This document discusses various types of endotracheal tubes and laryngoscopy techniques. It describes specialized tubes like armored tubes, RAE tubes, Oxford tubes, and laser-resistant tubes. It covers direct laryngoscopy using curved and straight blades. Optimal conditions for laryngoscopy are outlined, including using the appropriately sized blade and ensuring good muscle relaxation. Reliable signs of correct endotracheal tube placement include capnography, visualization of the tube passing the vocal cords, and fiberoptic bronchoscopy visualization of tracheal rings.
The transversus abdominis plane, more commonly referred to as the TAP block,
Places local anesthetic in the lateral abdominal wall in a plane between the internal oblique and the transversus abdominis muscles.
Here, the local anesthetic block can block many of the abdominal nerves as they pass to the abdominal structures.
The transversus abdominis plane, more commonly referred to as the TAP block,
Places local anesthetic in the lateral abdominal wall in a plane between the internal oblique and the transversus abdominis muscles.
Here, the local anesthetic block can block many of the abdominal nerves as they pass to the abdominal structures.
SPINAL & EPIDURAL ANAESTHESIA DR OYETUNDE.pptxOlaideOyetunde1
Spinal and epidural anaesthesia are forms of local regional anaesthesia. They are neuraxial anaesthesia which involves introduction of local anaesthetic agents into the subarachnoid space (Spinal) or epidural space (epidural). Indications includes surgeries below the umbilicus and and labour or postoperative analgesia. The most dangerous side effect is high spinal anaesthesia. Other common side effects are postspinal headaches, Hypotension, Bradycardia, infection,
Similar to Endotracheal intubation and laryngoscopy part 2 (20)
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. ENDOTRACHEAL INTUBATION LECTURES
INCLUDE THE FOLLOWING IN 5a, and 5b
1-The basic Technique
2-Requirements of Tracheal intubation
3-Examination and investigations of
correct Placement of endotracheal
tube (ETT)
4-Differet ETT’s and their use
5-Fixation of the ETT
3. -SPECIALIZED ENDOTRACHEAL
TUBE TYPES
-ARMORED TUBE
It is flexible and wire – reinforced
ADVANTAGES
--It resists kinking, therefore it is used in Head and Neck
operations or in abnormal positions as Prone position
DISADVANTAGES
--It may be kinked by extreme pressure e.g
a-Biting by an awake patient because the lumen will
tend to remain occluded and the tube will need
replacement. Most of the Armored tubes are very
malleable and need a stylet for their insertion.
5. -Performed Tracheal Tubes (Oral and Nasal)
-RING – ADAIR – ELWYN (RAE)
--They have been designed, in 1975, by
Wallace H Ring,
John C Adair and
Richard A Elwyn.
They are used to direct the breathing
circuit away from the field of surgery
in HEAD AND Neck surgeries with
decreasing the Risk of kinking
--The RAE oral tubes direct the breathing
circuit to the feet of the patient
(some times it is called south – Facing
--While the RAE Nasal tubes direct the
breathing circuit to the Head of the patient
(sometimes it is called North – Facing)
6. -TE DISTIGUISHED FEATURES OF RAE TUBES.
--In comparison to slandered ET tubes is there pre – formed
bend. The Pre – forming during manufacturing reduces the
risk of kinking and obstruction which could occur if a
“slandered” ET tube was bent into the same shape as RAE
tube. A black marker Bar is imprinted on the tube at the
point of maximum angle of the bend
--DISADVANTAGES OF THE RAE TUBE
--One disadvantage of the Nasal and the oral RAE tube is that
depth of tube insertion is very much pre – determined by the
tube’s pre – formed shape i.e th bend of the oral and nasal
RAE will always want to sit just at the lower lip and at the
nostril respectively, not allowing you much flexibility as to
how deeply you can place the tube into the trachea. In some
patients specially very short or Tall once, it might be difficult
to achieve a good tube “Fit” together with the correct
insertion depth which avoids accidental bronchial intubation
or cuff placement between the vocal cords
-RING – ADAIR – ELWYN
(RAE) contd.
8. ADVANTAGES
--It is L – shaped and its distal end has a fixed length therefore,
it has the advantages of a deceased risk of bronchial intubation,
and a decreased risk of kinking with flexed head during surgery
--The tube can be made of rubber or plastic and can be cuffed or
uncuffed the bevel is oval in shape and faces posteriorly and an
introducing stylet is supplied to aid the insertion of the tube.
--Its thick wall adds to the tube’s external diameter making it wider
for a given internal diameter. This is undesirable especially in
pediatric anesthesia.
DISADVANTAGES
--The distance form the bevel to the curve of the tube is fixed. If the
tube too long the problem cannot be corrected by withdrawing the
tube and shortening it because this means losing its anatomical Fit
-OXFORD TUBE
10. -LASER RESISTANT
ENDOTRACCHEAL TUBES
-They are used in LASER surgery
FEATURES
--1-Like standard endotracheal tubes, laser tubes are made
of poly – vinyl – chloride (PVC) which is flammable in the
presence of oxygen and an ignition source i.e LASER light
--2-The PVC core of the LASER tubes is therefore wrapped in
two layers one metallic foil layer which protects the actual
tube from the LASER light, and an outer non – reflective layer
12. -LASER RESISTANT
ENDOTRACCHEAL TUBES
--The cuff of the laser tube is not protected in anyway and therefore
most are vulnerable to laser light. The pilot balloon contains blue
dye granules which dissolved when filled with water or saline.
The Dyed water in the cuff serves two functions.
--1-It acts as an indicator in case the cuff bursts. Puncture of the cuff
from the laser beam causes the dye to spill under the cuff pressure.
--2-It acts as fire prevention / a fire extinguisher.
--3-The cuff of the laser tube is of the high pressure – low volume design.
14. -LASER RESISTANT
ENDOTRACCHEAL TUBES contd.
-DIRECT LARYNGOSCOPY
---They are instruments used for direct examination of the larynx
and intubating the trachea.
COMPONENTS
--1-The handle houses the power source (Batteries) and is designed
in different sizes
--2-The blade is fitted to the handle and can be either curved or
straight. There is a wide range of designs for both curved and
straight blades
Types of Blades:
There are many types of the blades and Laryngoscopes. Most of
the Ordinary laryngoscopes have either curved or straight blades.
16. -CURVED BLADE
TECHNIQUE
--The blade is introduced to the base of epiglottis at the vallecula then it is elevated
forward pressuring on the hyo – epiglottic ligament to elevate the epiglottis and
expose the vocal cords
--The blade touches the upper surface of epiglottis (supplied by the Glossopharyngeal
nerve
INDICATIONS
--In patients with small upper airway room to pass the endotracheal tube e.g
--small narrow mouth
--Palate or
--Oropharynx
DISADVANTAGES
--It is useless with large floppy infantile U shaped epiglottis
TYPES
--English Macintosh blade (The most common) There are Four sizes available and
There is a disposable blade
--American Macintosh blade
19. -STRAIGHT BLADE
TECHNIQUE
--The blade is introduced under the lower surface of the Epiglottis
then it elevated forward, lifting the epiglottis to expose the
vocal cords.
--The blade touches the lower posterior surface of epiglottis
(Supplied by Vagus Neve)
INDICATIONS
--In patients with
a- smaller mandibular space
b- anterior larynx
c- large incisors or
d- large infantile U shaped floppy epiglottis
--In infants with large infantile epiglottis
20. -STRAIGHT BLADE contd.
-DISADVANTAGES
--As it touches the lower posterior
surface of the epiglottis, it stimulates
the Vagus nerve causing Bradycardia
and spasm. Therefore, anticholinergics
are essential before its usage especially
in pediatrics
EXAMPLE
Millar blade:- There are 4 sizes
21. -THE McCoy LARYNGOSCOPE
---It is based on the standard Macintosh blade.
It has a hinged Tip which is operated by the
liver mechanism present on the back of the
handle.
--It is suited for both routine use and in cases of
difficult intubation
--A more recent McCoy design has a straight blade
with a hinged Tip
23. -LARYNGOSCOPE
-Should be examined for the following points
--THE SIZE:-Always proper blade size should be chosen. In infants, Miller size-1 is used and for
infants > 2.5 Kg. While Miller size-0 is used for smaller infants
--THE LIGHT INTENSITY:-It is tested as it should remain constant (a blinking light indicates poor
electrical contact while Fading indicates Low strength of batteries
--SPARE:-Laryngoscope should be prepared
--THE TYPE:-Either straight or curved blade
-In infants, it is better to use a straight blade (Miller) laryngoscope due to the large floppy
U – shaped epiglottis where it is introduced until the epiglottis is reached. The epiglottis is
elevated from its under surface by the blade, but it may cause Vagal Nerve stimulation
because the under surface of the epiglottis is supplied by the Vagus Nerve
24. --Failure of one laryngoscopic intubation should force
the anesthesiologist to perform the second intubation
attempt in optimum conditions, which include:-
--1-A reasonably experienced anesthesiologist should be
available (the experience of using the Laryngoscope
is usually maximally reached after 2 to 3 years of experience
--2-No significant resistive muscle tone should be present
(There is good muscle relaxation)
--3-Sniffing position should be made
-OPTIMAL / BEST LARYNGOSCOPIC
-INTUBATION ATTEMPT
25. --4-Optimal laryngeal manipulation:- (Pressuring thyroid cartilage
posteriorly or laterally) should be done by a trained assistant,
instructed by the anesthesiologist. This may improve laryngoscopic
grade by one degree
--5-The length of the blade of the laryngoscope may be changed to a
larger size(either Macintosh or a Miller)
--6-The type of the blade (sometimes) may be changed according to
the patient as
a-The Macintosh blade is preferred in patients with little upper
airway room to pass the endotracheal tube e.g small narrow
mouth, palate or oropharynx
b-The Miller blade is preferred in patients with small mandibular
space (i.e anterior larynx, Large incisors, or large floppy infantile
epiglottis
-OPTIMAL / BEST LARYNGOSCOPIC
INTUBATION ATTEMPT
26. --No oxygen is delivered to the patients lungs, resulting in severe Hypoxia that may cause death.
Therefore, if there is doubt regarding the position of the Endotracheal tube or Unexplained
Hypoxia that occurred after intubation, removal of the tube and ventilation by Mask may be
life saving
ESOPHAGEAL INTUBATION CAN BE DETECTED BY THE FOLLOWING
A- RELIABLE SIGNS
--1-CAPNOGRAPHY:-For consistent rise and fall of end – tidal CO2 (more than 30 mm Hg for
3 to 5 consecutive breaths) with normal wave form. It is the most reliable method
--2-Direct visualization of the Tip of the tube passing via the vocal cords
--3-FIBROPTIC BRONCHOSCOPY:-By seeing tracheal rings and carina via the Endotracheal tube.
--4-A WEE ESOPHAGEAL DETECTOR:-To detect the esophagus as through which air is introduced
inside the tube. If the tube lies in the trachea, the esophageal detector is Re – inflated, but
if the tube lies in the Esophagus, the esophageal detector remains deflated because the
air will not return from the stomach back to the detector
--5-A colorimetric End – Tidal CO2 detector (A disposable chemical indicator) to detect the expired
end – tidal CO2
--6-Trnstracheal illumination by a special light stylet via the tube
-ERRORS OF ENDOTRACHEAL
TUBE POSITIONING
28. --1-Bilateral 4 quadrant auscultation of breath sounds with
absence of Gastric Gargling.
--2-Chest X Ray to see the position of the tube, It is a common
practice in intensive care units
--3-Absence of Cyanosis (Hypoxia) or high pulse oximeter reading
is unreliable, because if the patient is well pre – oxygenated
Cyanosis(Hypoxia) can be delayed upto 5 minutes
--4-Expiratory condensation of PVC tubes (Breath holding)
--5-Chest or Abdominal movements with ventilation
--6-Refilling of the Anesthetic reservoir bag
-UNRELIABLE SIGNS