1) The document discusses the basics of airway management in pediatrics, including anatomy, developmental considerations, signs of impending respiratory failure, and methods of assessing and establishing an airway.
2) It covers various airway devices that can be used including oropharyngeal and nasopharyngeal airways, bag mask ventilation, laryngeal mask airways, and endotracheal tubes. Precautions for different pediatric populations are highlighted.
3) The process of endotracheal intubation is outlined including preparation, positioning, drug administration, inserting the laryngoscope, and passing the tube. Specific challenges and their management are also summarized.
The insertion of a cannula or a tube into a hollow organ such as intestines or trachea, to maintain an opening or passageway is known as intubation.
The insertion of a long breathing tube or artificial airway (endotracheal tube - ETT) into the trachea (windpipe) via the mouth is called endotracheal intubation
The insertion of a cannula or a tube into a hollow organ such as intestines or trachea, to maintain an opening or passageway is known as intubation.
The insertion of a long breathing tube or artificial airway (endotracheal tube - ETT) into the trachea (windpipe) via the mouth is called endotracheal intubation
a complete slide of endotracheal intubation for mbbs students and students of other medical background. the refrence is from uptodate.com and short text book of anaesthesia by Ajay yadav, 5th edition.
ET Intubation- Definition, Anatomy of Respiratory Track, Types Of Tubes, Measurement of Tube, Measurement of mouth, Position, procedure, Tray Preparation, Education of Pts, Fixations, Testing of tube, Advantages, Disadvantages.
a complete slide of endotracheal intubation for mbbs students and students of other medical background. the refrence is from uptodate.com and short text book of anaesthesia by Ajay yadav, 5th edition.
ET Intubation- Definition, Anatomy of Respiratory Track, Types Of Tubes, Measurement of Tube, Measurement of mouth, Position, procedure, Tray Preparation, Education of Pts, Fixations, Testing of tube, Advantages, Disadvantages.
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Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
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Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
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.
3. Developmental consideration
• Tongue
• Epiglottis
• Tracheal diameter and length
• Glottic opening
• Large occiput
• Cricoid ring
• Small cricothyroid membrane
4.
5. Funneled shape larynx
• narrowest part of infant’s
larynx is the undeveloped
cricoid cartilage, whereas in
the adult it is the glottis
opening (vocal cord)
• Tight fitting ETT may cause
edema and trouble upon
extubation
• Uncuffed ETT preferred for
patients < 8 years old
• Fully developed cricoid
cartilage occurs at 10-12
years of age
Image from:
http://www.hadassah.org.il/NR/rdonlyres/59B531BD-
EECC-4FOE-9E81-
14B9B29D139B1945/AirwayManagement.ppt
INFANTADULT
6.
7.
8. Signs of Impending Respiratory Failure
• Increase work of breathing
• Tachypnea/tachycardia
• Nasal flaring
• Drooling
• Grunting
• Wheezing
• Stridor
• Head bobbing
• Use of accessory muscles/retraction of muscles
• Cyanosis despite O2
• Irregular breathing/apnea
• Altered consciousness/agitation
• Inability to lie down
• Diaphoresis
15. Nasopharyngeal Airway
•Distance from nares to angle of mandible approximates the proper length
•Nasopharyngeal airway available in 12F to 36F sizes
•Shortened endotracheal tube may be used in infants or small children
•Avoid placement in cases of hypertrophied adenoids - bleeding and trauma
Image from: http://www.hadassah.org.il/NR/rdonlyres/59B531BD-EECC-4FOE-9E81-14B9B29D139B1945/AirwayManagement.ppt
16. Bag-Mask Ventilation
•Clear, plastic mask with inflatable rim
provides atraumatic seal
•Proper area for mask application-bridge of
nose extend to chin
•Maintain airway pressures <20 cm H2O
•Place fingers on mandible to avoid
compressing pharyngeal space
•Hand on ventilating bag at all times to
monitor effectiveness of spontaneous breaths
•Continous postitive pressure when needed to
maintain airway patency
Image from: http://www.hadassah.org.il/NR/rdonlyres/59B531BD-EECC-4FOE-9E81-14B9B29D139B1945/AirwayManagement.ppt
23. Intubation Procedure
• Pre-oxygenate with 100% bag valve mask
ventilation
– Contraindicated in known congenital
diaphragmatic hernia
• Apply monitors
• Give drugs
– Ensure ability to bag/mask ventilate before
paralysis
24.
25. Intubation Procedure
• Inserting the
laryngoscope blade
– Hold laryngoscope in left
hand
– While standing above
the patient, insert the
blade in the right side of
the mouth WITHOUT
trying to visualize the
cords.
26. Intubation Procedure
• Take a step back
• Lower your head to the
level of the label
• Slowly advance
laryngoscope until you
visualize the epiglottis
• Use straight or curved
blade appropriately
27. Intubation Procedure
• Visualize the vocal cords
– Both moving if not
paralyzed?
– Structurally normal?
• Pick up endotracheal
tube and pass between
vocal cords
Size
How to put
In whom to put
Not recocommended in
Can b used in pts +/- intact cough & gag reflex
If too long –vagal stimulation
If too large– sustained blanching of alae nasi
Size
How to put
Seal pr
Merits
limitations
Monitoring equipment
Suction equipment—80-120mmhg yankauer,catheter
Bag & mask
Medication
Intubation equipments
Confirmation device
Tabe to secure tube
syringe
Analysis of data in pediatric national emergency airway registry shows that intubation success rate is higher if seadtion & neuromuscular blockade r used anticholinergic agents ---ATRopine --<1yr,1-5yr receiving succinylcholine,adolescents with >doses of succinylcholine
Fentanyl..5min. Pr to blunt hemodynamic response to intubation
Ketamine– for hemodynamic instability,no inc. in ICP,inc.airway secretions
Etomidate—maintains hemodynamics & cerebral perfusion without raising ICP but may lower seizure threshold –myoclonic cough, hiccups
BURP
If not possible yet– bag mask ,reposition
Then put finger in right of mouth
If only post. Aspect of glottis—stylet
Verification of placement
RSI-SAMPLE
Preoxygenation
IV anesthetic ,sedative, analgesic,MR
CRICOID PR.
Awake intubation– adult, without sedation esp. in arrest, sevoflurane
Full stomach– ph, volume, antacids, anticholinergics, N G tube—awake alert child with intact reflexes. Sequence—preoxygenate,sedatives/anesthetics,cricoid pressure,parlytic agents the classic combinationis---sodium thiopental(4-6mg/kg) +succinylcholine(1-4mg/kg) with defasciculating dose of NDMR e.g vecuronium
Normal cardiopulmonary interaction—dec. LV afterload during PPV, but dec LV preload, bradycardia so bolus ,inotropes, atropine,ketamine, etomidate,rocuro
2)Maxillary injury—compression of nasopharynx. If spon. Breathing then –by mask, laryngeal injuries-burn,inhalational injuries, caustic ingestion anaphylaxis, hereditary angiooedema
3) Cns depressants lower IOP with exception of ketamine ,intuabation under full muscle relaxant ( schn CI) , lidocaine
4) Pierre robin ,treacher collin, goldenhar,cleft palate,glossoptosis,midface abnormalities —micrognathia ,cephalad positioning of larynx
5) Mediastinal mass– induction of aneas.– loss of tone ---airway collapse—ineffective oxygenation & ventilation even after intubation----sokeep pt breathing spontaneously, lateral or prone position,anaesthesia with minimal hemodynamic instability—ketamine,optimise preload
6) macroglossia- prefercurved blade
7)obesity—drug doses,2 rescuers for bagging, sniffing position ,big handle,surgical airways,incision place
8) mucopoly– deposition ---thickening---hypertrophy—hunters as early as 2 years of age