This document discusses various types of endotracheal tubes and laryngoscopy techniques. It covers specialized tubes like armored tubes, RAE tubes, Oxford tubes, and laser-resistant tubes. It also describes curved and straight laryngoscope blades and their uses. Key points include the advantages and disadvantages of different tube types, components of laryngoscopes, and reliable vs unreliable signs of correct endotracheal tube placement.
Regional anesthesia is anesthesia affecting only a specific area of the body when the patient is conscious, e.g. foot, arm, lower extremities, insensate to stimulus of surgery or other instrumentation.
oxygen is a medication. oxygen therapy must be known to all health professionals for optimum management of patient and optimum use of resourses. even more oxygen can cause oxygen toxicity and can harm the patient in many ways. There are various methods for giving oxygen,varieties of face masks, cylinders. also there is criteria when to give oxygen ,how to give oxygen,what are the benefits and mechanism of oxygen therapy.
Regional anesthesia is anesthesia affecting only a specific area of the body when the patient is conscious, e.g. foot, arm, lower extremities, insensate to stimulus of surgery or other instrumentation.
oxygen is a medication. oxygen therapy must be known to all health professionals for optimum management of patient and optimum use of resourses. even more oxygen can cause oxygen toxicity and can harm the patient in many ways. There are various methods for giving oxygen,varieties of face masks, cylinders. also there is criteria when to give oxygen ,how to give oxygen,what are the benefits and mechanism of oxygen therapy.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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
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.
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.
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
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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