This brief presentation does not cover all of the ophthalmology surgeries, but will give you a brief review about what is what. It starts with eye anatomy, physiology, pharmacology and leads up to anaesthesia considerations.
This document discusses the dental management of asthmatic pediatric patients. It begins by defining asthma as a chronic inflammatory airway disorder characterized by recurrent wheezing, breathlessness, chest tightness and coughing. It notes that asthma prevalence has increased in children over the past 20 years. The document then discusses the burden of asthma in children, signs and symptoms, diagnosis, medications used to treat and manage asthma, as well as considerations for treating asthmatic patients in a dental setting including avoiding triggers and properly managing acute asthma attacks.
Evidence based Management of acute severe asthmaDr Rakesh Kumar
This document provides evidence-based guidelines for the management of acute asthma exacerbations in children aged 0-18 years. It discusses the epidemiology and classification of exacerbation severity based on symptoms, signs, and functional assessment. Treatment recommendations include supplemental oxygen, short-acting beta-agonists, ipratropium bromide, corticosteroids, magnesium sulfate, and epinephrine or terbutaline for more severe cases. Inhalation delivery devices, heliox, and care for patients not responding to initial treatment are also covered.
Asthma is a chronic inflammatory airway disease characterized by periods of reversible bronchospasm. Common triggers include allergens, irritants, and environmental factors. Symptoms include wheezing, coughing, chest tightness, and shortness of breath. Diagnosis involves assessing symptoms, lung function tests, and response to treatment. Management involves long-term control medications like inhaled corticosteroids and bronchodilators, as well as quick-relief medications for exacerbations. Treatment is tailored based on asthma severity and level of control.
Respiratory Distress & Status asthmaticus in Paediatricsmeducationdotnet
1. Respiratory distress is a clinical condition of increased respiratory rate and accessory muscle use that can progress to respiratory failure. Common causes include central or peripheral airway obstruction, diffuse lung damage, or issues with the respiratory pump.
2. Management involves ABCDE emergency care and non-invasive respiratory support with oxygen, nasal CPAP, or BiPAP if not in impending respiratory failure. The goal is restoring gas exchange with minimal complications by addressing underlying causes.
3. Mechanical ventilation may be needed for severe hypoxemia or hypercarbia from pneumonia, or when other systemic dysfunction jeopardizes gas exchange. Hypoxemia is prioritized over hypercarbia.
Treatment of Asthma Exacerbations in the Pediatric Emergency Departmentjrhoffmann
This document discusses the treatment of asthma exacerbations in pediatric emergency departments. It begins with definitions of an asthma exacerbation and status asthmaticus. It then covers approaches to determining the severity of an exacerbation. The primary treatments discussed are bronchodilation with inhaled beta agonists and systemic corticosteroids. Delivery methods like nebulizers and metered dose inhalers are compared. Overall, the document provides an overview of assessing and treating pediatric asthma exacerbations in the emergency department.
This document provides an overview of acute asthma and recent evidence-based guidelines. It discusses the pathophysiology of asthma and clinical presentation. Updated guidelines from NAEPP, GINA, and ERS/ATS are presented which classify asthma severity and provide stepwise recommendations for pharmacological management. Key points include distinguishing between severe versus uncontrolled asthma, evaluating for treatment non-adherence and comorbidities before diagnosing severe asthma, and emphasizing environmental control and inhaler technique.
This document discusses paediatric asthma management from theory to clinical practice. It provides an overview of childhood asthma as a global health issue, outlines factors influencing prevalence, and discusses the burden of childhood asthma. It also covers evaluating asthma control, Global Initiative for Asthma treatment guidelines, and strategies for maintaining control or stepping up treatment in response to loss of control. Key studies comparing inhaled versus oral therapies and the efficacy of different controller medications are summarized.
This document discusses the dental management of asthmatic pediatric patients. It begins by defining asthma as a chronic inflammatory airway disorder characterized by recurrent wheezing, breathlessness, chest tightness and coughing. It notes that asthma prevalence has increased in children over the past 20 years. The document then discusses the burden of asthma in children, signs and symptoms, diagnosis, medications used to treat and manage asthma, as well as considerations for treating asthmatic patients in a dental setting including avoiding triggers and properly managing acute asthma attacks.
Evidence based Management of acute severe asthmaDr Rakesh Kumar
This document provides evidence-based guidelines for the management of acute asthma exacerbations in children aged 0-18 years. It discusses the epidemiology and classification of exacerbation severity based on symptoms, signs, and functional assessment. Treatment recommendations include supplemental oxygen, short-acting beta-agonists, ipratropium bromide, corticosteroids, magnesium sulfate, and epinephrine or terbutaline for more severe cases. Inhalation delivery devices, heliox, and care for patients not responding to initial treatment are also covered.
Asthma is a chronic inflammatory airway disease characterized by periods of reversible bronchospasm. Common triggers include allergens, irritants, and environmental factors. Symptoms include wheezing, coughing, chest tightness, and shortness of breath. Diagnosis involves assessing symptoms, lung function tests, and response to treatment. Management involves long-term control medications like inhaled corticosteroids and bronchodilators, as well as quick-relief medications for exacerbations. Treatment is tailored based on asthma severity and level of control.
Respiratory Distress & Status asthmaticus in Paediatricsmeducationdotnet
1. Respiratory distress is a clinical condition of increased respiratory rate and accessory muscle use that can progress to respiratory failure. Common causes include central or peripheral airway obstruction, diffuse lung damage, or issues with the respiratory pump.
2. Management involves ABCDE emergency care and non-invasive respiratory support with oxygen, nasal CPAP, or BiPAP if not in impending respiratory failure. The goal is restoring gas exchange with minimal complications by addressing underlying causes.
3. Mechanical ventilation may be needed for severe hypoxemia or hypercarbia from pneumonia, or when other systemic dysfunction jeopardizes gas exchange. Hypoxemia is prioritized over hypercarbia.
Treatment of Asthma Exacerbations in the Pediatric Emergency Departmentjrhoffmann
This document discusses the treatment of asthma exacerbations in pediatric emergency departments. It begins with definitions of an asthma exacerbation and status asthmaticus. It then covers approaches to determining the severity of an exacerbation. The primary treatments discussed are bronchodilation with inhaled beta agonists and systemic corticosteroids. Delivery methods like nebulizers and metered dose inhalers are compared. Overall, the document provides an overview of assessing and treating pediatric asthma exacerbations in the emergency department.
This document provides an overview of acute asthma and recent evidence-based guidelines. It discusses the pathophysiology of asthma and clinical presentation. Updated guidelines from NAEPP, GINA, and ERS/ATS are presented which classify asthma severity and provide stepwise recommendations for pharmacological management. Key points include distinguishing between severe versus uncontrolled asthma, evaluating for treatment non-adherence and comorbidities before diagnosing severe asthma, and emphasizing environmental control and inhaler technique.
This document discusses paediatric asthma management from theory to clinical practice. It provides an overview of childhood asthma as a global health issue, outlines factors influencing prevalence, and discusses the burden of childhood asthma. It also covers evaluating asthma control, Global Initiative for Asthma treatment guidelines, and strategies for maintaining control or stepping up treatment in response to loss of control. Key studies comparing inhaled versus oral therapies and the efficacy of different controller medications are summarized.
This document reviews the emergency presentation and management of acute severe asthma in children. It discusses the pathophysiology, epidemiology, clinical assessment, and treatment of acute severe asthma attacks in children. The key points are:
1) Acute severe asthma is one of the most common medical emergencies in children and involves inflammation and bronchoconstriction of the airways.
2) The cornerstones of treatment are rapid administration of oxygen, inhalations with bronchodilators such as beta-2 agonists, and systemic corticosteroids.
3) Additional treatments may include intravenous bronchodilators, corticosteroids, magnesium sulfate, or non-invasive ventilation if medical treatment fails
Management of severe asthma an update 2014avicena1
This document discusses the management of severe asthma. It begins by defining several phenotypes of severe asthma, including refractory asthma and steroid-dependent asthma. It then reviews the diagnostic criteria for severe asthma established by the American Thoracic Society and European Respiratory Society, which requires one or more major criteria and two or more minor criteria. The document further discusses approaches to diagnosing and treating severe asthma, including evaluating for alternative diagnoses, assessing treatment compliance and triggers, addressing comorbidities, and considering immunotherapy options. It emphasizes the importance of phenotyping and endotyping asthma to enable personalized treatment approaches.
The document provides guidelines for the acute management of asthma exacerbations, including risk factors, classifications of exacerbation severity from mild to life-threatening, and treatment protocols based on peak expiratory flow rate and clinical presentation. It also covers discharge planning and the use of peak expiratory flow monitoring to assess asthma control and exacerbation risk.
An 8-year-old male presents to the emergency room with acute shortness of breath likely due to an asthma exacerbation. His symptoms have been worsening over the past 24 hours. On examination, he has increased work of breathing and wheezing. Arterial blood gas shows respiratory acidosis. He is started on nebulized bronchodilators and steroids to treat the exacerbation.
A 24-year-old male presents to clinic with worsening cough, wheezing, and dyspnea over the past 3 days in the setting of an upper respiratory infection. Examination reveals wheezing. He is diagnosed with an asthma exacerbation from his upper respiratory symptoms and started on inhaled
The document discusses the assessment and treatment of acute asthma exacerbations. It outlines markers of severity seen on arterial blood gas measurements, including elevated PaCO2, low oxygen levels, and low pH. For severe or life-threatening exacerbations, initial treatment involves salbutamol 5mg via nebulizer. Ongoing treatment is based on the patient's response and may include additional nebulized bronchodilators, systemic corticosteroids, magnesium, and admission to the hospital for close monitoring.
The document discusses the assessment and management of acute severe asthma. It outlines factors that identify patients at high risk of near-fatal or fatal asthma attacks, including a history of previous severe attacks and adverse psychosocial features. It also describes the levels of asthma severity and recommends initial assessments including peak expiratory flow, pulse oximetry, blood gases and chest X-rays in certain situations to guide treatment decisions. Specialist follow-up is advised for patients hospitalized with severe asthma.
1) A 7-year-old girl with a history of recurrent asthma exacerbations presented with severe respiratory distress.
2) In the emergency department she was conscious but agitated, talking in short sentences, and had increased work of breathing with wheezing. Her oxygen saturation was 92% on 6L oxygen.
3) She was assessed as having moderate status asthmaticus. Treatment would include oxygen to maintain saturation above 92%, systemic corticosteroids started within the first 48 hours, and inhaled short-acting beta-agonists.
This document provides recommendations from the British guideline on the management of asthma. It recommends that the initial assessment of asthma in both children and adults should focus on taking a thorough clinical history and considering alternative diagnoses. For those with a high probability of asthma, treatment should be started, while further testing is reserved for poor responders. For intermediate probability cases, tests like lung function and a treatment trial can help determine if a diagnosis of asthma is appropriate. Self-management education and written asthma action plans are recommended to improve health outcomes.
This document discusses status asthmaticus in children. It covers the epidemiology, pathophysiology, presentation, assessment and treatment of severe or life-threatening asthma exacerbations in pediatric patients. Key points include rising rates of asthma morbidity and mortality in children, risk factors for fatal asthma, the inflammatory mechanisms that drive asthma symptoms, signs of impending respiratory failure, and first-line as well as advanced treatment approaches including bronchodilators, steroids, mechanical ventilation and other interventions.
this guideline based on recent articles by major education establishments concerned with building national guidelines. please dont be hurry to make comments about use of IV aminophylline. aminiphylline used under some extra care and when other treatment options are failing. benefits of those treatments yet remain controversial. IV aminophylline has its own risks including the possibility of toxicity.
This patient presents with an acute exacerbation of asthma. She has a history of asthma and is experiencing tachypnea, shortness of breath, wheezing, and her symptoms are not relieved by her usual medications. On examination, she has tachycardia, tachypnea, use of accessory muscles, decreased breath sounds, and wheezing. Her oxygen saturation is low. Treatment should focus on aggressive use of bronchodilators and systemic corticosteroids to reverse the exacerbation. Close monitoring is needed given the severity of the presentation.
Status asthmaticus is an acute exacerbation of asthma that does not respond to initial bronchodilator treatment. It can range from mild to severe, causing difficulty breathing, carbon dioxide retention, hypoxemia and respiratory failure. The airway obstruction is due to spasm, edema, increased secretions, inflammation and injury of the airway walls. Treatment involves bronchodilators, corticosteroids, oxygen and monitoring for ICU admission if the patient does not improve or their condition worsens. Prevention focuses on medication compliance and avoiding triggers.
This document discusses asthma in children and provides guidelines for diagnosis and management. It notes that most childhood asthma starts in the preschool years and can be classified into different phenotypes based on risk factors and symptoms. The goals of treatment are to control symptoms and prevent exacerbations. Spirometry can help diagnose and monitor asthma in children over 6 years old, while other tools like peak flow meters and exhaled nitric oxide can help in younger children. Treatment involves a stepwise approach starting with reliever medications and adding controller medications like inhaled corticosteroids based on symptom severity and risk of exacerbations. Close monitoring is important to maintain control and reduce medication doses if possible.
1. The document provides guidelines for assessing and managing acute severe asthma exacerbations. It discusses defining exacerbations, assessing severity, pharmacological treatments including inhaled bronchodilators, systemic corticosteroids, oxygen therapy, ventilation methods, patient transfer criteria, and considerations for pregnant patients.
2. Treatment recommendations include administering inhaled short-acting beta-2 agonists, systemic corticosteroids, oxygen therapy, and adding inhaled anticholinergics if no improvement. Intubation may be needed if medical treatment fails or symptoms are severe.
3. The guidelines aim to optimize oxygen levels, ventilation pressures, sedation, and discuss transferring patients based on response and ability to be managed at home with
An acute asthma exacerbation is an acute worsening of asthma symptoms requiring urgent medical treatment. The document outlines the management of acute asthma exacerbations in children, with a focus on risk assessment, treatment goals, medications, and handling severe exacerbations requiring intensive care. Key points include using inhaled short-acting beta-agonists as first-line treatment, adding oral corticosteroids for incomplete responses, and considering intravenous magnesium sulfate or beta-agonists for refractory cases. Close monitoring and supportive care including oxygen are also emphasized.
This document discusses the case presentation, treatment, and management of acute severe asthma in children. It begins by describing a 2-year-old boy presenting with tight chest and wheezing who was cyanotic and in respiratory distress. He was treated with nebulized bronchodilators and steroids, but desaturated and required intubation. The document then discusses factors that define severe acute asthma attacks, common treatments including inhaled bronchodilators, systemic steroids, magnesium, and intubation in critical cases. It also reviews risks for fatal asthma and cardiopulmonary interactions in acute severe asthma.
Management of asthma exacerbation in childrenAzad Haleem
This document discusses the management of acute asthma exacerbations from home through hospitalization. It begins with the clinical assessment and severity classification of exacerbations. For home management, it recommends immediate use of rescue medications and contacting a physician for worsening or incomplete responses. In the emergency department, treatment focuses on correcting hypoxemia, improving airflow, and preventing progression using oxygen, frequent bronchodilators, and systemic corticosteroids. Hospital admission is indicated for moderate-severe exacerbations not improving within 1-2 hours of intensive treatment or for patients with high-risk features. Intensive care is needed for severe respiratory distress or failure to respond to therapy.
Asthma 2010 new gina guidelines[pediatric]Pradeep Gc
This document provides information on asthma management guidelines and tools. It discusses the goals of asthma management, which include achieving control of symptoms, maintaining normal activity levels, pulmonary function, and preventing exacerbations and mortality. It outlines a six-part asthma management program involving education, assessment, avoiding triggers, medication plans, managing exacerbations, and follow-up care. Classification systems for severity are presented for children and adults. Peak flow meters, spirometry, inhaler devices, and stepwise treatment approaches are also summarized.
This document discusses anaesthesia for eye surgery. It begins with a brief history of local anaesthesia for eye surgery and the development of regional techniques. It then covers anatomy of the eye, orbit and surrounding structures. Factors that influence intraocular pressure are explained, including effects of anaesthetic drugs and muscle relaxants. The document discusses pre-operative evaluation and anaesthetic management considerations for eye surgery, including different anaesthetic techniques and their indications. Post-operative complications are also mentioned.
This document discusses tracheal intubation and rapid sequence intubation (RSI). RSI involves rapidly sedating and paralyzing a patient to facilitate endotracheal intubation. The key steps of RSI are preoxygenation, induction with sedatives, paralysis with neuromuscular blocking agents, protection of the airway with cricoid pressure during intubation, confirmation of proper endotracheal tube placement, and post-intubation management and securing of the airway. RSI aims to minimize risks of aspiration and facilitate safe and rapid intubation in emergency situations.
This document reviews the emergency presentation and management of acute severe asthma in children. It discusses the pathophysiology, epidemiology, clinical assessment, and treatment of acute severe asthma attacks in children. The key points are:
1) Acute severe asthma is one of the most common medical emergencies in children and involves inflammation and bronchoconstriction of the airways.
2) The cornerstones of treatment are rapid administration of oxygen, inhalations with bronchodilators such as beta-2 agonists, and systemic corticosteroids.
3) Additional treatments may include intravenous bronchodilators, corticosteroids, magnesium sulfate, or non-invasive ventilation if medical treatment fails
Management of severe asthma an update 2014avicena1
This document discusses the management of severe asthma. It begins by defining several phenotypes of severe asthma, including refractory asthma and steroid-dependent asthma. It then reviews the diagnostic criteria for severe asthma established by the American Thoracic Society and European Respiratory Society, which requires one or more major criteria and two or more minor criteria. The document further discusses approaches to diagnosing and treating severe asthma, including evaluating for alternative diagnoses, assessing treatment compliance and triggers, addressing comorbidities, and considering immunotherapy options. It emphasizes the importance of phenotyping and endotyping asthma to enable personalized treatment approaches.
The document provides guidelines for the acute management of asthma exacerbations, including risk factors, classifications of exacerbation severity from mild to life-threatening, and treatment protocols based on peak expiratory flow rate and clinical presentation. It also covers discharge planning and the use of peak expiratory flow monitoring to assess asthma control and exacerbation risk.
An 8-year-old male presents to the emergency room with acute shortness of breath likely due to an asthma exacerbation. His symptoms have been worsening over the past 24 hours. On examination, he has increased work of breathing and wheezing. Arterial blood gas shows respiratory acidosis. He is started on nebulized bronchodilators and steroids to treat the exacerbation.
A 24-year-old male presents to clinic with worsening cough, wheezing, and dyspnea over the past 3 days in the setting of an upper respiratory infection. Examination reveals wheezing. He is diagnosed with an asthma exacerbation from his upper respiratory symptoms and started on inhaled
The document discusses the assessment and treatment of acute asthma exacerbations. It outlines markers of severity seen on arterial blood gas measurements, including elevated PaCO2, low oxygen levels, and low pH. For severe or life-threatening exacerbations, initial treatment involves salbutamol 5mg via nebulizer. Ongoing treatment is based on the patient's response and may include additional nebulized bronchodilators, systemic corticosteroids, magnesium, and admission to the hospital for close monitoring.
The document discusses the assessment and management of acute severe asthma. It outlines factors that identify patients at high risk of near-fatal or fatal asthma attacks, including a history of previous severe attacks and adverse psychosocial features. It also describes the levels of asthma severity and recommends initial assessments including peak expiratory flow, pulse oximetry, blood gases and chest X-rays in certain situations to guide treatment decisions. Specialist follow-up is advised for patients hospitalized with severe asthma.
1) A 7-year-old girl with a history of recurrent asthma exacerbations presented with severe respiratory distress.
2) In the emergency department she was conscious but agitated, talking in short sentences, and had increased work of breathing with wheezing. Her oxygen saturation was 92% on 6L oxygen.
3) She was assessed as having moderate status asthmaticus. Treatment would include oxygen to maintain saturation above 92%, systemic corticosteroids started within the first 48 hours, and inhaled short-acting beta-agonists.
This document provides recommendations from the British guideline on the management of asthma. It recommends that the initial assessment of asthma in both children and adults should focus on taking a thorough clinical history and considering alternative diagnoses. For those with a high probability of asthma, treatment should be started, while further testing is reserved for poor responders. For intermediate probability cases, tests like lung function and a treatment trial can help determine if a diagnosis of asthma is appropriate. Self-management education and written asthma action plans are recommended to improve health outcomes.
This document discusses status asthmaticus in children. It covers the epidemiology, pathophysiology, presentation, assessment and treatment of severe or life-threatening asthma exacerbations in pediatric patients. Key points include rising rates of asthma morbidity and mortality in children, risk factors for fatal asthma, the inflammatory mechanisms that drive asthma symptoms, signs of impending respiratory failure, and first-line as well as advanced treatment approaches including bronchodilators, steroids, mechanical ventilation and other interventions.
this guideline based on recent articles by major education establishments concerned with building national guidelines. please dont be hurry to make comments about use of IV aminophylline. aminiphylline used under some extra care and when other treatment options are failing. benefits of those treatments yet remain controversial. IV aminophylline has its own risks including the possibility of toxicity.
This patient presents with an acute exacerbation of asthma. She has a history of asthma and is experiencing tachypnea, shortness of breath, wheezing, and her symptoms are not relieved by her usual medications. On examination, she has tachycardia, tachypnea, use of accessory muscles, decreased breath sounds, and wheezing. Her oxygen saturation is low. Treatment should focus on aggressive use of bronchodilators and systemic corticosteroids to reverse the exacerbation. Close monitoring is needed given the severity of the presentation.
Status asthmaticus is an acute exacerbation of asthma that does not respond to initial bronchodilator treatment. It can range from mild to severe, causing difficulty breathing, carbon dioxide retention, hypoxemia and respiratory failure. The airway obstruction is due to spasm, edema, increased secretions, inflammation and injury of the airway walls. Treatment involves bronchodilators, corticosteroids, oxygen and monitoring for ICU admission if the patient does not improve or their condition worsens. Prevention focuses on medication compliance and avoiding triggers.
This document discusses asthma in children and provides guidelines for diagnosis and management. It notes that most childhood asthma starts in the preschool years and can be classified into different phenotypes based on risk factors and symptoms. The goals of treatment are to control symptoms and prevent exacerbations. Spirometry can help diagnose and monitor asthma in children over 6 years old, while other tools like peak flow meters and exhaled nitric oxide can help in younger children. Treatment involves a stepwise approach starting with reliever medications and adding controller medications like inhaled corticosteroids based on symptom severity and risk of exacerbations. Close monitoring is important to maintain control and reduce medication doses if possible.
1. The document provides guidelines for assessing and managing acute severe asthma exacerbations. It discusses defining exacerbations, assessing severity, pharmacological treatments including inhaled bronchodilators, systemic corticosteroids, oxygen therapy, ventilation methods, patient transfer criteria, and considerations for pregnant patients.
2. Treatment recommendations include administering inhaled short-acting beta-2 agonists, systemic corticosteroids, oxygen therapy, and adding inhaled anticholinergics if no improvement. Intubation may be needed if medical treatment fails or symptoms are severe.
3. The guidelines aim to optimize oxygen levels, ventilation pressures, sedation, and discuss transferring patients based on response and ability to be managed at home with
An acute asthma exacerbation is an acute worsening of asthma symptoms requiring urgent medical treatment. The document outlines the management of acute asthma exacerbations in children, with a focus on risk assessment, treatment goals, medications, and handling severe exacerbations requiring intensive care. Key points include using inhaled short-acting beta-agonists as first-line treatment, adding oral corticosteroids for incomplete responses, and considering intravenous magnesium sulfate or beta-agonists for refractory cases. Close monitoring and supportive care including oxygen are also emphasized.
This document discusses the case presentation, treatment, and management of acute severe asthma in children. It begins by describing a 2-year-old boy presenting with tight chest and wheezing who was cyanotic and in respiratory distress. He was treated with nebulized bronchodilators and steroids, but desaturated and required intubation. The document then discusses factors that define severe acute asthma attacks, common treatments including inhaled bronchodilators, systemic steroids, magnesium, and intubation in critical cases. It also reviews risks for fatal asthma and cardiopulmonary interactions in acute severe asthma.
Management of asthma exacerbation in childrenAzad Haleem
This document discusses the management of acute asthma exacerbations from home through hospitalization. It begins with the clinical assessment and severity classification of exacerbations. For home management, it recommends immediate use of rescue medications and contacting a physician for worsening or incomplete responses. In the emergency department, treatment focuses on correcting hypoxemia, improving airflow, and preventing progression using oxygen, frequent bronchodilators, and systemic corticosteroids. Hospital admission is indicated for moderate-severe exacerbations not improving within 1-2 hours of intensive treatment or for patients with high-risk features. Intensive care is needed for severe respiratory distress or failure to respond to therapy.
Asthma 2010 new gina guidelines[pediatric]Pradeep Gc
This document provides information on asthma management guidelines and tools. It discusses the goals of asthma management, which include achieving control of symptoms, maintaining normal activity levels, pulmonary function, and preventing exacerbations and mortality. It outlines a six-part asthma management program involving education, assessment, avoiding triggers, medication plans, managing exacerbations, and follow-up care. Classification systems for severity are presented for children and adults. Peak flow meters, spirometry, inhaler devices, and stepwise treatment approaches are also summarized.
This document discusses anaesthesia for eye surgery. It begins with a brief history of local anaesthesia for eye surgery and the development of regional techniques. It then covers anatomy of the eye, orbit and surrounding structures. Factors that influence intraocular pressure are explained, including effects of anaesthetic drugs and muscle relaxants. The document discusses pre-operative evaluation and anaesthetic management considerations for eye surgery, including different anaesthetic techniques and their indications. Post-operative complications are also mentioned.
This document discusses tracheal intubation and rapid sequence intubation (RSI). RSI involves rapidly sedating and paralyzing a patient to facilitate endotracheal intubation. The key steps of RSI are preoxygenation, induction with sedatives, paralysis with neuromuscular blocking agents, protection of the airway with cricoid pressure during intubation, confirmation of proper endotracheal tube placement, and post-intubation management and securing of the airway. RSI aims to minimize risks of aspiration and facilitate safe and rapid intubation in emergency situations.
1. The document discusses anaesthesia considerations for various ophthalmic surgeries including cataract surgery, glaucoma surgery, and procedures in children.
2. Key goals of anaesthesia for eye surgery are to have an immobile eye, stable intraocular pressure, minimize bleeding and nausea/vomiting, and avoid complications like the oculo-cardiac reflex.
3. Different procedures and patient conditions require specific anaesthetic approaches. For example, glaucoma patients may require mannitol or catheterization due to eye drop medications, while gas injections require avoiding nitrous oxide due to gas bubble expansion.
Anesthesia in ophthalmic surgery dr ferdous Ferdous101531
This document discusses anesthesia considerations for ophthalmic surgery. It covers various techniques including general anesthesia, local anesthesia, and different regional block techniques. It discusses preoperative evaluation and management of comorbidities. Complications related to different techniques are outlined such as increases in intraocular pressure, retrobulbar hemorrhage, oculocardiac reflex, brainstem anesthesia, and postoperative nausea and vomiting. Agents, adjuvants, and proper techniques are emphasized to minimize risks and complications during ophthalmic anesthesia.
Anesthesia in ophthalmic surgery and complicationsDR SHADAB KAMAL
Anesthesia for ophthalmic surgery presents unique challenges for the anesthesiologist, including regulation of intraocular pressure and prevention of complications. The document discusses ocular anatomy and physiology, techniques of anesthesia like facial nerve blocks and general anesthesia, considerations for preoperative evaluation, and complications. Precise control of drugs and positioning are important due to the sensitivity of the eye and potential effects on vision.
Rapid sequence intubation (RSI) involves administering sedatives and paralytics to quickly sedate and paralyze a patient to facilitate emergency intubation. It aims to minimize risks of aspiration, trauma, and hypoxia. Proper preparation, pre-oxygenation, pretreatment, paralysis, protection with cricoid pressure, intubation, and post-intubation management are the "seven P's" of RSI. Indications include those at high risk of aspiration. Etomidate or ketamine are commonly used sedatives depending on the patient's condition. Succinylcholine or rocuronium are often used as paralytics. Cricoid pressure protects
This document provides an introduction to general anaesthesia. It discusses the stages of anaesthesia according to the Guedel classification system and describes various drugs used in anaesthesia including intravenous agents like thiopentone, propofol, and benzodiazepines. It also discusses inhalational agents such as nitrous oxide, ether, halothane, isoflurane, and sevoflurane. Finally, it covers muscle relaxants, distinguishing between depolarizing agents like suxamethonium and non-depolarizing agents. The document provides an overview of the pharmacodynamics and uses of these different drug classes for anaesthesia.
This document provides information on rapid sequence intubation (RSI) in adults. It defines RSI as the simultaneous administration of a sedative and neuromuscular blocking agent to facilitate endotracheal intubation while minimizing aspiration risk. The principles of RSI are described, including preparation, preoxygenation, pretreatment, paralysis with induction, protection/positioning, tube placement confirmation, and post-intubation management. Contraindications and advantages of RSI are outlined. Specific induction agents, paralytics, and reversal drugs are also discussed.
This document provides information on rapid sequence intubation (RSI) in adults. It defines RSI as the virtually simultaneous administration of a sedative and neuromuscular blocking agent to facilitate endotracheal intubation while minimizing aspiration risk. The principles of RSI are described, including preparation, preoxygenation, pretreatment, paralysis with induction, protection/positioning, tube placement confirmation, and post-intubation management. Contraindications and advantages of RSI are also outlined.
(1) Postoperative nausea and vomiting (PONV) is a common complication following anesthesia and surgery, with incidence rates of 22-38% for nausea and 12-26% for vomiting. (2) The vomiting center located in the brainstem plays a key role in coordinating the vomiting reflex in response to various emetogenic stimuli. (3) Identifying patient, anesthesia, and surgery risk factors can help determine those at higher risk of PONV and guide prophylaxis.
Anesthesia for eye surgery presents unique challenges. The anesthesiologist must have detailed knowledge of ocular anatomy, physiology, and pharmacology to prepare an appropriate anesthesia plan. They must regulate intraocular pressure, prevent oculocardiac reflex, and ensure smooth intubation and extubation. Regional techniques may be preferable to general anesthesia in some cases to avoid risks of increases in intraocular pressure.
Pediatric anesthesia presents unique challenges compared to adult anesthesia due to developmental differences in children's cardiovascular, pulmonary, airway and pharmacologic systems. Key considerations include smaller airway diameters, higher metabolic rates, increased drug effects due to higher body water content, and different responses to induction agents and muscle relaxants. Careful attention to dosing, equipment selection, and monitoring is needed to safely anesthetize pediatric patients.
This document discusses anesthesia considerations for eye surgery. It begins by describing the anatomy of the eye and its nerve supply. It then discusses risks like the oculocardiac reflex and increases in intraocular pressure. Common ophthalmic drugs are outlined along with their systemic effects. The document reviews preoperative evaluation, various regional anesthesia techniques like facial nerve blocks and retrobulbar blocks, topical anesthesia, and general anesthesia. It concludes with considerations for pediatric ophthalmic procedures.
This document provides an outline and overview of cardiopulmonary resuscitation (CPR). It defines CPR and describes its key components, including airway management, artificial ventilation, and chest compressions. The document outlines indications and contraindications for CPR, proper techniques for chest compressions and ventilation, medications commonly used in CPR including epinephrine and vasopressin, the role of defibrillation, and factors to consider when determining whether to stop CPR efforts. It concludes by discussing post-cardiac arrest care and potential complications of CPR. The intended learning objectives are to understand all aspects of performing CPR effectively.
This document discusses various intravenous induction agents used in anesthesia. It begins by providing an overview of the ideal properties of IV induction drugs and then discusses the mechanisms of action, pharmacokinetics, effects on organ systems, uses, doses and complications of specific drugs - barbiturates, propofol, ketamine and etomidate. It also presents several case scenarios and asks which IV induction drug would be most appropriate in each case. The document aims to educate attendees on the properties and appropriate uses of common IV induction agents.
INTRAOCULAR PROCEDURES AND IT’S ANAESTHETIC IMPLICATIONS.pptxSaikumar Patil
1) Intraocular procedures require careful anaesthetic management to control intraocular pressure, prevent oculocardiac reflex, and minimize risks of bleeding and vomiting.
2) Regional techniques like retrobulbar blocks or general anaesthesia can both be used, with general anaesthesia allowing better airway control but higher risk of nausea.
3) Procedures like strabismus surgery carry risk of oculocardiac reflex while retinal detachment surgery requires avoiding nitrous oxide if intraocular gases are used.
4) Ophthalmic drugs can cause systemic side effects like hypertension, bradycardia, or bronchospasm that anaesthetists must manage. Emergencies require prompt intervention to prevent vision loss
Combination Therapy for Glaucoma Management (1).pptxJyotiNikale
The document discusses combination therapy for glaucoma management using ripasudil and timolol. It provides background on glaucoma prevalence in India. It outlines the standard treatment algorithm and rationale for combination therapy when monotherapy fails to control intraocular pressure. The document reviews evidence that combination therapy provides better IOP control than monotherapy. It describes the mechanisms of action, efficacy, and safety of ripasudil and timolol as well as clinical trial results demonstrating the additive IOP-lowering effects of the combination.
Obstetric anaesthesia involves risks from both general anaesthesia and spinal anaesthesia due to physiological changes in pregnancy and the need to consider both mother and baby. The document outlines protocols for administering spinal anaesthesia including patient assessment, monitoring for complications like hypotension, and management of issues in recovery. It emphasizes vigilant monitoring and proactive treatment of any complications throughout the procedure and recovery.
This document provides an overview of myasthenia gravis (MG), an autoimmune disorder characterized by muscle weakness and fatigability. It describes the anatomy of the neuromuscular junction where antibodies in MG interfere with signal transmission. Symptoms range from weakness of extraocular muscles to respiratory muscles. Diagnosis involves testing for acetylcholine receptor antibodies and repetitive nerve stimulation studies. Treatment includes acetylcholinesterase inhibitors, immunomodulators like prednisone, plasmapheresis, and thymectomy for those with thymoma. Prognosis is good with treatment but respiratory failure remains a risk without proper management.
Anaesthetic considerations for pelvic endoscopic surgeryAtul Dixit
This presentation encapsulates how to proceed with anaesthesia for pelvic endoscopies. It outlines the do's and the dont's for these simple set of procedures which can turn into a nightmare if handled in an off-hand way.
Similar to Anaesthesia in ophthalmology By Dr Sardar Saud Abbas (20)
Everything you need to know about Local Anesthetics. Dose, mechanism of action, toxicity, management. How to use, where to use. It also contains receptors which are involved. Which factors prolongs and makes the drug work quicker.
In this presentation I tried to explain the classification of muscle relaxants. along with differences between these classes. there is also a brief discussion about NMT and how they work. furthermore it has dose, maintenance dose, adverse effects and how to manage toxicity about these drugs.
A short presentation covering most important anatomical differences along with physiological difference of pediatric population from adult. Also covers important aspects of anaesthesia consideration in pediatric patients.
I specifically made this presentation by using morgan and miller books.
This presentation explains change physiological changes occurs in obesity. Which pre op investigation should be done of those patient before scheduling them for surgery. What in the end anaesthesia consideration of obesity with post op care.
Just a review on cardiopulmonary resuscitation.
I hope everyone finds it useful and resourceful.
major reference is American Heart Association Guidelines
if there is any mistake or somebody wants to make an edition please feel free to email me at sardar.saud@gmail.com
By Dr Sardar Saud Abbas
Brief description on how to assess airway and manage difficult intubation. There is alot of detail about airway management but this will get you through
This document describes various components and types of breathing circuits used in anesthesia. It discusses the basic principles of delivering oxygen/gases and eliminating carbon dioxide. The key components described include the reservoir bag, breathing tubes, adjustable pressure limiting valve, and filters. Circuits are classified based on gas flow and include open, semi-open, closed, and semi-closed types. Specific circuits discussed in detail include the Mapleson A-F circuits, Bain's circuit, and the circle breathing system. Advantages and disadvantages of each system are provided.
This document provides information about pheochromocytoma and considerations for anesthesia. It begins with definitions and descriptions of pheochromocytoma as a catecholamine producing tumor. It then discusses signs and symptoms, methods of diagnosis including biochemical tests and imaging, and goals for anesthesia including hemodynamic stability. The document provides detailed guidance on pre-induction, induction, and post-operative management strategies to reduce risks such as hypertensive crises during tumor manipulation and hypotension after resection. Key elements include preoperative alpha-adrenergic blockade, careful induction to avoid sympathetic stimulation, invasive monitoring, and vasoactive drugs to control blood pressure fluctuations intraoperatively and postoperatively.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
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.
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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.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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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).
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.
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.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
2. CONTENTS
Anatomy
The effect of cardiac and respiration on IOP
Effects of anaesthetic agents on IOP
Oculocardiac Reflex
Intraocular gas expansion
Systemic effects of ophthalmic medication
Regional Anaesthesia in ophthalmic surgery
Case Discussion
4. NERVE SUPPLY OF EYE
Muscle of the eye
Superior, Medial, Inferior, inferior oblique rectus muscles are supplied by
occulomotor nerve.
Occulomotor nerve also supplies superior palpebral levator muscle
Lateral rectus is supplied by Abducent nerve
Superior oblique is supplied by Trochlear nerve
7. The effect of cardiac and respiration on
IOP
Central venous pressure:
Increase in CVP increases IOP, decreases in CVP decreases IOP.
Arterial blood pressure:
Increase in arterial blood pressure also increases IOP and vice versa.
PaCO2:
Increase in PaCO2 concentration (hypoventilation) increases IOP.
Decrease in PaCO2 concentration (hyperventilation) decreases IOP.
PaO2:
Increase in PaO2 doesn’t have significant effect on IOP
But decrease in PaO2 increases IOP
Any event that alters these parameters (eg, larygoscopy, airway obstruction, coughing, intubation, tredelenburg
postion) can affect IOP.
8. Effects of anaesthetic agents on IOP
Inhaled anaesthetics:
All inhalation agents decrease IOP. Volatiles agents decreases IOP more than
nitrous oxide.
IV anaesthetics:
Propofol, Benzodiazepines, Opiods decreases IOP.
Ketamine usually raises arterial blood pressure, so it increases IOP.
Muscle relaxants:
Succinylecholine increases IOP by 5-10 mmHG for 5-10mins after administration of
drug.
Non depolarizing muscles relaxant either decreases or have no effect
9. Oculocardiac Reflex
It is a reflex resulting in severe bradycardia, leading to cardiac arrest
What causes oculocardiac reflex?
Traction on extra ocular muscles
Pressure of the eye ball
Trauma to the eye
Retrobublar block administration
10.
11. Management
Immediate cessation of surgery
Confirmation of adequate ventilation, oxygenation and depth of anaesthesia
Administer IV atropine (10mcg/kg)
Anticholinergics(atropine, glycopyrolate) used as premedication usually decrease the
incident
IV works better than IM
Anticholinergics should be given with caution to patients with coronary artery disease
12. Intraocular gas expansion
Gas bubble or Sulfur hexafluoride are used in retinal detachment
Gas bubble is absorbed in 5 days into the bloodstream
Sulfur hexafluoride is absorbed into the blood after 10 days
During these gas insertion nitrous is stopped 15 min prior to the insertion.
Nitrous oxide tends to absorb more readily (35 time more readily absorbed in
blood than nitrogen), it expands the gas bubble
Which leads to unnecessary increase in IOP after surgery.
14. Regional Anaesthesia in ophthalmic
surgery
Retrobulbar block
Peribulbar block
Facial nerve block
Van Lint, Atkinson and O’brien technique
Topical Anaethesia
0.5% proparacaine drops, repeated after 5 min interval, 5 applications
followed by anaesthetic gel (lidocaine chlorhydrate plus 2% methyl-cellulose)
15.
16.
17. Case Discussion
A 6 year old girl came to the emergency with
a history of fire arm injury to the eye. Quick
examination revealed intraocular contents
presenting at the wound. Girl is taken to the
emergency OT for repair of the ruptured
globe. Make a plan for her safe induction.
18. Pre-op Evaluation
History of the patient
Physical and airway examination
Most important question is when was the last meal taken by the patient
If it is less than 8 hours patient should be considered full stomach
Because pain also decreases gastric emptying
Significance of a full stomach in a patient with an open globe injury?
It increases risk of further injury to the eye
Prevent further injury to the eye, because it further increases IOP
We have to prevent pulmonary aspiration.
20. Avoid direct pressure on the globe:
Patch eye with fox shield
No retrobulbar or peribulbar injections
Careful face mask technique
Avoid increase in CVP:
Prevent coughing during induction and intubation (1.5mg/kg IV Lidocaine, good
analgesia, adequate depth of anaesthesia before intubation)
Ensure a deep level of muscle relaxation prior to laryngoscopy
Avoid head down position of the patient
Awake extubation
Avoid pharmacological agent that increase IOP
22. Premedication:
Metochlorpromide
Histamine H2-receptor antagonist (ranitidine 50mg, cimetidine 300mg, famotidine
Sodium citrate 15-30 ml orally (works within 30-60 min)
Evacuation of gastric contents:
Nasogastric tube should be passed and suction should be done (not in this case
patient is young. If you pass NG in awake and young patient it will cause cough and
straining which increases IOP). In young patients NG can be passed after intubation
Rapid-sequence induction:
Cricoid pressure
Rapid induction with rapid onset of paralysis
Avoid positive pressure ventilation via mask
Intubate as soon as possible
Extubation awake
23. Recommended induction agent
Ideal agent for induction is propofol (etomidate if patient was a cardiac patient but
not in this case)
Both propofol and etomidate reduced intraocular pressure
Ketamine increases arterial blood pressure which leads to transient increase in IOP,
not recommended
Propofol does not decrease hypertensive response that is caused by laryngoscopy
Which can be reduced by prior administration of:
Fentanyl 1-3mcg/kg
Remifentanil 0.5-1 mcg/kg
esmolol 0.5-1 mcg/kg
Lidocaine 1.5 mg/kg
24. Choice of muscle relaxant for Rapid
sequence induction
There is a conflict but worth knowing, pre administration of 1/10th dose of non
depolarizing muscle relaxant before succinylcholine decreases the increase in IOP.
There is also less case report documenting further eye injury caused by
succinylcholine.
Succinylcholine still is drug of choice in this case for RSI.
Non depolarizing muscle relaxant doesn’t increases IOP and cause further damage
to the.
NDMR that can be used for RSI is rocuronium 0.6-1.2 mg/kg
25. Why Awake extubation?
Pre medication to reduce gastric pH and Volume
And adequate suction can decrease risk of aspiration but not completely diminish
it
There is risk of aspiration at extubation too
Therefore, extubation must be delayed until patient is awake and has intact airway
reflexes.
Coughing and gag reflex can be blunted with lidocaine and afentanil.