Ergonomics is the study of designing equipment and tasks to optimize human well-being and system performance. The document discusses various types of ergonomic research conducted in anesthesiology including task analysis, workload studies, attention studies, and critical incident analysis. It provides examples of how ergonomic principles were applied to modernize anesthesia machine design, such as reducing errors from improper gas connections or flow settings. The goal of ergonomic guidelines is to produce easy to use, reliable devices through principles like visibility, natural mapping of controls, and constraining undesirable actions.
1) A community hospital implemented a process to fast-track eligible ambulatory surgery patients by bypassing the post-anesthesia care unit (PACU) and sending them directly to an ambulatory care unit (ACU).
2) In the reference period before implementation, 81% of patients were eligible for fast-tracking based on a scoring tool. After implementing the fast-tracking process, 79% of patients bypassed the PACU, with decreased incidence and duration of operating room holds.
3) Length of stay in the ACU and total postoperative time were reduced in the implementation period. The process improvement was estimated to save over $1 million annually and demonstrated potential for sustainability through standardized eligibility criteria.
This document discusses clinical audits in anaesthesia. It defines clinical audits as quality improvement processes that systematically review care against criteria to improve outcomes. The document outlines the history of audits dating back to Florence Nightingale. It describes different types of audits including clinical, critical event, outcome, training, and survey audits. The audit cycle is also explained as preparing criteria, measuring performance, implementing improvements, and sustaining changes. Barriers to audits are a lack of resources, expertise, and leadership. Audits aim to improve standards but challenges include support, time constraints, and obtaining consent.
Neuromuscular monitoring, also known as train of four monitoring, is a technique used during recovery from the application of general anesthesia to objectively determine how well a patient's muscles are able to function. It involves the application of electrical stimulation to nerves and recording of muscle response using, for example, an acceleromyograph. Neuromuscular monitoring is typically used when neuromuscular-blocking drugs have been part of the general anesthesia and the doctor wishes to avoid postoperative residual curarization (PORC) in the patient, that is, the residual paralysis of muscles stemming from these drugs.
This document discusses capnography, which is the monitoring of carbon dioxide levels in exhaled breath. It can be used to assess ventilation, circulation, and metabolism during anesthesia and intensive care. The document defines capnography and describes the capnogram waveform and how it reflects respiratory parameters. Abnormal waveforms can indicate various lung diseases. Capnography is useful for confirming endotracheal tube placement and detecting malpositions. It provides advantages over pulse oximetry during procedures done under sedation. The principles of mainstream and sidestream capnography devices are outlined, as well as clinical applications in emergency medical services and indications for diagnostic usage.
This document discusses the use of ultrasound in assessing airway and lung conditions in the emergency department. It provides an overview of how ultrasound can be used to detect endotracheal tube placement, assess for one-lung intubation, and evaluate diaphragm movement. The document also discusses evaluating lung sliding and the lung pulse with ultrasound, identifying pneumothorax using the stratosphere and seashore signs, and differentiating wet vs. dry dyspnea using the BLUE protocol which assesses B-lines on ultrasound to detect pulmonary edema. Pleural effusions can also be semiquantitatively assessed with ultrasound by measuring interpleural space distances.
This document provides an overview of capnography including:
1) The objectives of describing ventilation, perfusion, and their relationship as assessed by capnography.
2) A description of the normal capnogram waveform and factors that can cause abnormal waveforms related to airway, breathing, and circulation problems.
3) Clinical applications of capnography including confirming endotracheal tube placement, assessing ventilation status, and predicting outcomes of cardiac arrest resuscitation.
Anaesthesia International Certificates FRCA, MCAI & EDAIC -OrientationSCORE Training Centre
Anesthesia International Certificates FRCA, MCAI & EDAIC -Orientation
Session surmise most of the reputable Postgraduate international certificates in the Anesthesia specialty. Which are:
FRCA, Fellowship of the Royal College of Anesthetists
MCAI, Membership of College of Anesthesia of Ireland.
EDAIC, European Diploma in Anesthesia and Intensive Care Medicine.
Awake fiberoptic intubation and total intravenous anesthesia (TIVA) are described. Awake fiberoptic intubation is the gold standard for predicted or known difficult airways and involves conscious sedation and analgesia during intubation. TIVA involves using intravenous propofol and remifentanyl infusions without inhalational gases. It has advantages like reduced postoperative nausea but risks include accidental awareness and postoperative apnea. Both techniques require monitoring and experience to perform safely.
1) A community hospital implemented a process to fast-track eligible ambulatory surgery patients by bypassing the post-anesthesia care unit (PACU) and sending them directly to an ambulatory care unit (ACU).
2) In the reference period before implementation, 81% of patients were eligible for fast-tracking based on a scoring tool. After implementing the fast-tracking process, 79% of patients bypassed the PACU, with decreased incidence and duration of operating room holds.
3) Length of stay in the ACU and total postoperative time were reduced in the implementation period. The process improvement was estimated to save over $1 million annually and demonstrated potential for sustainability through standardized eligibility criteria.
This document discusses clinical audits in anaesthesia. It defines clinical audits as quality improvement processes that systematically review care against criteria to improve outcomes. The document outlines the history of audits dating back to Florence Nightingale. It describes different types of audits including clinical, critical event, outcome, training, and survey audits. The audit cycle is also explained as preparing criteria, measuring performance, implementing improvements, and sustaining changes. Barriers to audits are a lack of resources, expertise, and leadership. Audits aim to improve standards but challenges include support, time constraints, and obtaining consent.
Neuromuscular monitoring, also known as train of four monitoring, is a technique used during recovery from the application of general anesthesia to objectively determine how well a patient's muscles are able to function. It involves the application of electrical stimulation to nerves and recording of muscle response using, for example, an acceleromyograph. Neuromuscular monitoring is typically used when neuromuscular-blocking drugs have been part of the general anesthesia and the doctor wishes to avoid postoperative residual curarization (PORC) in the patient, that is, the residual paralysis of muscles stemming from these drugs.
This document discusses capnography, which is the monitoring of carbon dioxide levels in exhaled breath. It can be used to assess ventilation, circulation, and metabolism during anesthesia and intensive care. The document defines capnography and describes the capnogram waveform and how it reflects respiratory parameters. Abnormal waveforms can indicate various lung diseases. Capnography is useful for confirming endotracheal tube placement and detecting malpositions. It provides advantages over pulse oximetry during procedures done under sedation. The principles of mainstream and sidestream capnography devices are outlined, as well as clinical applications in emergency medical services and indications for diagnostic usage.
This document discusses the use of ultrasound in assessing airway and lung conditions in the emergency department. It provides an overview of how ultrasound can be used to detect endotracheal tube placement, assess for one-lung intubation, and evaluate diaphragm movement. The document also discusses evaluating lung sliding and the lung pulse with ultrasound, identifying pneumothorax using the stratosphere and seashore signs, and differentiating wet vs. dry dyspnea using the BLUE protocol which assesses B-lines on ultrasound to detect pulmonary edema. Pleural effusions can also be semiquantitatively assessed with ultrasound by measuring interpleural space distances.
This document provides an overview of capnography including:
1) The objectives of describing ventilation, perfusion, and their relationship as assessed by capnography.
2) A description of the normal capnogram waveform and factors that can cause abnormal waveforms related to airway, breathing, and circulation problems.
3) Clinical applications of capnography including confirming endotracheal tube placement, assessing ventilation status, and predicting outcomes of cardiac arrest resuscitation.
Anaesthesia International Certificates FRCA, MCAI & EDAIC -OrientationSCORE Training Centre
Anesthesia International Certificates FRCA, MCAI & EDAIC -Orientation
Session surmise most of the reputable Postgraduate international certificates in the Anesthesia specialty. Which are:
FRCA, Fellowship of the Royal College of Anesthetists
MCAI, Membership of College of Anesthesia of Ireland.
EDAIC, European Diploma in Anesthesia and Intensive Care Medicine.
Awake fiberoptic intubation and total intravenous anesthesia (TIVA) are described. Awake fiberoptic intubation is the gold standard for predicted or known difficult airways and involves conscious sedation and analgesia during intubation. TIVA involves using intravenous propofol and remifentanyl infusions without inhalational gases. It has advantages like reduced postoperative nausea but risks include accidental awareness and postoperative apnea. Both techniques require monitoring and experience to perform safely.
The document discusses different types of breathing circuits used in anesthesia. It begins by describing the basic components and functions of a breathing circuit, which delivers oxygen and anesthetic gases to patients while removing carbon dioxide. Circuits are classified as open, semi-open, semi-closed, or closed based on how exhaust gases are handled. Several specific circuit types are then outlined in detail, including the Mapleson A, Bain, Ayres T-piece, and Jackson-Rees systems. Key features and uses of each system are provided. Semi-closed circuits are explained as using a carbon dioxide absorber to remove carbon dioxide from exhaled gases so they can be rebreathed, allowing for lower fresh gas flow rates than open systems
Capnography measures carbon dioxide in exhaled breath through capnography and can be used by paramedics to objectively evaluate a patient's ventilation and indirectly their circulation and metabolism. It provides important information about respiratory status and can help confirm endotracheal tube placement, guide CPR efforts, and predict resuscitation outcomes. Capnography is a useful vital sign monitoring tool for paramedics.
The document discusses awake intubation, including indications, patient preparation, pharmacological considerations like using lidocaine to anesthetize the airway via various methods to block different nerves, equipment needs, and personnel requirements to safely perform an awake intubation. It also reviews closed claims analyses related to airway management and difficult intubation, and the ASA's difficult airway algorithm.
This document discusses different oxygen therapy techniques including conventional oxygen therapy and high flow nasal cannula (HFNC) oxygen therapy. It provides details on:
- How HFNC works by using an air/oxygen blender to deliver high flows of humidified oxygen at variable concentrations.
- The physiologic effects of HFNC including improved oxygen delivery to the alveoli and prevention of adverse effects from lack of humidification.
- Techniques called THRIVE and STRIVE-Hi that use HFNC to provide apneic oxygenation and tubeless anesthesia, extending the time available to secure an airway without risk of hypoxemia.
Anaesthesia for interventional neuroradiologyDr Kumar
The document provides information on anaesthesia for interventional neuroradiology procedures. It discusses:
1. The indications for anaesthesia including maintaining immobility, rapid recovery, managing anticoagulation, and treating complications.
2. Pre-operative assessment considerations like pulmonary and cardiovascular risks in subarachnoid hemorrhage patients.
3. Techniques for induction, maintenance and recovery from anaesthesia aimed at maintaining stability while allowing the procedure, including use of propofol, remifentanil and sevoflurane.
4. Managing risks like hypertension, hypotension and temperature during the procedure.
Crisis resource management (CRM) is an approach adapted from aviation that focuses on human factors and team performance to improve patient safety. CRM training teaches skills like situational awareness, communication, leadership, and teamwork. Through simulation-based exercises, it aims to address known human errors like fixation, poor communication, and workload issues. Implementing CRM training has been shown to improve outcomes like provider satisfaction, safety culture, clinical performance, and decreased errors and complications.
Physiological changes in pregnancy & its anaesthetic implicationsSwadheen Rout
This document discusses the physiological changes that occur during pregnancy and how they impact anesthesia practice. It notes that pregnancy results in increased blood volume, cardiac output, respiratory rate and oxygen consumption to support the growing fetus. Regional and general anesthesia can impact the mother's cardiovascular and respiratory physiology, with risks of supine hypotension, hypoxemia and decreased uterine blood flow. Careful anesthetic management is needed to support both mother and fetus simultaneously during pregnancy and delivery.
Spinal anesthesia (Anatomy and Pharmacology) Saeid Safari
This document discusses spinal anesthesia anatomy, pharmacology, and techniques. It covers spinal cord and epidural space anatomy, spinal artery and vein anatomy, and anatomical variations. It discusses the classification, properties, doses, and durations of various local anesthetics used for spinal anesthesia including short, intermediate, and long-acting agents. It also covers spinal anesthetic additives like opioids, and vasoconstrictors and their effects.
The document provides guidance on airway management in emergency situations. It discusses assessing the need for airway control, oxygen delivery devices, signs of respiratory distress, techniques for difficult intubation like video laryngoscopy, and alternative airway devices like combitubes. Factors like patient comorbidities, anatomy, and mechanism of respiratory failure help determine the best approach. Proper planning, backup devices, and skills are important for managing challenging airways.
This document provides information on thoracic anesthesia. It discusses topics such as double lumen tube placement, one lung ventilation, and the effects of thoracic anesthesia on intraoperative and postoperative cardiopulmonary function. It describes the goals of thoracic anesthesia as minimizing cardiac depression, pulmonary pressures, and V/Q disturbances during one lung ventilation. It also discusses preoperative evaluation, investigations, respiratory function tests, ventilation/perfusion assessments, and preparation of patients for thoracic surgery. The document outlines techniques for one lung ventilation including double lumen tubes and bronchial blockers. It addresses the lateral decubitus position and associated physiological impacts.
No ventilation, yet full oxygenation - Åse Lodenius - SSAI2017scanFOAM
A talk by Åse Lodenius at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Content delivered in collaboration between scanFOAM, SSAI & SFAI.
1) The document discusses preoperative evaluation and anesthetic considerations for thoracic surgery patients, with a focus on patients undergoing one-lung ventilation.
2) Key points of preoperative evaluation include assessing pulmonary function, cardiac status, investigating the extent of lung involvement, and optimizing patients with respiratory conditions like COPD.
3) Anesthetic management focuses on techniques for one-lung ventilation using devices like double-lumen endotracheal tubes, as well as strategies for ventilation, induction, and analgesia tailored to patient comorbidities.
1) Airway management is challenging in patients with cervical spine injuries or trauma due to the risk of worsening spinal injuries during intubation attempts. 2) Manual in-line stabilization is the preferred technique for intubating these patients to minimize head and neck movement, but it can impair the laryngoscopic view and increase intubation difficulties. 3) Awake fiberoptic intubation allows for intubation without cervical spine movement but requires patient cooperation. Overall the goal is to secure the airway while preventing further cervical spine injury.
Anaesthesia management of patient posted for scoliosis correctionNaveen Kumar Ch
This document discusses the anesthetic considerations for scoliosis surgery. It begins with definitions and classifications of scoliosis. It then discusses epidemiology, measurement of severity, pre-anesthetic assessment, anesthesia techniques used, and conclusions. Key points include the need for careful preoperative pulmonary and cardiac evaluation given the risks of respiratory impairment. Intraoperatively, neuromuscular monitoring is important to detect any spinal cord issues, and total intravenous anesthesia is typically used. Postoperatively, close monitoring and respiratory care are essential to address issues like pain management and pulmonary complications.
This document discusses anesthesia considerations for in vitro fertilization (IVF). It outlines the IVF process and notes that oocyte retrieval is a stressful, painful component. The role of the anesthesiologist is to provide pain relief, proper medical history evaluation, and counseling to reduce patient anxiety. Various anesthesia techniques are described, including monitored anesthesia care, general anesthesia, regional techniques, and total intravenous anesthesia. Factors like medication interactions, obesity, and medical comorbidities require special consideration. The goal of anesthesia is to provide adequate pain relief while using agents and techniques that minimize potential negative effects on fertility and pregnancy outcomes.
This document discusses quality improvement and patient safety in anesthesia. It defines key terms like quality improvement, continuous quality improvement and differentiates it from traditional quality assurance. It outlines frameworks for improvement like the Model for Improvement and discusses tools used for quality improvement like Lean methodology, Six Sigma and PDSA cycles. It discusses important measures for quality improvement like process, outcome and balancing measures. Methods for analyzing and displaying quality improvement data like control charts and dashboards are described. Sources of quality improvement information and the importance of incident reporting are also summarized.
Anaesthetic problems of open chest and pathophysiology of one lung ventilation aratimohan
Mechanics and physiology of lung isolation/ one-lung ventilaion,
Anaesthetic implications of one-lung ventilation and management strategies
West zones of the lung
Ventilation-perfusion mismatch, V-Q
Hypoxic pulmonary vasoconstriction
Pharmacokinetics of inhalational agents relavant to anaestheistnarasimha reddy
The document summarizes key concepts in pharmacokinetics relevant to anesthesiologists, including:
1) Factors that influence the delivery and uptake of inhalational anesthetic agents in the lungs, such as ventilation, solubility, blood flow, and alveolar-arterial gradient.
2) How partial pressures of anesthetic agents change from inspired gas to alveoli to blood and tissues like the brain. Solubility determines equilibration rate between compartments.
3) Definition of MAC and factors that increase or decrease an agent's potency. Tissue uptake depends on perfusion, solubility and saturation over time.
This document discusses anesthesia management for laparoscopic assisted surgery. Some key points include:
- Laparoscopy has advantages over open surgery like shorter hospital stays and faster recovery, but can pose respiratory and cardiovascular risks under anesthesia.
- Maintaining adequate ventilation and oxygenation can be challenging due to absorption of carbon dioxide and positioning effects.
- Gas embolism is a serious risk if gas is directly injected into blood vessels, which can cause hypotension, arrhythmias and death if massive.
- Patient positioning like head-down can increase risks like elevated intracranial pressure and decreased cardiac output that anesthesiologists must manage closely.
One Lung Ventilation (OLV) is a technique that isolates ventilation to one lung during surgery using double lumen tubes (DLTs) or bronchial blockers. DLTs allow control of ventilation to each lung and switching between single and dual lung ventilation. Placement is confirmed with fiberoptic bronchoscopy. OLV reduces the risk of cross contamination during certain procedures. Preoperative pulmonary function tests assess risk, with an FEV1 <40% or DLCO <40% indicating high risk. During OLV, hypoxic pulmonary vasoconstriction and gravity divert blood flow away from the non-ventilated lung to reduce shunting. Anesthesia aims to maintain cardiovascular stability and minimize inhibition of hypo
Patient Safety And Human Factors Engineering Spring2006Carolyn Jenkins
1) Human Factors Engineering (HFE) uses principles to identify and control patient safety hazards by designing systems that fit human capabilities and limitations.
2) A study redesigning a Patient Controlled Analgesia pump found the new design reduced errors by 55% and completion time by an average of 18% compared to the original design.
3) HFE considers the whole healthcare system, including training, documentation, environment, and how users interact with equipment, rooms and facilities.
This document summarizes a study on using a CNN model to predict lung conditions from X-ray images. It introduces common lung diseases and the 10 conditions analyzed. It describes challenges in medical AI like lack of data and the need for sophisticated algorithms. The methods section outlines dataset collection, object extraction from images, feature extraction using CNNs, and model training/validation. Results show the model achieved 90.6% training accuracy and 82.6% validation accuracy after 12 epochs. The study aimed to accurately detect lung diseases from X-rays to help diagnoses and save lives.
The document discusses different types of breathing circuits used in anesthesia. It begins by describing the basic components and functions of a breathing circuit, which delivers oxygen and anesthetic gases to patients while removing carbon dioxide. Circuits are classified as open, semi-open, semi-closed, or closed based on how exhaust gases are handled. Several specific circuit types are then outlined in detail, including the Mapleson A, Bain, Ayres T-piece, and Jackson-Rees systems. Key features and uses of each system are provided. Semi-closed circuits are explained as using a carbon dioxide absorber to remove carbon dioxide from exhaled gases so they can be rebreathed, allowing for lower fresh gas flow rates than open systems
Capnography measures carbon dioxide in exhaled breath through capnography and can be used by paramedics to objectively evaluate a patient's ventilation and indirectly their circulation and metabolism. It provides important information about respiratory status and can help confirm endotracheal tube placement, guide CPR efforts, and predict resuscitation outcomes. Capnography is a useful vital sign monitoring tool for paramedics.
The document discusses awake intubation, including indications, patient preparation, pharmacological considerations like using lidocaine to anesthetize the airway via various methods to block different nerves, equipment needs, and personnel requirements to safely perform an awake intubation. It also reviews closed claims analyses related to airway management and difficult intubation, and the ASA's difficult airway algorithm.
This document discusses different oxygen therapy techniques including conventional oxygen therapy and high flow nasal cannula (HFNC) oxygen therapy. It provides details on:
- How HFNC works by using an air/oxygen blender to deliver high flows of humidified oxygen at variable concentrations.
- The physiologic effects of HFNC including improved oxygen delivery to the alveoli and prevention of adverse effects from lack of humidification.
- Techniques called THRIVE and STRIVE-Hi that use HFNC to provide apneic oxygenation and tubeless anesthesia, extending the time available to secure an airway without risk of hypoxemia.
Anaesthesia for interventional neuroradiologyDr Kumar
The document provides information on anaesthesia for interventional neuroradiology procedures. It discusses:
1. The indications for anaesthesia including maintaining immobility, rapid recovery, managing anticoagulation, and treating complications.
2. Pre-operative assessment considerations like pulmonary and cardiovascular risks in subarachnoid hemorrhage patients.
3. Techniques for induction, maintenance and recovery from anaesthesia aimed at maintaining stability while allowing the procedure, including use of propofol, remifentanil and sevoflurane.
4. Managing risks like hypertension, hypotension and temperature during the procedure.
Crisis resource management (CRM) is an approach adapted from aviation that focuses on human factors and team performance to improve patient safety. CRM training teaches skills like situational awareness, communication, leadership, and teamwork. Through simulation-based exercises, it aims to address known human errors like fixation, poor communication, and workload issues. Implementing CRM training has been shown to improve outcomes like provider satisfaction, safety culture, clinical performance, and decreased errors and complications.
Physiological changes in pregnancy & its anaesthetic implicationsSwadheen Rout
This document discusses the physiological changes that occur during pregnancy and how they impact anesthesia practice. It notes that pregnancy results in increased blood volume, cardiac output, respiratory rate and oxygen consumption to support the growing fetus. Regional and general anesthesia can impact the mother's cardiovascular and respiratory physiology, with risks of supine hypotension, hypoxemia and decreased uterine blood flow. Careful anesthetic management is needed to support both mother and fetus simultaneously during pregnancy and delivery.
Spinal anesthesia (Anatomy and Pharmacology) Saeid Safari
This document discusses spinal anesthesia anatomy, pharmacology, and techniques. It covers spinal cord and epidural space anatomy, spinal artery and vein anatomy, and anatomical variations. It discusses the classification, properties, doses, and durations of various local anesthetics used for spinal anesthesia including short, intermediate, and long-acting agents. It also covers spinal anesthetic additives like opioids, and vasoconstrictors and their effects.
The document provides guidance on airway management in emergency situations. It discusses assessing the need for airway control, oxygen delivery devices, signs of respiratory distress, techniques for difficult intubation like video laryngoscopy, and alternative airway devices like combitubes. Factors like patient comorbidities, anatomy, and mechanism of respiratory failure help determine the best approach. Proper planning, backup devices, and skills are important for managing challenging airways.
This document provides information on thoracic anesthesia. It discusses topics such as double lumen tube placement, one lung ventilation, and the effects of thoracic anesthesia on intraoperative and postoperative cardiopulmonary function. It describes the goals of thoracic anesthesia as minimizing cardiac depression, pulmonary pressures, and V/Q disturbances during one lung ventilation. It also discusses preoperative evaluation, investigations, respiratory function tests, ventilation/perfusion assessments, and preparation of patients for thoracic surgery. The document outlines techniques for one lung ventilation including double lumen tubes and bronchial blockers. It addresses the lateral decubitus position and associated physiological impacts.
No ventilation, yet full oxygenation - Åse Lodenius - SSAI2017scanFOAM
A talk by Åse Lodenius at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Content delivered in collaboration between scanFOAM, SSAI & SFAI.
1) The document discusses preoperative evaluation and anesthetic considerations for thoracic surgery patients, with a focus on patients undergoing one-lung ventilation.
2) Key points of preoperative evaluation include assessing pulmonary function, cardiac status, investigating the extent of lung involvement, and optimizing patients with respiratory conditions like COPD.
3) Anesthetic management focuses on techniques for one-lung ventilation using devices like double-lumen endotracheal tubes, as well as strategies for ventilation, induction, and analgesia tailored to patient comorbidities.
1) Airway management is challenging in patients with cervical spine injuries or trauma due to the risk of worsening spinal injuries during intubation attempts. 2) Manual in-line stabilization is the preferred technique for intubating these patients to minimize head and neck movement, but it can impair the laryngoscopic view and increase intubation difficulties. 3) Awake fiberoptic intubation allows for intubation without cervical spine movement but requires patient cooperation. Overall the goal is to secure the airway while preventing further cervical spine injury.
Anaesthesia management of patient posted for scoliosis correctionNaveen Kumar Ch
This document discusses the anesthetic considerations for scoliosis surgery. It begins with definitions and classifications of scoliosis. It then discusses epidemiology, measurement of severity, pre-anesthetic assessment, anesthesia techniques used, and conclusions. Key points include the need for careful preoperative pulmonary and cardiac evaluation given the risks of respiratory impairment. Intraoperatively, neuromuscular monitoring is important to detect any spinal cord issues, and total intravenous anesthesia is typically used. Postoperatively, close monitoring and respiratory care are essential to address issues like pain management and pulmonary complications.
This document discusses anesthesia considerations for in vitro fertilization (IVF). It outlines the IVF process and notes that oocyte retrieval is a stressful, painful component. The role of the anesthesiologist is to provide pain relief, proper medical history evaluation, and counseling to reduce patient anxiety. Various anesthesia techniques are described, including monitored anesthesia care, general anesthesia, regional techniques, and total intravenous anesthesia. Factors like medication interactions, obesity, and medical comorbidities require special consideration. The goal of anesthesia is to provide adequate pain relief while using agents and techniques that minimize potential negative effects on fertility and pregnancy outcomes.
This document discusses quality improvement and patient safety in anesthesia. It defines key terms like quality improvement, continuous quality improvement and differentiates it from traditional quality assurance. It outlines frameworks for improvement like the Model for Improvement and discusses tools used for quality improvement like Lean methodology, Six Sigma and PDSA cycles. It discusses important measures for quality improvement like process, outcome and balancing measures. Methods for analyzing and displaying quality improvement data like control charts and dashboards are described. Sources of quality improvement information and the importance of incident reporting are also summarized.
Anaesthetic problems of open chest and pathophysiology of one lung ventilation aratimohan
Mechanics and physiology of lung isolation/ one-lung ventilaion,
Anaesthetic implications of one-lung ventilation and management strategies
West zones of the lung
Ventilation-perfusion mismatch, V-Q
Hypoxic pulmonary vasoconstriction
Pharmacokinetics of inhalational agents relavant to anaestheistnarasimha reddy
The document summarizes key concepts in pharmacokinetics relevant to anesthesiologists, including:
1) Factors that influence the delivery and uptake of inhalational anesthetic agents in the lungs, such as ventilation, solubility, blood flow, and alveolar-arterial gradient.
2) How partial pressures of anesthetic agents change from inspired gas to alveoli to blood and tissues like the brain. Solubility determines equilibration rate between compartments.
3) Definition of MAC and factors that increase or decrease an agent's potency. Tissue uptake depends on perfusion, solubility and saturation over time.
This document discusses anesthesia management for laparoscopic assisted surgery. Some key points include:
- Laparoscopy has advantages over open surgery like shorter hospital stays and faster recovery, but can pose respiratory and cardiovascular risks under anesthesia.
- Maintaining adequate ventilation and oxygenation can be challenging due to absorption of carbon dioxide and positioning effects.
- Gas embolism is a serious risk if gas is directly injected into blood vessels, which can cause hypotension, arrhythmias and death if massive.
- Patient positioning like head-down can increase risks like elevated intracranial pressure and decreased cardiac output that anesthesiologists must manage closely.
One Lung Ventilation (OLV) is a technique that isolates ventilation to one lung during surgery using double lumen tubes (DLTs) or bronchial blockers. DLTs allow control of ventilation to each lung and switching between single and dual lung ventilation. Placement is confirmed with fiberoptic bronchoscopy. OLV reduces the risk of cross contamination during certain procedures. Preoperative pulmonary function tests assess risk, with an FEV1 <40% or DLCO <40% indicating high risk. During OLV, hypoxic pulmonary vasoconstriction and gravity divert blood flow away from the non-ventilated lung to reduce shunting. Anesthesia aims to maintain cardiovascular stability and minimize inhibition of hypo
Patient Safety And Human Factors Engineering Spring2006Carolyn Jenkins
1) Human Factors Engineering (HFE) uses principles to identify and control patient safety hazards by designing systems that fit human capabilities and limitations.
2) A study redesigning a Patient Controlled Analgesia pump found the new design reduced errors by 55% and completion time by an average of 18% compared to the original design.
3) HFE considers the whole healthcare system, including training, documentation, environment, and how users interact with equipment, rooms and facilities.
This document summarizes a study on using a CNN model to predict lung conditions from X-ray images. It introduces common lung diseases and the 10 conditions analyzed. It describes challenges in medical AI like lack of data and the need for sophisticated algorithms. The methods section outlines dataset collection, object extraction from images, feature extraction using CNNs, and model training/validation. Results show the model achieved 90.6% training accuracy and 82.6% validation accuracy after 12 epochs. The study aimed to accurately detect lung diseases from X-rays to help diagnoses and save lives.
The Effects of Sleep Deprivation, Caffeine, and Alcohol on Simulated Neurosur...Crimsonpublisherssmoaj
- The study examined the effects of sleep deprivation, caffeine intake, and alcohol consumption on performance of a simulated neurosurgical task using a virtual reality simulator.
- For sleep deprivation, participants who slept less than 6 hours showed significantly higher right hand excessive force and cut more correct and incorrect fibers than those sleeping more than 6 hours.
- For caffeine, participants who consumed caffeine showed significantly lower right hand excessive force than non-consumers, and cut more correct and incorrect fibers.
- For alcohol, the 4 participants who consumed alcohol the night before, averaging a 0.14 blood alcohol content, showed no significant differences in performance compared to non-drinkers.
Have you ever wanted to learn more about human factors in health care and it’s impact on patient safety? Well now is the time. Join us on Oct. 4th at noon ET as Dr. Kathy Momtahan and Dr. Gianni D’Egidio explore the work of the Canadian Human Factors in Healthcare Network and recent human factors evaluations of hospital external defibrillators.
This document discusses various industrial hygiene principles and health hazards. It provides examples of chemical hazards like mercury, trichloroethylene, lead, silica, copper fumes, iron oxide, carbon monoxide, chromium, cadmium, and methylene chloride. It also discusses ergonomic hazards like repetitive stress injuries. The document outlines methods for evaluating, controlling and preventing exposure to health hazards through engineering controls, work practices, PPE, and other means.
The document outlines a research proposal on detecting arthritis using thermal imaging. It discusses the literature surrounding using infrared thermography and machine learning to diagnose arthritis. The proposed methodology would involve collecting thermal images of knees, extracting statistical features, and using support vector machines for classification of images as normal or arthritic. The expected outcomes are more accurate detection of arthritis at earlier stages to improve treatment. The timeline outlines the stages of data collection, model development and testing over months.
once upon a time 12345once upon a t..pptxMinaz Patel
This study evaluated the performance of the VL3 video laryngoscope for intubation. It observed 35 patients undergoing elective surgery requiring intubation. The mean intubation time was 24.7 seconds. Most patients (57%) had an intubation difficulty score of 0, indicating easy intubation. Most patients (86%) had a glottic view score of 100%, allowing full view of the vocal cords. Hemodynamic parameters like heart rate and blood pressure did not change significantly from baseline values during intubation. The study concluded that the VL3 provided quick and easy intubation without significant hemodynamic response.
Medical Deep Learning: Clinical, Technical, & Regulatory Challenges and How t...Devon Bernard
Deep Learning is proving to be a powerful tool that can improve healthcare for both patients and care-providers. In this talk I’ll cover an intro to some of the medical problems currently being solved by deep learning, market adoption, healthcare challenges (e.g regulation, data quality, data acquisition), deep learning challenges (e.g. model stability, training/convergence time, scalable training environment), and tips learned by tackling these problems head-on.
This talk was presented Oct 15, 2017 at http://ai.withthebest.com/.
1) Procedural sedation is used for many medical procedures and aims to provide analgesia, amnesia, and reduce anxiety while maintaining airway reflexes and spontaneous breathing.
2) While pulse oximetry became standard in the 1980s, capnography has emerged as the new gold standard for monitoring procedural sedation as it can detect respiratory issues that oximetry may miss.
3) Overlake Hospital developed a new monitoring protocol using capnography based on evidence that it improves patient safety during procedural sedation. They saw reduced need for respiratory therapist intervention after implementing routine capnography use.
1) Procedural sedation is used for many medical procedures and aims to provide analgesia, amnesia, and reduce anxiety while maintaining airway reflexes and spontaneous breathing.
2) While pulse oximetry became standard in the 1980s, capnography has emerged as the new gold standard for monitoring procedural sedation as it can detect respiratory issues that oximetry may miss.
3) Overlake Hospital implemented capnography monitoring for all procedural sedations after reviewing evidence and determining it was more effective for patient safety than relying on respiratory therapists to continuously monitor each procedure.
Technology will save our minds and bodiesmark_power
The document discusses several new medical technologies from 2012 including:
1) An origami-inspired paper sensor that can detect diseases like malaria and HIV for 10 cents per test.
2) The I-BESS system, a body suit and vehicle sensors that record blast impacts to help diagnose soldier injuries.
3) An instrument that performs tissue sealing and cutting to help surgeons reduce operating time.
4) Microrobots designed to swim inside the body and deliver targeted drug therapies.
This paper details the use of Electroencephalography, a methodology commonly applied for
medical purposes such as in detection of mental disorders and in upcoming technological research areas like BCI
(Brain Computer Interfaces), is now re-purposed to use in the Manufacturing sector to reduce the risk of error
and anomalies. Manufacturing involves many tasks that require mental alertness of an operator who supervises a
particular process, failure to do this, might leave unchecked errors in the finished product. Fatigue could lead to
serious consequences to health of the worker and may also lead to on-job accidents. To minimize possibility of
such instances, a study has been conducted to measure and find ways to tackle issues of mental fatigue. To
quantify the study, we have taken the case study of Pharmaceutical Sector where this kind of study might have
some impact. [3] The study reveals that workers doings tasks that require high alertness develop fatigue earlier
than anticipated, and therefore need frequent rotation from such activities.
This paper details the use of Electroencephalography, a methodology commonly applied for
medical purposes such as in detection of mental disorders and in upcoming technological research areas like BCI
(Brain Computer Interfaces), is now re-purposed to use in the Manufacturing sector to reduce the risk of error
and anomalies. Manufacturing involves many tasks that require mental alertness of an operator who supervises a
particular process, failure to do this, might leave unchecked errors in the finished product. Fatigue could lead to
serious consequences to health of the worker and may also lead to on-job accidents. To minimize possibility of
such instances, a study has been conducted to measure and find ways to tackle issues of mental fatigue. To
quantify the study, we have taken the case study of Pharmaceutical Sector where this kind of study might have
some impact. [3] The study reveals that workers doings tasks that require high alertness develop fatigue earlier
than anticipated, and therefore need frequent rotation from such activities.
1. Researchers developed an X-ray disease identifier using a deep learning model to analyze chest X-ray images and diagnose diseases.
2. They used the VGG19 classification model to process X-ray images from the NIH dataset and diagnose diseases, achieving over 60% accuracy for most diseases.
3. The system aims to assist radiologists by providing automated disease diagnoses from X-ray images to reduce their workload and enable diagnoses in remote areas.
Implanted Neural Prosthetics - an IntroductionJennifer French
This webinar discussed implanted neural prosthetics for restoring function. It defined neural prosthetics as devices that connect directly to the nervous system to replace or supplement function. The webinar outlined therapeutic applications that aim to restore voluntary motor control through temporary treatment versus prosthetic applications that replace lost function with an implanted device. Examples of neurostimulation applications included bladder control, breathing, hand function, and more. Clinical trials were discussed as the process for testing these devices, and resources were provided to learn about eligibility and participation. The webinar concluded by discussing how the Institute for Functional Restoration aims to create a sustainable commercialization model for neuromodulation systems to restore function long-term.
Low Complexity System Designs for Medical Cyber Physical Human SystemsMDPnP_UIUC
Prepare and inject drugs, assist with medical procedures
Head nurse: Record diagnosis, treatments and patient conditions
Physician in charge: Diagnose patient condition and order treatments
Medical devices: Monitor and display patient conditions
Code sheet: Record diagnosis, treatments and patient conditions
This model helps understand the workflow and information flow.
This document proposes the development of an "Artificial Electronic Nose" capable of detecting toxic gases, chemical vapors, smoke, and flammable oils through an array of sensors. The nose would not only detect the presence of these elements but also quantify their concentration. It aims to benefit those unable to detect hazards in their environment and would find application in industrial monitoring. The project is proposed to occur in two phases: first enhancing an existing industrial interface and integrating relevant sensors, then exploring a bio-electric interface for impaired patients. The feasibility lies in building upon commercially available gas detection technology and simulations show the design could accommodate 24 sensors with further resources.
The document provides an introduction and guidelines for testing vital signs monitoring equipment. It describes the physiology of the respiratory system and circulation. It then discusses testing various vital signs monitoring functions, including non-invasive blood pressure (NIBP), invasive blood pressure (IBP), pulse oximetry (SpO2), electrocardiography (ECG), respiration, and temperature. The guidelines provide information on test setup and procedures for evaluating the accuracy, alarms, sensitivity and other performance characteristics of the monitoring equipment. Regular performance testing is recommended to ensure the equipment continues to provide accurate vital sign measurements.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
1. ERGONOMICS IN ANAESTHESIA
PRESENTER: Dr. SHAHBAZ ALAM
MODERATOR: Dr. RAJIV CHAWLA
Chairman Departmentof Anaesthesia
Rajiv Gandhi Cancer Institute and
Research Center, Rohini, New Delhi
2. What is Ergonomic.
Examples of ergonomic researches.
Ergonomic guidelines.
Progress in Ergonomics.
Types of Ergonomics.
Basic requirement of Ergonomically efficient operating
room.
Ergonomic injuries.
Prevention of Ergonomic injuries.
3. 1.ERGONOMIC
o Ergonomics is a discipline that investigates and
applies information about human requirements,
characteristics, abilities, and limitations to the
design, development, engineering, and testing of
equipment, tools, systems, and job.
o It is the study of work & way to make jobs / tasks
in a better way safely.
5. Scope of ergonomics
In 1972 Edwards introduced
S.H.E.L model.
As per this model all jobs are
performed by three classes of
resources,
1.Hardware: equipment or
machine for the job
2.Software: procedures and
rules
3.Liveware: people
Live
ware
Soft
ware
Hard
ware
Enviroment
6. Why Ergonomics?
Benefit of Patients : Safety
Benefit of Anaesthesiologist : Comfort / ease
To reduce the risk of
•Accidents
•Injury
•Ill health due to poor ergonomics
Increase Performance / Output
Reduce Sickness absence / Costs
Everyone in any organization is at risk and it is not
just “heavy” or “physical” jobs that cause injury
7. Ergonomic is the discipline of designing and testing of this
S.H.E.L model in view of improving safety, comfort and work
efficiency.
8. Hypoxia : A constant Threat !
Decades ago, accidental delivery of hypoxic gas mixtures was a
constant threat during general anesthesia.
In some cases the anesthesiologist mistakenly turned the wrong
gas flow control knob or failed to recognize that the oxygen
cylinder was empty.
In another case, a technician placed the flow meter tubes in
the wrong positions while servicing the anesthesia machine.
These small human errors led to major injury or death of the
patient.
9. Modern Anesthesia Machines :
Reduced Human Errors
With modern anesthesia machines, the risk of
accidental hypoxia has been dramatically reduced. In
effect, the potential for human error has been reduced by
redesigning the equipment.
The concept that, equipment can be designed for
optimal performance by the human user is one of the
core principles of ergonomics.
10. • Ergonomics is both a science and a profession, including
both research and application.
• One goal of ergonomics research is to understand and
describe the capabilities and limitations of human
performance.
• Another is to develop principles of interaction between
people and machines
11. 2.Ergonomics Research
A. Task Analysis
B. Workload Studies
C. Attention Studies
D. Automation & New Technology
E. Critical Incident Studies
12. Examples of ergonomics research are:
The investigation of visual perception in relation to a
particular task, and auditory vigilance in relation to attention.
Application involves the use of these data in the development
of equipment.
For example, the selection of color coding for displays is
based on understanding of visual perception, whereas
auditory vigilance data are used for development of alarm in
machines.
13. The number of ergonomics studies in anesthesiology continues
to grow. The focus of these studies has been to identify human/
machine interface factors that affect patient safety and the
anesthesia caregiver’s job performance.
Many recent efforts are concisely summarized.
14. A.TASK ANALYSIS STUDIES
Drui and colleagues’s, time and motion study for
anaesthesiologists:-
• Found that filling out the records occupies a large
proportion of time for anaesthetists.
• Anesthesiologist’s attention was directed away from the
patient or surgical field 42% of the time.
• Drui’s recommendations were published and based on the
study, electronic anesthesia record-keeping systems and
integrated anesthesia workstations have attained
commercial viability.
15. B.WORKLOAD STUDIES:
• Workload is multidimensional and complex
• When workload increases, the sympathetic nervous
system is activated, leading to a variety of physiological
changes. For example, increased workload is associated
with increases in heart rate or respiratory rate.
• Work load is highest during induction and emergence
phase of anaesthesia.
• Toung et al reported that anaesthetists heart rate increase
39% to 65% of base line during intubation, though more
experienced anaesthetist, manifested less.
16. C. ATTENTION STUDIES:
• Cooper and Cullen described a method for investigating
auditory vigilance.
• They used a computer-controlled device to occlude the
stethoscope tubing silently at random intervals during
routine general anesthesia.
• Study participants were instructed to press a button to
restore function, whenever they perceived the absence of
sounds.
• The elapsed time between the occlusion of the tubing and
the press of the button was automatically recorded.
17. • In another study, Loeb evaluated visual vigilance in eight
anesthesia residents by displaying numbers at random
intervals on an OR monitor during operative procedures.
• The residents were instructed to detect an “abnormal”
value and asked to respond by pressing a button on the
anesthesia machine.
• The response time was recorded.
• Then compared with Cooper’s study:-
It appears that response times in the OR are longer
for visual than for auditory signals.
C. ATTENTION STUDIES: II
18. In another attention study it was found that overall,
anaesthesiologists looked at the patient monitor :
8% of the time prior to injecting induction agents.
20% of the time after injecting induction agents, during
routine induction.
30% of the time after injecting induction agents, during
eventful induction.
C. ATTENTION STUDIES: III
19. D. Automation And New Technologies
• A recurrent application of task analysis, workload, and
attention studies lead to investigate the effect of
automation and new technologies on anesthesiologist
performance.
• Different studies done for checking, whether it decreases
workload and increases efficiency or it removes human
from the information loop.
• Then after automated record keepers, automated drug
dispensing carts are now available.
20. E. Critical incident studies
• Critical incidents- defined as occurrence of human error
or equipment failure that if not discovered or corrected in
time may lead to increased length of hospital stay or even
death.
• Examples;-syringe and drug ampule swaps, drug
overdoses, wrong i.v line used, endotracheal tube
disconnection.
• Cooper and colleagues studied in 1975 and first applied
these critical incidents to anaesthesiology, they found that
human errors were responsible for 65% to 70% of
incidents.
• On the basis of their findings they recommended a
standardized system of syringe labels and redesign of the
breathing circuit to prevent disconnections.
21. E.Critical incident studies II
• In 1993 Runciman et al: done an exhaustive analysis of the
first 2000 incidents reported in Australian Patient Safety
Foundation report and found that:-
83% incidents related to Human Error.
9% related to Equipment Failure.
22. 3.Ergonomics Guidelines
PRINCIPLES OF GOOD DEVICE DESIGN:
The goal is to produce devices that are
Easily maintained.
Have an effective user interface.
Are tailored to the user’s abilities.
This is best accomplished during the early phases of system
and equipment design, when the ergonomics and
engineering specialists can work together with end users to
produce a safe, reliable, and usable product.
25. What did Ergonomics do ?
Make things visible.
Provide good mapping.
Appropriate constraints creation.
Design for error.
Visual display.
Auditory display.
Manual control.
26. Make Things Visible
• People expect certain objects to always function in a
particular manner, like knobs are for turning, buttons are
for pushing, and so on
knob
button
28. Provide Good Mapping
Mapping is the relationship between an action and a
response
Natural Mapping
Artificial Mapping
29. Mapping
Natural Mapping : like squeezing the bag to inflate the lung.
It is innate.
Artificial mapping: have to learn, like turning the oxygen flow
control knob counter clockwise to increase gas flow.
30. Appropriate Constraints Creation
• It is done to facilitate simple, logical and innate operation.
• When a series of indicator lights are arranged in a row,
each with a switch underneath, indicates particular switch.
Here another constraint lies,
the selection will get finalized
after pressing the knob.
knob
constraints
31. Design For Error
• It is also a type of constraint that prevents an
undesirable action.
EXAMPLE :
Vaporizer interlock
Pin index in cylinders:
32. Color Coding of cylinders:
oxygen Nitrous Oxide CO2
Design For Error : II
33. Display magnitudes: Numeric or Graphic
Grouping of displays: similar items are grouped together,
so that easy to read-
Object display: Pictorial
Visual Display
c
c
34. • Display coding: Colour and numeric codes were
superior in any task but colour is most effective
coding method.
• Thus we can quickly and easily find them-
Visual Display
37. Auditory Displays
• Auditory Displays: Primary advantage of human auditory
system is that it can simultaneously detect signals from
multiple locations.
• This made auditory displays useful for displaying alarms
and warnings, those require immediate response.
• Example- pulse oximeter, low and high gas pressure
alarms.
38. Manual Controls
• Just as the equipment transmits information to the user
through displays.
• The user transmits information to the device via controls.
• Different types of controls are preferable for different kinds of
tasks.
• Examples Switches or buttons are used to transmit binary:-
on and off information. Continuous information is usually
conveyed with knobs, wheels, levers, or pedals.
39. 5.TYPES OF ERGONOMICS
• Physical ergonomics is the human body’s responses to
physical and physiological work loads.
Repetitive strain injuries, vibration, force, and posture
fall into this category.
• Cognitive ergonomics deals with the mental processes and
capacities of humans when at work.
Mental strain from workload, decision making, human
error, and training fall into this category.
• Organizational ergonomics deals with the organizational
structures, policies and processes in the work environment.
Examples: shiftwork, job satisfaction, motivation,
supervision, teamwork, telecommuting, and ethics.
40. 6.Basic requirement of ergonomically
efficient operating room
1.Induction room and post operative care unit may be
integrated with operating room to minimize
anaesthesiologist movement and fatigue.
2.The size of the operating room can be as per the
requirement but recommended size is 6.5 m x 6.5m x
3.5 m for easy movement of the staff.
41. Basic requirement of ergonomically
efficient operating room….
3.The surface/flooring must be slip resistant, strong &
impervious with minimum joints (e.g., mosaic with copper
plates for antistatic effect ) or jointless conductive tiles. The
recommended minimum conductivity is 1 mΩ and maximum
10 mΩs.
4.Walls and ceiling should be aesthetically pleasing
nonporous, fire resistant, water and stain proof, seamless,
non-reflective and easy to clean. A semi matt surface paint
reduces reflection of light and tiring of eyes of OT personnel.
42. Basic requirement of ergonomically
efficient operating room….
5.The sliding doors are preferred to the double action leaf
type since they are more user friendly, save space and
prevent air turbulences.
6. Sufficient electric points should be available on the wall to
prevent entangling of wires and also preferably at a height of
less than 1.5 meters from the floor for easy approach.
7.Taps in the scrub room should be knee/elbow operated or
preferably electronically controlled taps activated by infrared
sensor.
43. Basic requirement of ergonomically
efficient operating room….
8.Central air conditioning should ensure temperature
range of 18-24° C with 50-60% humidity levels. A
minimum of 20 air exchanges/h should be ensured. It is
preferred to have 100% fresh air.
9.Sound level in OT should be limited to 25-35 db.
10.There should be emergency communication system
that can be activated without the use of hands.
44. Thus, ergonomics
• All about patient’s increase safety ,anaesthetist’s
comfort and increase work efficiency.
47. Snow face piece 1857
Heavy, cumbersome, non transparent
to
Light weight, easy to hold ,transparent
48. Torn pocket with
Suspended instruments
PRIVATE ITEMS OVER
LOADED POCKET pager
V-neck with private items
TYPICAL CLOTHINGS OF SURGICAL STAFFS
Some interesting ergonomics
49. Some commonly used items
which are related to safety and comfort
Courtesy : Ergonomics
52. 6.Ergonomic injuries
Tendon disorders:
Inflammation of tendon or tendon sheathing caused by
repeated rubbing against ligaments, bone, etc.
Ex. Lateral epicondylitis (tennis elbow).
Nerve disorders:
Compression of nerves from repeated or sustained
exposure to sharp edges,bones,ligaments,or tendons
Ex. Carpal tunnel syndrome.
Neurovascular disorders:
Compression of blood vessels or nerves from repeated
exposure to vibration or cold temperatures
Ex. Raynaud’s phenomenon (white finger syndrome)
53. Ergonomic injuries
Strains & Sprains:
Injury to connective tissue caused by single forceful
event: lifting heavy objects in awkward position.
Common to large body segments (i.e. back, legs,
and shoulders).
Risk of injury increases with the presence of
multiple risk factors.
55. Musculoskeletal Disorders- MSDs
o Musculoskeletal Disorders affect the muscles, nerves
and tendons. They are:-
o Carpal Tunnel Syndrome
o Tendinitis
o Rotator cuff injuries (shoulder problem)
o Epicondylitis (elbow problem)
o Muscle strains and low back pain
58. 7.PREVENTION
• Warm up & stretch before activities that are
repetitive, static or prolonged.
• Take frequent breaks from any sustained posture
every 20-30 minutes.
• Stop painful activity.
• Recognize early signs of inflammatory process, and
treat early.
• Be aware of workstation environment.
59. a) Maintain erect position of back and neck
shoulders relaxed.
b) Position equipment & work directly in front of
and close to your major tasks.
c) Keep upper arms close to the body, elbows
90-100 degrees
d) Keep feet flat on floor, upper body weight resting on
“sits bones”
e) Wrists as neutral as possible; safe zone for wrist
movement is 15 degrees in all directions
Maintain neutral posture during office work:-
60.
61. o
o
o
o
o
One of the biggest injury risk factors is static posture.
Try to spend at least 5 minutes /hr hour away from your computer.
Remember to only stretch to the point of mild tension.
Try to incorporate the stretches into your daily routine.
This slide provides some illustrations of simple active stretches to
perform at the office.
Hand Exercises
o Tightly clench your hand into a fist and release, fanning out the
fingers. Repeat 3 times
Good ergonomics