This document discusses various topics related to anesthesia including:
- Delivery methods such as general anesthesia, epidural and spinal anesthesia.
- Client assessment tools like the ASA classification system and Apgar score.
- Potential complications including malignant hyperthermia.
- Post-anesthesia care involving careful monitoring in Phase I and Phase II.
This document provides links to various articles on different neurological conditions and syndromes, including agnosia, anaestoagnosia, asimboliaal dolor, ataxia, cefalea, daltonismo, epilepsiasensorialfocal, espasmomuscular, hemianestesia, herpeszoster, hiperalgesia, Lasegue, paresia, parestesia, syndrome del túnel carpiano, and TCE. The links are in Spanish and provide information on the anatomy, pathophysiology, diagnosis and treatment of these neurological disorders and symptoms.
The document lists the file paths for 12 images that were downloaded to a user's computer. The images have file names ranging from img001.jpg to img012.jpg and were saved to the Downloads folder of the Administrator user on a Windows computer.
This document contains 30 photo credits from various sources such as Flickr and Pixabay. The photos cover a wide range of topics from headphones and records to soldiers, pens, and train stations. Michael Williams is credited as the photographer for one image.
This document appears to be a school project by an 8th grade student investigating whether weight training is safe for young athletes. The paper discusses the background and pros and cons of teen weightlifting, includes data collected from various sources, and will conclude with a determination on the safety of weight training for teens. Citations are provided from several websites discussing strength training, weightlifting, and muscle development for teens and young athletes.
Human cruise control technology uses electrical stimulation of the sartorius muscle in the leg to guide a person's movement in a particular direction without requiring attention to a phone. If made reliable and comfortable, it could help guide exercise workouts or emergency responders in difficult situations. However, simpler technologies like the Apple Watch are also emerging for less disruptive navigation assistance.
The document discusses the various types of bio-signals in the human body, including electroencephalogram (EEG), electrocardiogram (ECG), electromyogram (EMG), mechanomyogram (MMG), electrooculography (EOG), galvanic skin response (GSR), and magnetoencephalogram (MEG). These bio-signals provide information about brain activity, heart function, muscle activity, eye movements, sweat gland activity, and more. Links are provided with more details about each type of bio-signal and their roles in monitoring and diagnosing physiological functions and disorders.
The document discusses guidelines for providing antiretroviral therapy (ART) to HIV positive patients, noting that ART should be provided to patients with CD4 counts of 350 or less, and certain priority groups like pregnant women and tuberculosis patients regardless of CD4 count. It outlines the process of assessing patients' eligibility for ART and monitoring their treatment, with the goal of improving patients' health and preventing transmission of HIV.
This document provides links to various articles on different neurological conditions and syndromes, including agnosia, anaestoagnosia, asimboliaal dolor, ataxia, cefalea, daltonismo, epilepsiasensorialfocal, espasmomuscular, hemianestesia, herpeszoster, hiperalgesia, Lasegue, paresia, parestesia, syndrome del túnel carpiano, and TCE. The links are in Spanish and provide information on the anatomy, pathophysiology, diagnosis and treatment of these neurological disorders and symptoms.
The document lists the file paths for 12 images that were downloaded to a user's computer. The images have file names ranging from img001.jpg to img012.jpg and were saved to the Downloads folder of the Administrator user on a Windows computer.
This document contains 30 photo credits from various sources such as Flickr and Pixabay. The photos cover a wide range of topics from headphones and records to soldiers, pens, and train stations. Michael Williams is credited as the photographer for one image.
This document appears to be a school project by an 8th grade student investigating whether weight training is safe for young athletes. The paper discusses the background and pros and cons of teen weightlifting, includes data collected from various sources, and will conclude with a determination on the safety of weight training for teens. Citations are provided from several websites discussing strength training, weightlifting, and muscle development for teens and young athletes.
Human cruise control technology uses electrical stimulation of the sartorius muscle in the leg to guide a person's movement in a particular direction without requiring attention to a phone. If made reliable and comfortable, it could help guide exercise workouts or emergency responders in difficult situations. However, simpler technologies like the Apple Watch are also emerging for less disruptive navigation assistance.
The document discusses the various types of bio-signals in the human body, including electroencephalogram (EEG), electrocardiogram (ECG), electromyogram (EMG), mechanomyogram (MMG), electrooculography (EOG), galvanic skin response (GSR), and magnetoencephalogram (MEG). These bio-signals provide information about brain activity, heart function, muscle activity, eye movements, sweat gland activity, and more. Links are provided with more details about each type of bio-signal and their roles in monitoring and diagnosing physiological functions and disorders.
The document discusses guidelines for providing antiretroviral therapy (ART) to HIV positive patients, noting that ART should be provided to patients with CD4 counts of 350 or less, and certain priority groups like pregnant women and tuberculosis patients regardless of CD4 count. It outlines the process of assessing patients' eligibility for ART and monitoring their treatment, with the goal of improving patients' health and preventing transmission of HIV.
Following are marketing results for several different companies. The marketing strategies include Facebook ads, Google Adwords, Email Marketing and Most Important SEO.
Anesthesiologists order epidural infusions which are prepared by pharmacy and administered by nurses trained in epidural infusion pumps. Nurses maintain and modify infusion rates as ordered, can administer bolus doses up to 10ml, and must change tubing every 72 hours and solutions every 24 hours. Blood thinners are not used or given when a patient has an epidural in place due to risk of bleeding. Nurses should address any side effects by following protocols before contacting anesthesia.
The document describes combined spinal epidural anesthesia (CSEA). It discusses the anatomy related to CSEA, including the spinal cord, subarachnoid space, epidural space, and bony landmarks. It also covers the physiology of regional anesthesia, advantages of CSEA over other techniques, indications for CSEA, prerequisites, contraindications, problems that can occur, and techniques for performing CSEA.
Each month, join us as we highlight and discuss hot topics ranging from the future of higher education to wearable technology, best productivity hacks and secrets to hiring top talent. Upload your SlideShares, and share your expertise with the world!
Not sure what to share on SlideShare?
SlideShares that inform, inspire and educate attract the most views. Beyond that, ideas for what you can upload are limitless. We’ve selected a few popular examples to get your creative juices flowing.
SlideShare is a global platform for sharing presentations, infographics, videos and documents. It has over 18 million pieces of professional content uploaded by experts like Eric Schmidt and Guy Kawasaki. The document provides tips for setting up an account on SlideShare, uploading content, optimizing it for searchability, and sharing it on social media to build an audience and reputation as a subject matter expert.
Computational Disease Management with Wearable DevicesPetteriTeikariPhD
Machine Learning modelling of disease trajectory with deep
learning and/or Gaussian Processes.
Alternative download link:
https://www.dropbox.com/s/jg73ymvkenx8rv4/computational_disease_management.pdf?dl=0
Many people want to improve their appearance so they often seek plastic surgery. People who wish to improve the appearance of their noses have found plastic surgery very popular. Anesthesia is required for any type of surgery. This article will discuss the use of anesthesia for rhinoplasty.
The document summarizes several medical studies that tested the effectiveness of the LifeVac device. A simulation study using choking simulators found that LifeVac successfully dislodged obstructing objects like grapes, hot dogs, and toy cars in 79-100% of trials. A closed system study demonstrated LifeVac generated over 300mmHg of suction, 3 times greater than the highest recorded choke pressure. Additional cadaver and environmental testing, as well as reviews in medical journals, provide further support that LifeVac is effective at clearing obstructions when standard choking protocols fail.
Biotechnology has progressed significantly from selective breeding and food preservation techniques used historically to more advanced methods used now. Current biotechnology utilizes recombinant DNA techniques, bioinformatics, and genetic engineering to develop products in green, white, and red biotechnology. Examples include developing pest-resistant crops, producing industrial chemicals, and engineering bacteria to produce antibiotics or insulin.
This document summarizes several articles from the New York Times Fitness & Nutrition section, including:
- Studies on whether compression clothing can enhance workouts.
- Plans to reduce traffic deaths through shared responsibilities among drivers, cyclists, pedestrians, and street designers.
- A study finding that napping infants are actively learning and memorizing during naps.
- A study showing over 11% of people taking daily aspirin for heart health should not be.
- Tips for creating an exercise habit in response to a reader's question.
- A challenge to the idea that one can be healthily obese long-term.
This document discusses pacemaker rhythms and includes images of pacemaker components, ECG tracings of different pacemaker rhythms, and diagrams illustrating pacemaker complications. It describes the different chambers that can be paced and sensed, response to sensing, rate modulation capabilities, and multi-site pacing options for pacemakers. Potential pacemaker issues like oversensing, undersensing, loss of capture, lead problems, and abnormal rhythms are depicted. Licensing information is provided for the various images.
LifeVac is a medical device that creates suction to clear the airway from obstruction. The device is intended to be used when the standard choking protocol has been followed without success. LifeVac has been proven to work and is FDA / Health Canada / CE registered. LifeVac is an over-the-counter (OTC) device.
The document discusses ritidectomy, also known as a facelift. It is a plastic surgery procedure performed to reduce facial wrinkles and signs of aging by removing skin and tightening underlying tissues. The procedure aims to lift sagging facial tissues and tighten the skin of the face and neck. It typically lasts a few hours and is performed under general or local anesthesia with intravenous sedation. The effects of a ritidectomy generally last between 5 to 10 years.
EBM resources for the expert: A Hyperlinked Page with an Impressive collectio...Imad Hassan
A file to keep on your desktop or favourites for a quick access to useful EBM websites and resources.
May be saved on your desktop as a webpage (instead of as a word doc) for an even quiker access.
The document summarizes that a 13-year-old patient needs two grams of medication every other week for the rest of his life. It costs $4,000 per gram to produce the medication, and it takes 450 bottles of 850 ml of plasma to make one gram. The patient will die without the medication.
Keeping Your Finger on the Pulse...of Technologycoffeyac
While the library is the heart of the school, the grasp of digital tools is the pulse. Middle and high school librarians, take note. PowToon, Narrable, Vocaroo and Aurasma are some of the tools you can share with teachers and students to breathe new life into the classroom and beyond.
1) The document discusses the myth that eating late at night leads to weight gain. While some studies on mice and humans have found disrupted circadian rhythms may impact metabolism and weight gain, other data contradict this.
2) A study in humans found no significant difference in weight loss between those who ate meals in the morning versus at night.
3) The conclusion is that when calories are equal, late night eating does not appear to cause weight gain or disrupt energy balance. Environmental factors may influence nighttime eating habits and calorie intake more than physiology.
A brief guide on what to look for in a plastic surgeon by William F. DeLuca, MD FACS. Dr. DeLuca is a board certified plastic surgeon in Albany, NY with over 26 years of experience. This presentation is based on the slides from a recent open house Dr. DeLuca hosted at his practice (which is located at 711 Troy Schenectady Rd, Suite 123 Latham NY.
Cells are the basic building blocks of all animals and plants. Cells contain a cell membrane, cytoplasm, and nucleus. Plant cells also contain chloroplasts, a vacuole, and cell wall. Cells can be specialized, such as root hair cells, leaf cells, red blood cells, and nerve cells in animals or phloem and xylem tissues in plants. Cells combine to form tissues, organs, and organ systems.
This document contains information about cellular respiration and photosynthesis. It discusses the circulatory system and how oxygen and glucose are transported to cells through capillaries. It also summarizes how animal cells undergo respiration in the mitochondria to produce carbon dioxide, water, and energy from oxygen and glucose, while plant cells perform photosynthesis in chloroplasts to produce glucose and oxygen from carbon dioxide, water, and sunlight. Diagrams show key structures in cells like mitochondria, nucleus, and chloroplasts, and different types of yeast reproduction.
Hemoglobin is an important protein in red blood cells that binds to oxygen and transports it throughout the body. It allows for oxygen to circulate in a gaseous form in the bloodstream. Hemoglobin's ability to bind oxygen is crucial for activities like climbing Mount Everest where oxygen levels are very low. Blood doping involves increasing the number of red blood cells, often by transfusing one's own stored blood back into the body, to enhance athletic performance by improving oxygen delivery to muscles. However, blood doping poses health risks like heart attack and stroke if not done properly.
Following are marketing results for several different companies. The marketing strategies include Facebook ads, Google Adwords, Email Marketing and Most Important SEO.
Anesthesiologists order epidural infusions which are prepared by pharmacy and administered by nurses trained in epidural infusion pumps. Nurses maintain and modify infusion rates as ordered, can administer bolus doses up to 10ml, and must change tubing every 72 hours and solutions every 24 hours. Blood thinners are not used or given when a patient has an epidural in place due to risk of bleeding. Nurses should address any side effects by following protocols before contacting anesthesia.
The document describes combined spinal epidural anesthesia (CSEA). It discusses the anatomy related to CSEA, including the spinal cord, subarachnoid space, epidural space, and bony landmarks. It also covers the physiology of regional anesthesia, advantages of CSEA over other techniques, indications for CSEA, prerequisites, contraindications, problems that can occur, and techniques for performing CSEA.
Each month, join us as we highlight and discuss hot topics ranging from the future of higher education to wearable technology, best productivity hacks and secrets to hiring top talent. Upload your SlideShares, and share your expertise with the world!
Not sure what to share on SlideShare?
SlideShares that inform, inspire and educate attract the most views. Beyond that, ideas for what you can upload are limitless. We’ve selected a few popular examples to get your creative juices flowing.
SlideShare is a global platform for sharing presentations, infographics, videos and documents. It has over 18 million pieces of professional content uploaded by experts like Eric Schmidt and Guy Kawasaki. The document provides tips for setting up an account on SlideShare, uploading content, optimizing it for searchability, and sharing it on social media to build an audience and reputation as a subject matter expert.
Computational Disease Management with Wearable DevicesPetteriTeikariPhD
Machine Learning modelling of disease trajectory with deep
learning and/or Gaussian Processes.
Alternative download link:
https://www.dropbox.com/s/jg73ymvkenx8rv4/computational_disease_management.pdf?dl=0
Many people want to improve their appearance so they often seek plastic surgery. People who wish to improve the appearance of their noses have found plastic surgery very popular. Anesthesia is required for any type of surgery. This article will discuss the use of anesthesia for rhinoplasty.
The document summarizes several medical studies that tested the effectiveness of the LifeVac device. A simulation study using choking simulators found that LifeVac successfully dislodged obstructing objects like grapes, hot dogs, and toy cars in 79-100% of trials. A closed system study demonstrated LifeVac generated over 300mmHg of suction, 3 times greater than the highest recorded choke pressure. Additional cadaver and environmental testing, as well as reviews in medical journals, provide further support that LifeVac is effective at clearing obstructions when standard choking protocols fail.
Biotechnology has progressed significantly from selective breeding and food preservation techniques used historically to more advanced methods used now. Current biotechnology utilizes recombinant DNA techniques, bioinformatics, and genetic engineering to develop products in green, white, and red biotechnology. Examples include developing pest-resistant crops, producing industrial chemicals, and engineering bacteria to produce antibiotics or insulin.
This document summarizes several articles from the New York Times Fitness & Nutrition section, including:
- Studies on whether compression clothing can enhance workouts.
- Plans to reduce traffic deaths through shared responsibilities among drivers, cyclists, pedestrians, and street designers.
- A study finding that napping infants are actively learning and memorizing during naps.
- A study showing over 11% of people taking daily aspirin for heart health should not be.
- Tips for creating an exercise habit in response to a reader's question.
- A challenge to the idea that one can be healthily obese long-term.
This document discusses pacemaker rhythms and includes images of pacemaker components, ECG tracings of different pacemaker rhythms, and diagrams illustrating pacemaker complications. It describes the different chambers that can be paced and sensed, response to sensing, rate modulation capabilities, and multi-site pacing options for pacemakers. Potential pacemaker issues like oversensing, undersensing, loss of capture, lead problems, and abnormal rhythms are depicted. Licensing information is provided for the various images.
LifeVac is a medical device that creates suction to clear the airway from obstruction. The device is intended to be used when the standard choking protocol has been followed without success. LifeVac has been proven to work and is FDA / Health Canada / CE registered. LifeVac is an over-the-counter (OTC) device.
The document discusses ritidectomy, also known as a facelift. It is a plastic surgery procedure performed to reduce facial wrinkles and signs of aging by removing skin and tightening underlying tissues. The procedure aims to lift sagging facial tissues and tighten the skin of the face and neck. It typically lasts a few hours and is performed under general or local anesthesia with intravenous sedation. The effects of a ritidectomy generally last between 5 to 10 years.
EBM resources for the expert: A Hyperlinked Page with an Impressive collectio...Imad Hassan
A file to keep on your desktop or favourites for a quick access to useful EBM websites and resources.
May be saved on your desktop as a webpage (instead of as a word doc) for an even quiker access.
The document summarizes that a 13-year-old patient needs two grams of medication every other week for the rest of his life. It costs $4,000 per gram to produce the medication, and it takes 450 bottles of 850 ml of plasma to make one gram. The patient will die without the medication.
Keeping Your Finger on the Pulse...of Technologycoffeyac
While the library is the heart of the school, the grasp of digital tools is the pulse. Middle and high school librarians, take note. PowToon, Narrable, Vocaroo and Aurasma are some of the tools you can share with teachers and students to breathe new life into the classroom and beyond.
1) The document discusses the myth that eating late at night leads to weight gain. While some studies on mice and humans have found disrupted circadian rhythms may impact metabolism and weight gain, other data contradict this.
2) A study in humans found no significant difference in weight loss between those who ate meals in the morning versus at night.
3) The conclusion is that when calories are equal, late night eating does not appear to cause weight gain or disrupt energy balance. Environmental factors may influence nighttime eating habits and calorie intake more than physiology.
A brief guide on what to look for in a plastic surgeon by William F. DeLuca, MD FACS. Dr. DeLuca is a board certified plastic surgeon in Albany, NY with over 26 years of experience. This presentation is based on the slides from a recent open house Dr. DeLuca hosted at his practice (which is located at 711 Troy Schenectady Rd, Suite 123 Latham NY.
Cells are the basic building blocks of all animals and plants. Cells contain a cell membrane, cytoplasm, and nucleus. Plant cells also contain chloroplasts, a vacuole, and cell wall. Cells can be specialized, such as root hair cells, leaf cells, red blood cells, and nerve cells in animals or phloem and xylem tissues in plants. Cells combine to form tissues, organs, and organ systems.
This document contains information about cellular respiration and photosynthesis. It discusses the circulatory system and how oxygen and glucose are transported to cells through capillaries. It also summarizes how animal cells undergo respiration in the mitochondria to produce carbon dioxide, water, and energy from oxygen and glucose, while plant cells perform photosynthesis in chloroplasts to produce glucose and oxygen from carbon dioxide, water, and sunlight. Diagrams show key structures in cells like mitochondria, nucleus, and chloroplasts, and different types of yeast reproduction.
Hemoglobin is an important protein in red blood cells that binds to oxygen and transports it throughout the body. It allows for oxygen to circulate in a gaseous form in the bloodstream. Hemoglobin's ability to bind oxygen is crucial for activities like climbing Mount Everest where oxygen levels are very low. Blood doping involves increasing the number of red blood cells, often by transfusing one's own stored blood back into the body, to enhance athletic performance by improving oxygen delivery to muscles. However, blood doping poses health risks like heart attack and stroke if not done properly.
The document defines an Emergency Action Plan (EAP) as a written document that outlines steps to take in the event of an injury or emergency during athletic events. An EAP should prepare for common emergencies in high school athletics like cardiac events, head injuries, heat illnesses, sickle cell trait crises, and lightning. It recommends that an EAP establish protocols for immediate care, activation of EMS, and guidelines for coaches, trainers, and staff to follow. Developing, writing, and rehearsing an EAP helps protect athletes' health and safety.
These are group notes from a small group hands-on activity to analyze data from Health OER Network YouTube channels. This activity is from day 2 of the Health OER Tech Africa 2012 workshop.
This document is shared under a CC BY license.
The document discusses guidelines for cardiopulmonary resuscitation (CPR) and first aid. It notes that cardiac arrest is a leading cause of death in the US and other countries. Guidelines for CPR and basic life support (BLS) were first published in 1966 and have been updated periodically since. It defines in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA), and distinguishes between a heart attack (a circulation problem) and sudden cardiac arrest (an electrical problem). The document reviews BLS procedures like calling for help, assessing pulse, and performing chest compressions. It also discusses advanced cardiovascular life support (ACLS) algorithms and identifying unstable patients needing intervention.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
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.
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
1. Anesthesia: Delivery Systems and Client Care http://images.google.com/imgres?imgurl=http://img.alibaba.com/photo/50577770/Spinal_Needles_and_Epidural_Needles.jpg&imgrefurl=http://sinorgmed.en.alibaba.com/product/50577770-50126379/Spinal_Needles_and_Epidural_Needles.html&usg=__a4Low-fK4K4DtBuFDprVa91v3cc=&h=360&w=360&sz=11&hlen&start=14&tbnid=9wUtPp3fNmRwgM:&tbnh=121&tbnw=121&prev=/images%3Fq%3Depidural%26gbv%3D2%26hl%3Den%26sa%3DX By Jessica Whittemore http://farm3.static.flickr.com/2014/2547402658_628d69dbcb.jpg
2. Assessment of Risk American Society of Anesthesiologists Classification System http://www.asahq.org/clinical/physicalstatus.htm
3.
4. Measurement of Outcomes dsf.chesco.org/.../health/dental/thermometer.jpg “ Apgar” Gawande, A.A. (02/2007). An Apgar Score for Surgery. Journal of the American College of Surgeons , 204 , Retrieved 03/04/09 < 55 56-65 66-75 76-85 >85 Lowest Heart Rate (bpm) ----- > 70 55-69 40-54 < 40 Lowest Mean Arterial Pressure (mmHG) ------ < 100 101-600 601-1,000 > 1,000 Estimated Blood Loss (mL) 4 3 2 1 0
5.
6.
7. http://sinorgmed.en.alibaba.com/product/50577770-50126379/Spinal_Needles_and_Epidural_Needles.html Epidural animation Epidural and Spinal Anesthesia Spinal “ Neural Blockade” Pros Smaller needle Cons Limited duration Uses Lower extremity/abdominal issues Epidural “ Segmental Neural Blockade” Pros Catheter allows for continuous or intermittent administration Can be combined with other methods Cons -Large volume of medication -Technically more difficult Uses Longer cases Post-op Pain Management
8.
9. CVPH. (2001). Immedeate Post-Procedure Patient, the Nursing Management of (Phase I & Phase II) [Brochure]. Plattsburgh, NY: Lisa Rabideau, RN.
11. So, Let’s Review….. Anesthesia is…. -Inhaled -IV -Intrathecal -Regional -Topical Client Care -ABC it’s easy as 123! -Requires careful assessment Any Questions???? Activity Time!
12.
Editor's Notes
Clients are assessed prior to receiving anesthetic to determine their level of risk, not to determine their outcome. This is usually recorded on operative paperwork.
When undergoing major surgery, some clients are made completely unconscious, though it goes deeper than that, and requires airway management as well as constant monitoring of physiological functions like blood pressure, heart rate and rhythm and oxygen saturation. General anesthesia is used when movement by the client would be detrimental to the outcome of their case. Narcotics- fentanyl, alfentanil, sufentanil, merperidine, morphine Sedative hypnotics (induction agents) given prior to intubation, these cause amnesia, but do nothing for pain. Propofol is pretty common, it is the only induction agent with antiemetic properties. The sedative hypnotics have a short onset and duration, other examples are phenothal, ketamine which can sometimes be used in combination with propofol, ketamine changes perception of pain which lends it an analgesic property. It is also a bronchodialator but it increases salivation and can give people pretty unpleasant “dreams” there is also amidate and brevital. Dep-succiynlcholine which may increase k+ levels and can be linked with malignant hyperthermia which will be discussed in a few slides, also this can lead to myalgias postoperatively Nondep- short, intermediate, and long acting. Crystalloids, colloids, and blood products also given here. Inhaled-don’t even ask how they work, just know they do. Isoflurane, intermediate induction/emergence Sevoflurane-rapid action, easier to titrate than isoflurane Desflurane- acts real real quick, but smells real terrible so probably don’t put it anywheres near a conscious person IV: propofol, ketamine, narcotics, benzos Anticholinesterases, i.e. neostigmine, which I saw given at CVPH and edrophonium these increase circulating aCH to restore fctn of SKM Anticholinergix- glycopyrrolate and atropine. Both are given together to reduce the rxn of cholinergic resp to inc aCH (slow hr, bronchospasm, salivation, tearing, urination, defecation, myosis, and sweating.)
This chart is based on a 2007 study done at brigham and women’s hospital. As with the APGAR score for infants, the higher the score for clients on a scale of 1-10, the better. The benefits of this system is that it is less subjective and easily measurable. There are other systems in place like the APACHE and POSSUM scores. Using a score such as this one can help identify clients at higher risk of postoperative complications.
An autosomal dominant disorder, one form is associated with a defect in the ryanodine receptor gene. Usually noticed after the first time a client is placed under general anesthesia, yet one more reason a family history is important prior to surgery. Renal failure is caused by protein destruction as a result of exposure to high, uncontrolled temperature. Rhabdomyolysis occurs and myoglobin can be detected in the urine Dantroline reduces calcium release and relaxes skeletal muscle, can be given PO preoperatively or IV intraoperatively. It can cause heptaotoxicity so liver labs should be monitored on clients receiving this medication Sore throats are real common
-under rigidity-masseter spasm or total body All potential inhalation agents- Succinylcholine Cell damage-Potassium Myoglobin CK (CPK) compensatory mechanisms-Sweating Cutaneous vasodilatation Increased circulating catecholamines-Increased heart rate Cutaneous vasoconstriction Increased systemic vascular resistance Increased CO-Decreased mixed venous oxygen content Decreased arterial oxygen content depends on shunt Lactic acidosis Increased ventilation - may not keep up with need Increased respiratory drive Increased end tidal carbon dioxide
So, the blockade can spread both up and down from the injection site. A larger volume of fluid is injected here (about 5-20 mL) with a larger needle (17 gauge) and, in most cases a small indwelling catheter. Spinal- catheter may be used, in fact spinal may be in conjunction with epidural or other methods. Uses- c-sections, lower extremity fractures, knee arthroscopy, TURP They both have similar risks like post-dural headaches resulting from a leak of CSF, and hypotension
Immediatly, you need to COIN your client Connection-client is placed on proper monitoring equipment Oxygenation/Ventilation-assess the adequacy of the client’s airway/breathing. all that good stuff Institution of emergency ventilatory support measures as needed iNitiate-oxygen therapy asap for all phase one clients. Airway/Breathing-02 sat, resp r8/depth, breath sounds, as well as any artificial airways/ventilatory support Circulation-pulses, bp, temp, cardiac rhythm, hemodynamic pressure readings, CAST of extremities when applicable PARS-next slide Everything else- Respiratory, Cardiovascular (capillary refill), Neuro i.e. movement/sensation, intugumentary- site appearance, general skin color/condition, signs of labor/FHR, patency, type, condition and position for all drainage tubes and dressings…and of course level of comfort!!!!! Know happy-sad faces, 1-10 or any acceptable pain scale. My post op client referred to his pain as a “low simmer” that could “turn into a boil” Phase one, stir it up basically encourage deep breathing and coughing q5-10 minutes, assist the client to change position every hour, good ones are side lying/semi-prone, encourage client movement of extremities “ watch” monitor vitals, pressure readings and cardiac rhythm until they meet d/c criteria, give 02 2-4 LPM as ordered by MD so what would we use? (nasal canula) as client grows more and more stable, wean to room air so long as they don’t drop below 92%. If they’ve had regional anesthesia, assess their sensory dermatome levels ( this just refers to innervation of specific muscles and limbs on the level of the spine the block was on. Keep watching, vs q15 til stable, assess urine output/ability to void, measure bodily fluid drainage and check the dressing to make sure it is still intact/usable reorient them to person/place (general or sedating meds) I had my wisdom teeth out with IV sedation and demanded to see my teeth in order to make a necklace from them, so obviously anesthesia can be pretty disorienting to people. Maintain the patency of IV lines/monitor IV therapy Analgesia, do I need to say more? Do a focused assessment, give meds as ordered, reassess pain. While we’re talking about it, now is the time you begin to implement the rest of the doctor’s orders “ care”-your client has unique age specific, psychosocial, religious/cultural needs and restrictions, know what these are and remember to treat your client they way you’d want someone to treat you or your mother/family/SO The five rights still apply here, make sure they’re in a position they can breathe in, keep side rails up and the bed locked, suction prn, maintain an open airway-tilt, artificial airways, bag-valve-mask, call MD if airway problems occur, vital signs declining/unstable, significant abnormality detected by lab/radiology, client’s sensory status changes/decreases, no pain relief, unexpected events, not improving w/i time frame Obviously document everything ever
In the CVPH pacu, you are either “in” or you are “out.” This is a table attached to the post anesthesia care protocol, as you can see, it uses several markers to determine client advancement. Systems like this one help to eliminate subjectivity and objectively measure client outcomes with easily measurable items that lend themselves well to standardization.
Carla is right about a lot of things, hypnosis has been proven effective in things like weight loss, and smoking cessation. There is even a Hypnobirth movement which promises a “pain free labor” we do use distraction and other methods like visualization to help our clients alleviate pain.