PEFR measurements, the proper technique for patients, and the procedure staff should follow. PEFR is an objective measure of lung function used to monitor patients with asthma or chronic obstructive pulmonary disease. Serial measurements allow clinicians to track a patient's condition and response to treatment over time. The guidelines aim to promote accurate and reproducible PEFR readings.
This document discusses prenatal screening and diagnosis of fetal anomalies. It describes various risks that can affect every fetus, including chromosomal anomalies, structural anomalies, growth disorders, placental problems, infections, and liquor problems. Screening tests are recommended to triage mothers into high-risk and low-risk categories, prevent maternal complications, and screen the fetus for chromosomal and structural defects to decide the optimal time and mode of delivery. Approximately 3% of viable fetuses would be born with a severe anomaly, and prenatal diagnosis has reduced the incidence of severe defects at birth by diagnosing many early in the first trimester.
This document summarizes guidelines for managing the unanticipated difficult airway. It outlines a 4-plan approach:
Plan A is the initial intubation attempt. Plan B is secondary intubation methods if Plan A fails, such as video laryngoscopy or supraglottic airway devices. Plan C focuses on oxygenation and ventilation if intubation still cannot be achieved.
Plan D describes rescue techniques for "can't intubate, can't ventilate" situations. It recommends cannula cricothyroidotomy as first-line over surgical cricothyroidotomy, as studies show anaesthetists have lower success rates with scalpel techniques than surgeons. Proper training and familiar equipment are
This document discusses evidence and recommendations for improving airway management to prevent errors. It notes that evidence for current practices is limited. Data on airway errors comes from case reports, expert opinions, and rare cohort studies. Two key sources of data are the American Society of Anesthesiologists’ Closed Claim Project and the NHS Litigation Authority closed litigation database in the UK. The document recommends practices like using capnography for all intubations, developing intubation checklists, recognizing difficult airway risks and having backup plans, training staff, and conducting regular audits to improve airway management in emergency departments, intensive care units, and other clinical settings.
1) Balanced anesthesia aims to achieve loss of consciousness, memory, pain, and muscle tone. It involves preoperative, intraoperative, and postoperative management.
2) Preoperative management includes obtaining history, performing examination, ordering relevant investigations, and administering premedication. Key parts of examination focus on cardiovascular, respiratory, airway, and neurological systems.
3) Intraoperative management consists of monitoring, positioning the patient, selecting anesthesia technique, inducing and maintaining anesthesia, administering fluids, and performing extubation and recovery.
4) Postoperative management involves transferring the patient, providing pain management, and addressing any complications.
Two years before surgery, the surgeon must prepare themselves through skills training, observing other surgeons, and ensuring the operating room (OR) and team are ready. One week before, the surgeon confirms the indication for surgery, reviews contraindications and counsels the patient. The day before, the patient receives instructions and the surgeon ensures the OR and team are prepared. On the day of surgery, the surgeon obtains consent, checks equipment and the anesthetized patient is brought to the OR. Special considerations are discussed for obese, pregnant and high risk patients.
This document discusses respiratory disorders in newborns. It begins by defining respiratory distress and noting that it affects 4-7% of neonates and is responsible for 30-40% of NICU admissions, with higher rates in preterm infants. The main causes of respiratory distress are discussed as transient tachypnea of the newborn, respiratory distress syndrome, pneumonia, meconium aspiration syndrome and persistent pulmonary hypertension of the newborn. Diagnosis involves assessing respiratory rate, retractions, oxygen saturation and chest x-rays. Management involves supportive care, surfactant replacement therapy and managing complications.
The document summarizes the key changes to first aid guidelines published jointly by the American Red Cross and American Heart Association in 2005 based on a review of scientific evidence and expert consensus. Some of the major changes included recommendations around controlling external bleeding, treating wounds, burns, and frostbite. The guidelines aimed to provide medically sound, evidence-based assessments and interventions for first aid while avoiding delays in activating emergency medical services when needed. The development process involved an international collaborative effort to achieve scientific consensus on first aid practices.
This document discusses guidelines for imaging pregnant women to minimize radiation risk to the fetus. It provides that for most extra-abdominal exams, the fetal radiation dose is less than 0.1 mSv and risks are only increased above 150 mSv. Exams of the abdomen/pelvis can deliver up to 25 mGy but rarely exceed risks. Proper screening and documentation of pregnancy status is important. Guidelines recommend explicit questioning and documentation of last menstrual period and fetal risks/benefits should be considered before higher dose exams. Increased awareness through signage is suggested.
This document discusses interval colorectal cancer (CRC) diagnosed after a colonoscopy that did not detect cancer. It provides background on CRC screening and defines interval CRC. It examines the scope of the problem and explanations for interval CRC, including missed lesions, new lesions, and incompletely resected lesions. It discusses approaches to prevent interval CRC, such as improving bowel preparation, cecal intubation rates, adenoma detection rates, and adherence to surveillance recommendations. Future directions discussed include improved technologies, training and quality assurance programs.
Acute appendicitis is one of the most common conditions treated in the emergency room all over the world. And it has come a long way from the first described it to present, where a number of studies are reported in the topic. Claudius Amyandin 1735 is credited with performing the first Appendectomy whilein 1886 Reginald Fitz first described the clinical features and pathologic abnormalities of appendicitis.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
2. Getting your credits
❖ NBCRNA Core Module #1: Airway
❖ Series of 3 Airway lectures online: INCLUDED in
conference fee
❖ CRNA Today is a recognized vendor for NBCRNA &
Prior Approve by the AANA
3. Getting your credits
❖ FIRST – Visit and Register at CRNAToday.com
❖ Enroll in the Airway: NBCRNA Core Module #1….At check out utilize your Coupon
Code “1FL” followed by your AANA number. NO Leading zero. Click Update
❖ Online lecture
❖ Can be viewed on-demand….
❖ 3 attempts to pass Post Test
❖ To get Class A Credit- A Post Test grade of 80% is required
❖ 3 Attempts
❖ Certificate is only available after passing
❖ All records submitted to the AANA monthly
4.
5. Objectives
❖ The Learner will demonstrate the appropriate steps in assessing an
airway to develop the appropriate patient-specific plan that ensures
safe management of the airway and facilitates continuity of care
❖ The Learner will identify the indications and contraindications
associated with the use of airway equipment.
❖ The Learner will understand the associated malpractice claims
arising from the management of the airway, using a closed claims
analysis.
❖ The Learner will identify the complications associated with airway
equipment
6. History of Airway
Management
Morton Inhaler
Dräger “Pulmonator”
Alfred Kirstein
Autoscope
1943 1941
Murphy Endotracheal Tube
“Airway Management”
A broad term used to describe the tools, techniques and procedures
used to support and control oxygenation and ventilation as well as
delivery of anesthetics.
7. Getting started
❖ What factors need to be considered?
• NPO status
• Risk of aspiration
• Patient factors
• Surgeon factors
• Type and length of surgery
• Regional anesthesia
• Provider competencies
8. Preoperative Fasting
Guidelines
❖ 2017: ASA updated recommendations for pre-operative
fasting1
• 2 hours clear liquids
• 4 hours breast milk
• 6 hours solid foods, infant formula & non-human milk
• 8 hours fried or fatty foods
9. Preoperative Fasting
Guidelines
❖ Gum, smokeless tobacco, hard
candy2
• Not specifically addressed
by the ASA guidelines
• European Society of
Anaesthesiology
guidelines do NOT
recommend delaying
anesthesia
10. Aspiration Prophylaxis
❖ Overall incidence of aspiration remains very low
❖ Incidence of anesthesia related fatal aspiration was only
1:350,000 (.0003%)3
❖ In the NAP4 study, aspiration was responsible for 50% anesthetic
deaths.3
❖ Risk of aspiration is greater with higher patient Physical Status
(ASA status) and emergency surgery3
11. Aspiration Prophylaxis
❖ The intended goal of aspiration prophylaxis is to
decrease gastric volume and pH.
❖ Sodium Citrate, Metoclopramide, Ranitidine (or other H2
antagonist)
The ASA guidelines do NOT recommend routine
prophylaxis1
12. Aspiration Prophylaxis
❖ Full stomach
❖ Diabetic gastroparesis
❖ Symptomatic GERD
❖ Pregnancy
❖ Emergency surgery
❖ ESRD
❖ GI obstruction
❖ Hiatal hernia
❖ Active N/V
❖ NG tube
❖ Morbid obesity
Indications: 4, 5
13. Aspiration Prophylaxis in
Pregnancy
Updated report from ASA task force on Obstetric Anesthesia & the
Society for Obstetric Anesthesia and Perinatology6
For clear liquids: “The uncomplicated patient undergoing elective surgery (e.g.
scheduled C/S, post partum tubal ligation) may have moderate amounts of clear
liquids before induction of anesthesia.”
For solids: “The patient undergoing elective surgery (e.g. scheduled C/S, post
partum tubal ligation) should undergo a fasting period of 6-8 hours depending on
the type of food ingested (e.g. fat content).”
Before surgical procedures (e.g., cesarean delivery or post- partum tubal
ligation) “The clinician should consider the timely administration of nonparticulate
antacids, H2 antagonists, and/or metoclopramide for aspiration prophylaxis.”
After 20 weeks gestation, extra caution should be exercised with the unprotected
airway to prevent aspiration29
14. Aspiration Prophylaxis
Strategies for reducing aspiration risk3
Reducing gastric
volume
Preoperative fasting, nasogastric aspiration, pro
kinetic premedication
Avoidance of general
anesthesia
Is regional anesthesia an option?
Reducing pH of gastric
contents
Antacids, H2 antagonists, proton pump inhibitors
Airway protection
Tracheal intubation, 2nd generation supra-glottic
airway devices
Prevent regurgitation Rapid sequence induction
Extubation
Extubate only after awake and airway reflexes have
returned
15. Cricoid Pressure & Preventing
Aspiration
Is it time to LET GO of cricoid pressure?
16. Cricoid Pressure & Preventing
Aspiration
❖ Does cricoid pressure (CP) reduce the risk of aspiration?
• Evidence to support that CP is effective is based almost exclusively on cadaver studies and
case reports of regurgitation occurring after CP has been released. There is no evidence for or
against the use of CP and there are no published randomized controlled trials comparing the
incident of regurgitation on induction, with or without the use of CP. Additionally, CP has been
shown to decrease LES tone thus potentially increasing the risk of aspiration.3
❖ Is cricoid pressure properly applied?
• Who is applying the CP? Have they been trained? Do YOU even know how to properly apply?
❖ Does properly applied cricoid pressure actually compress the esophagus?
• The esophagus is laterally displaced relative to the midline of the vertebral body in 49%-53% of
subjects without cricoid pressure being applied. When CP was applied, lateral displacement
increased by 53%- 91%.7
❖ Does cricoid pressure increase or decrease the quality of the laryngeal view?
• Numerous articles have been published with contradictory results. However, it has been found
that application of > 40N of force can compromise airway patency and cause difficulty with
tracheal intubation.7
❖ Is CP harmful?
• Difficult laryngoscopy, esophageal rupture, cricoid fracture8
❖ Are there any contraindications to use of CP?
• Trauma to anterior neck, unstable C-spine, obstructing mass, active vomiting8
17. Cricoid Pressure & Preventing
Aspiration
Is it time to LET GO of cricoid pressure?
Cochrane Anaesthesia, Critical and Emergency Care Group9
There is currently NO information available from published RCTs
(randomized controlled trials) on clinically relevant outcome measures
with respect to the application of cricoid pressure during RSI.
18. Cricoid Pressure & Preventing
Aspiration
To correctly apply cricoid pressure,
30 - 40N (3 - 4 Kg)
of force should be applied downward onto the cricoid cartilage.10
If you are going to do it, you should at least do it correctly.
19. Just how good is your
cricoid?
Investigator
Ok, please proceed with the application of
cricoid pressure to the test fixture
21. Just how good is your
cricoid?
Investigator
Are you applying cricoid pressure to the test
fixture?
22. Just how good is your
cricoid?
Participant
Yes, of course
23. Just how good is your
cricoid?
Investigator
Something must be wrong. We’re not
registering any pressure? You are pressing
down on the cricoid, right?
24. Just how good is your
cricoid?
Participant
Oh no, I would never do that. I always
“squeeze” the sides of the throat. Pushing down
would obstruct the view of the person
intubating.
25. Just how good is your
cricoid?
Investigator
And how long have you been applying cricoid
pressure in this manner?
26. Just how good is your
cricoid?
Participant
For 38 years!
28. Airway
Assessment
No single test has been devised that can
predict a difficult airway 100% of the time;
especially when tests are done by
themselves.
Evaluating the Airway
29. Modified Mallampati
Classification
• Originally described in 1983, Mallampati is an easy to perform, commonly used airway assessment
tool. As a stand alone tool however, it is insufficient to predict the difficult airway.11
• In a meta analysis of over 177,000 patients, only 35% of patients with a difficult intubation were
identified as Mallampati III or IV.11
• May be useful clinically when used in combination with other airway predictors11
• To properly perform, the neck should be neutral (not extended) and the patient should not phonate4
30. LEMON
Test15 Evaluation
Look externally
Are there any physical
attributes that stand out?
Evaluate 3-3-2 3-3-2 rule
Mallampati
Obstruction/Obesity
Facial trauma, edema,
foreign body, obesity, large
breasts?
Neck mobility RA? Radiation? Burns?
*Adapted with permission from The Difficult Airway Site (TheAirwaySite.com) &
Walls RM & Murphy, MF:Manual of Emergency Airway Management, 4th ed
Philadelphia, Lippincott, Williams and Wilkins, 2012
31. El-Ganzouri Multivariate Risk
Index
Abdel Raouf Sayed Ahmed El-Ganzouri, M.D.
Test 12, 13 Score
Mouth Opening 0 - 1
Mallampati 0 - 2
TM Distance 0 - 2
Neck Movement 0 - 2
Hx difficult intubation 0 - 2
Ability to prognath 0 - 1
Weight 0 - 2
TOTAL 0 - 12
A score ≥ 4 indicates potential difficulty when performing direct laryngoscopy
32. Documenting EGRI
A score ≥ 4 indicates potential difficulty when performing direct laryngoscopy
0 1 2
Mouth Opening ≥ 4 cm < 4 cm
Mallampati 1 2 3, 4
TM Distance > 6.5 cm 6 - 6.5 cm < 6 cm
Neck Movement > 90 80 - 90 < 80
Hx difficult intubation No Questionable Yes
Ability to prognath Yes No
Weight < 90 kg 90 - 110 kg > 110 kg
Total =_______
35. Positioning
Ideally, the external auditory meatus should be in horizontal alignment
with the sternal notch.
Positioning of the obese patient14
36. Capnography
❖ Continuously monitor ETC02 during controlled or assisted ventilation
and any anesthesia or sedation technique requiring artificial airway
support. During moderate or deep sedation, continuously monitor
for the presence of expired C02.16
37. Preoxygenation
❖ Optimal is 3 mins Vt, but 8 Vc
may be acceptable.4
❖ ET O2 should be > 90% to
maximize apnea time.4
❖ What’s the purpose?
Denitrogenation: increase
the time a patients will stay
oxygenated during apnea
38. Mask Ventilation
❖ Indications: preoxygenation, short
duration anesthetic, bridge to
definitive airway4
❖ Relative contraindication: full
stomach, facial trauma, unstable c-
spine4
❖ Complications: hyper/hypo
ventilation, aspiration4
Ideally, peak inspiratory pressure should be kept less than 20cm H2O4
39. Prediction of Difficult Mask
Ventilation
*Adapted with permission from The Difficult Airway Site (TheAirwaySite.com) & Walls RM & Murphy, MF:Manual of
Emergency Airway Management, 4th ed Philadelphia, Lippincott, Williams and Wilkins, 2012
MOANS15
Difficult Mask Ventilation Mnemonic
Mask Seal Beard? Jowls?
Obese
Age > 55 y/o
No Teeth Is the patient edentulous
Stiff/Snoring Stiff neck/jaw? Sleep apnea?
41. Supraglottic Airway
❖ Indication: facilitate oxygenation and ventilation, delivery
of anesthesia, conduit to intubation, bridge to extubation,
failed intubation (rescue device)17
❖ Relative Contraindications: Active GERD, obesity,
traumatic airway injury, intestinal obstruction, intoxication,
restricted mouth opening, deformed airway anatomy17
❖ Complications: Inadequate ventilation, airway injury, sore
throat, tongue edema, frenulum injury, aspiration17
Cuff pressure should be <60 cm H2O18
42. Supraglottic Airways (SGA)
❖ 1st generation: LMA Classic and
other manufacturers of laryngeal
masks19
• Simple, low pressure
• Easy to place
❖ 2nd generation: i-gel, LMA ProSeal,
LMA Supreme19
• Additional design features to reduce
aspiration risk, allow for higher seal
pressure to facilitate controlled ventilation,
and may also have integrated bite block.
43. Prediction of Difficult SGA
Placement
RODS15
Difficult SGA Placement Mnemonic
Restricted Mouth opening
Obstruction
Distorted Airway
Stiff lungs/neck
*Adapted with permission from The Difficult Airway Site (TheAirwaySite.com) & Walls RM & Murphy,
MF:Manual of Emergency Airway Management, 4th ed Philadelphia, Lippincott, Williams and Wilkins,
2012
44. LMA in the Prone Patient
❖ Review prone LMA insertion in 441
subjects in 1 RCT, 2 description
studies, 1 case series and 2 case
reports20
❖ Successful LMA placement: 100%
❖ Successful ventilation: 100%
❖ Risks: “Comparable to those when
LMA’s are used in the supine patient.”
45. Endotracheal Intubation
❖ Indications: General anesthesia, aspiration prevention,
respiratory failure, inadequate oxygenation/ventilation4
❖ Contraindications: Penetrating or blunt force trauma to
the upper airway anatomy, unstable c-spine4
❖ Complications: Sore throat, dental damage, soft tissue
damage, vocal cord damage4
46. Modified Cormack-Lehane
❖ The Cormack-Lehane classification, first described in 1984, is broadly used
to describe the laryngeal view obtained during laryngoscopy4
❖
4Yentis further defined this grading system in 1998 when he divided Grade 2 into 2A and 2B4
47. Direct Laryngoscopy
The goal of traditional direct laryngoscopy
is to obtain direct line of sight with the
glottic opening. To accomplish this task,
the rigid laryngoscope is used to align the
oral, pharyngeal and laryngeal axes.
In the overall patient population, clinicians are unable to visualize the
vocal cords when performing direct laryngoscopy up to 7.5% of
patients21
49. Predictors of Difficult Video
Laryngoscopy
❖ Usual clinical indicators of difficult direct laryngoscopy
& intubation do not appear to predict difficult video
laryngoscopy.22
❖ In a study of 6,278 subjects, patients were divided into
2 groups base on their EGRI score21
• ≥ 7 and patient received awake FOB
• ≤ 6 and patients were intubated via video
laryngoscope
❖ 6 patients received awake FOB based on protocol, 1
patients received awake FOB based on presence of
large neck tumor and another an awake tracheostomy
for the same reason (even though their score was less
than 7). All other patient were intubated via video
laryngoscope.
❖ The incidence of C/L grade III was only 0.14% when
performing VL. Grade IV was not encountered. All
patients in the study were successfully intubated.
50. Regional anesthesia and the difficult
airway
❖ Regional anesthesia is recommended in patients with
potentially difficult airways who present for surgery23
❖ However incidents may occur after the initiation of
regional anesthesia that would “force” the clinician to
manage the airway. These incidents may include
hemorrhage, high/total spinal, anaphylaxis, failed
block23
❖ A successful regional anesthetic may help avoid the
need to directly manage a difficult airway, it does not
prevent it23
Even when utilizing regional anesthesia, an airway management
strategy should always be discussed with the patient and planned in
advance23
51. Apneic Oxygenation
❖ 15 L/min
❖ May prolong the time patient
maintain adequate oxygen
saturation during
laryngoscopy/intubation
Use of high-flow nasal cannula oxygen therapy can
prevent desaturation during tracheal intubation24
52. ETT Cuff Pressure
❖ Complications associated with excessive ETT cuff
pressure can include25
• Sore throat
• Recurrent laryngeal nerve palsy
• Mucosal ischemia
• Tracheal ulceration
• Tracheal stenosis
• Trachea-esophageal fistula
• Death
❖ Studies have shown an inability to accurately identify ETT cuff pressure by palpating the
pilot balloon.
❖ No correlation between years in practice or number of intubations performed and the
ability to properly inflate the ETT cuff or detect over inflation.
❖ Current evidence suggests that a minimum volume of air to obviate air flow past the cuff,
up to a maximum pressure of less than 25cm H20, is safest to minimize complications
from high ETT cuff pressures.
53. Closed claims and the airway
Originally 223 cases (1989-1997) from the records of St. Paul Fire and Marine
Insurance Company. Reviewed by 8 CRNA researchers
Updated recently looking at 245 claims (2003-2012 ) provided by CNA insurance
company. Reviewed by 15 CRNA researchers
AANA Foundation Closed Claims Analysis26
54. Closed claims and the airway
❖ Years of experience do not appear to be a factor in terms of frequency of
occurrence of adverse events.
❖ 69.8% of adverse events occurred in hospitals
❖ 68.2% of the events are confirmed to have occurred during the intra-anesthesia
period but only 38.8% of the events became apparent to the provider during the
intra-anesthesia period.
❖ 45.5% of negative outcomes were preventable
❖ In 32.7%, anesthesia management was deemed to have been inappropriate
❖ Respiratory events are responsible for the most common negative outcomes
(31.8%).
❖ When there was a failure to meet AANA Practice Standards for Nurse Anesthetists,
breach of standard #5 (includes continuous monitoring of oxygenation and
ventilation) occurred 2nd most often behind breach of standard #4
AANA Foundation Closed Claims Analysis26
55. Closed claims and the airway
❖ Established in 1985 in an attempt to improve patient
safety and prevent anesthesia related injuries
❖ At the time, 11% of total dollars paid for anesthesia
related patient injuries while Anesthesiologist accounted
for only 3% of total physicians insured
❖ Data is derived from lawsuits regardless of the litigation
outcome
ASA Closed Claims Database27
56. Closed claims and the airway
❖ Respiratory system issues accounted for 17% of all
claims
❖ The most common respiratory events leading to
anesthesia claims were difficult intubation, inadequate
oxygenation or ventilation and pulmonary aspiration
❖ Claims arising from esophageal intubation have largely
disappeared with the adoption of capnography
ASA Closed Claims Database27
(1990-2007)
57. Closed claims and the airway
Respiratory events leading to claims27
(1990-2007)
58. Closed claims and the airway
Claims related to the difficult airway27
(1990-2007)
59. Closed claims and the airway
Lessons Learned27
❖ During airway emergencies, persistent intubation
attempts were associated with death or permanent
brain damage
❖ The LMA was not an effective rescue device in some
claims in which multiple, prolonged intubation
attempts had been made
❖ Surgical airway should be instituted early in the
management of the difficult airway
60. Closed claims and the airway
❖ NAP4: National Audit Project of the
Royal College of Anesthetist and the
Difficult Airway Society28
❖ Not a closed claims per se.
Evaluated cases from 309 NHS
hospitals in the UK over a year
(2008-2009)
❖ Designed to evaluate what types of
airway devices are used during
anesthesia, how often complications
resulting in serious harm occur and
to see how this information be used
to reduce the incidence of these
events and complications.
61. Closed claims and the airway
❖ NAP 4 Highlights28
• Poor airway assessment
• Poor planning: Plan vs Strategy
• Failure to plan for Failure
• Failed use of awake FOI
• Repeated intubation attempts
• Supraglottic devices were used inappropriately
• High failure rate of needle cricothyroidotomy
• Aspiration was the single most common cause of death
Poor judgment,
as determined by both the reporters and the reviewers,
repeatedly appeared to be the most common cause of events
62. The Takeaway
❖ Chose the right tool for the right patient (proper
preparation, strategy)
❖ Learn from other’s mistakes (closed claims)
63. References
1. Practice Guidelines for Preoperative Fasting & the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy
patients undergoing elective procedures. An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the
Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology. 2017;126(3):376-393.
2. Smith I, Kranke P, Murat I, et al. Perioperative fasting in adults and children. European Journal of Anaesthesiology. 2011;28(8):556-569.
doi:10.1097/eja.0b013e3283495ba1.
3. Robinson M, Davidson A. Aspiration under anesthesia: Risk assessment and decision making. Continuing Education in Anaesthesia Critical Care and Pain.
2014;14(4):171-175.
4. Miller RM et al.,eds. Miller's Anesthesia. 8th ed. Philadelphia: Saunders; 2015: 1652-1680.
5. Butterworth JF, Mackey DC, Wasnick JD, eds. Morgan & Mikhail’s Clinical Anesthesiology. 5th ed. McGraw Hill Companies. New York: 2013: 769.
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2014;30(1):3. doi:10.4103/0970-9185.125683.
8. Stewart JC, Bhananker S, Ramaiah R. Rapid-sequence intubation and cricoid pressure. International Journal Critical Illness and Injury Science.
2014;4(1):42–49.
9. Algie CM, Mahar RK, Tan HB, Wilson G, Mahar PD, Wasiak J. Effectiveness and risks of cricoid pressure during rapid sequence induction for
endotracheal intubation. Cochrane Database of Systematic Reviews. 2015. doi:10.1002/14651858.cd011656.
10. Lefave M, Harrell B, Wright M. Analysis of Cricoid Pressure Force and Technique Among Anesthesiologists, Nurse Anesthetists, and Registered Nurses.
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11. Lundstrom LH, Vester-Andersen M, Moller AM, Charuluxananan S, L'hermite J, Wetterslev J. Poor prognostic value of the modified Mallampati score: a
meta-analysis involving 177 088 patients. British Journal of Anaesthesia. 2011;107(5):659-667.
12. El-Ganzouri AR, Mccarthy RJ, Tuman KJ, Tanck EN, Ivankovich AD. Preoperative Airway Assessment. Anesthesia & Analgesia. 1996;82(6):1197-1204.
doi:10.1213/00000539-199606000-00017.
13. Corso RM, Cattano D, Buccioli M, Carretta E, Maitan S. Post analysis simulated correlation of the El-Ganzouri airway difficulty score with difficult
airway. Brazilian Journal of Anesthesiology (English Edition). 2016;66(3):298-303. doi:10.1016/j.bjane.2014.09.003.
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doi:10.1213/ane.0b013e31821c7e9c.
15. Walls RM, Murphy MF. Manual of Emergency Airway Management, 4th Ed Philadelphia: Lippincott Williams and Wilkins; 2012.
64. References
16. Standards for Nurse Anesthesia Practice. American Association of Nurse Anesthetists website.
http://www.aana.com/resources2/professionalpractice/Pages/Scope-of-Nurse-Anesthesia-Practice.aspx. Updated 2013. Accessed June 12, 2016.
17. Michalek P, Donaldson W, Vobrubova E, Hakl M. Complications Associated with the Use of Supraglottic Airway Devices in Perioperative Medicine.
BioMed Research International. 2015;2015:1-13. doi:10.1155/2015/746560.
18. Kang J-E, Oh C-S, Choi JW, Son IS, Kim S-H. Postoperative Pharyngolaryngeal Adverse Events with Laryngeal Mask Airway (LMA Supreme) in
Laparoscopic Surgical Procedures with Cuff Pressure Limiting 25 : Prospective, Blind, and Randomised Study. The Scientific World Journal. 2014;2014:1-7.
doi:10.1155/2014/709801.
19. Cook T, Howes B. Supraglottic Airway devices: Recent Advances. Contin Educ Anaesth Crit Care Pain Continuing Education in Anaesthesia, Critical Care
& Pain. 2011;11(2):56-61. 10.1093/bjaceaccp/mkq058.
20. Whitacre W, Dieckmann L, Austin PN. An Update: Use of Laryngeal Mask Airway Devices in Patients in the Prone Position; AANA Journal. 2014:82(2).
21. Caldiroli D, Cortellazi P. A new difficult airway management algorithm based upon the El Ganzouri Risk Index and GlideScope videolaryngoscope. A
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22. Diaz-Gomez JL, Satyapirya A, Satyapriya SV et al. Standard clinical risk factors for difficult laryngoscopy are not independent predictors of intubation
success with the GlideScope. Journal of Clinical Anesthesia. 2011; 23(8):603-610 doi:10.1016/j.jclinane.2011.03.006.
23. Saxena, N. (2013). Airway management plan in patients with difficult airways having regional anesthesia. J Anaesthesiology Clin Pharmacol Journal of
Anaesthesiology Clinical Pharmacology. 2013:29(4):558 doi.org/10.4103/0970-9185.119106.
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