It is a rare but potentially catastrophic event that is associated with high mortality. The reported incidence of ICA varies considerably across studies.
A basic overview on the management of intra-operative bronchospasm: the risk factors, triggers, diagnosis, prevention and management. Includes a case scenario – discussion.
A basic overview on the management of intra-operative bronchospasm: the risk factors, triggers, diagnosis, prevention and management. Includes a case scenario – discussion.
Anaesthesia to patiens with liver disease or a liver transplantscanFOAM
A presentation by Anna Januszkiewicz at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
General anesthesia & obstetrics- c-section part ISandro Zorzi
→ Discuss indications of general anesthesia for operative delivery
→ Explain aspiration risk for general anesthesia in pregnancy and prevention strategy
Outline anaesthesia plan of care for induction, maintenance and emergency
Describe effect of volatile anaesthetics on uterine blood flow and tone
Discuss intraoperative strategies to prevent postoperative nausea and vomiting
Discuss other complications of general anaesthesia and clinical management
Anaesthesia to patiens with liver disease or a liver transplantscanFOAM
A presentation by Anna Januszkiewicz at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
General anesthesia & obstetrics- c-section part ISandro Zorzi
→ Discuss indications of general anesthesia for operative delivery
→ Explain aspiration risk for general anesthesia in pregnancy and prevention strategy
Outline anaesthesia plan of care for induction, maintenance and emergency
Describe effect of volatile anaesthetics on uterine blood flow and tone
Discuss intraoperative strategies to prevent postoperative nausea and vomiting
Discuss other complications of general anaesthesia and clinical management
A study to assess the effectiveness of structured teaching program on knowledge regarding care of patients after cardiac surgery among staff nurses at Shree Narayana, Hospital, Raipur, chhattisgarh.
Anesthesia consideration in intestinal obstruction is gastric aspiration, rapid sequence induction, electrolyte and acid base disorder, hydration, AKI and hemodynamic status.
Hypothyroidism and hyperthyroidism have significant clinical effects. Both should be optimized. Anesthesia providers should be able to diagnose and manage.
Blood pressure optimization is important in pheochromocytoma patients before going to surgery. It is important for the anesthesia providers to diagnose, optimize and manage those patients..
Anesthetic management in Diabetic mellitusTenzin yoezer
Diabetic is a systemic disease. Preoperative assessment includes blood sugar control, involvement of systems, and types of medication. Intraoperative and postoperative management is also vital.
Describes coronary blood supply anatomy, myocardial oxygen demand and supply, and basic anesthesia consideration (history taking, special investigation, and optimization)
Scalp block is simple and easy to perform. It has the advantages of minimizing cardiovascular effects and decreasing intraoperative analgesia requirements.
New GCS, the GCS-P was adopted in 2018 by the same person who proposed GCS. It gives better prognosticate outcomes compared to GCS.
Guillain Barre’ syndrome(GBS) and Anesthesia considerationTenzin yoezer
Patients with GBS need special care when coming to the surgery. They have a high risk of aspiration, airway compromise, autonomic instability, altered response to NMBs. It is the duty of the anesthesia providers to recognize those problems and minimize the complications.
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.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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.
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.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
1. Case presentation on Intra-
operative Cardiac Arrest(ICA)
DR. TENZIN YOEZER (5/8/2019)
KHESAR GYALPO UNIVERSITY MEDICAL SCIENCES OF BHUTAN
2. History
74 y/M
Sustained cervical injury following RTA on
27/7/19 with C6-C7 dislocation with
quadraperesis.
Brought to OT to undergo Bolhmans triple
wing with IBG
Type 2 Diabetic and hypertensive patient
On Metformin 500 mg tid, Glipizide 5 mg
bid
Off medication for HTN
No other past medical hx
No past anesthetic and surgery history
3. History
Intubation was done with glideslope. (?
Manual in line- no document)
1st attempt success
Put on prone position with Gardner well(G W)
tong
In the middle of surgery patients HR and ECG
not recordable
Time from induction of anesthesia -?missing
Informed surgeon – released the traction
Given one dose of epinephrine
HR and ECG reappeared
ECG – AF and ST depression
RBS – 47 mg/dL
Started on D25
4.
5. History
Informed ICU for bed
Surgery finished uneventful
Started on amiodarone 300 mg IV bolus followed by 900 mg IV infusion over 24 h
RBS after 1 hr -139 mg/dL
Extubated in PACU- (bed not ready in ICU)
Fully conscious when transferred to ICU
6.
7.
8.
9.
10. History
Systolic murmur in all pericodal areas
Cardiac evaluation:
Severe aortic stenosis
EF -60%
Mild LVH
No thrombus
13. Background
Rare but potentially catastrophic event that is associated with high mortality.
The reported incidence of ICA varies considerably across studies.
Reason:
the incidence of ICA has decreased with improved technology and clinical practices –
inconsistence report
Study periods vary from 5 to 18 yr -thus the impact of changing technology and clinical
practices may result in variation in the incidence of ICA across individual studies.
Most studies are based on data from single institutions and consequently suffer from limited
external validity
Quality and the availability of health care
Combined adult & pediatric incidence
Combine incidence of cardiac risk suffering ICA & MI
Cardiac Arrest in the Operating Room: Resuscitation and Management for the Anesthesiologist: Part 1. 2017
International Anesthesia Research Society
14. Thus the reported incidence of ICA ranges from 1.1 to 34.6 cardiac arrests per
10,000 anesthetics
But, the case fatality of ICA has remained consistently high at approximately 60–
80% since the 1950s
However, the survival rate after intraoperative cardiac arrest is 34.5% and is higher
than the 15-20% overall survival rate reported after in-hospital cardiac arrest
In cases where cardiac arrest is solely attributable to anaesthesia the outcome is
even more favorable when about 70-80% patients survive
Cardiac arrest in the operating room. J. Andres. European society of anesthesiology
Cardiac Arrest in the Operating Room: Resuscitation and Management for the
Anesthesiologist: Part 1. 2017 International Anesthesia Research Society
15. Causes:
Intraoperative haemorrhage – most common
End-stage organ failure
Thromboembolic events
Cardiac events (myocardial infarction)
Sepsis
Anaesthesia – rare
Charuluxanan S, Thienthong S, Rungreunvanich M. et al. Cardiac arrest after spinal anesthesia in
Thailand: a prospective multicenter registry of 40,271 anesthetics. Anesthesia and Analgesia 2008
16. Anesthesia related ICA
Of the 2,211 USA between 1999-2005 (2,211 pts),:
46.6% - overdose of anaesthetic drugs
42.5% - adverse effects from anaesthetics used for therapeutic purposes
3.6% - complications arising from anaesthesia during pregnancy, labour and
puerperium
7.3% - other complications of anaesthesia
Cardiac arrest in the operating room. J. Andres.
European society of anesthesiology
17. MOA : Bradycardia, hypoxia & circulatory shock
Bradycardia
Vagal responses to surgical manipulation
vagotonic anesthetics
sympatholysis from anesthetic agents
β-blockers
Suppression of cardiac-accelerator fibers arising from T1 to T4
Hypoxia
Difficult intubation
Cardiac Arrest in the Operating Room: Resuscitation and Management for the
Anesthesiologist: Part 1. 2017 International Anesthesia Research Society
18. Circulatory shock
Hypovloaemia
Inhalational & IV anesthetic overdose
Neuraxial block
LAST
Malignant hyyperthermia
Auto-PEEP
Bronchospasm
Air embolism
Increased IAP
Anaphylaxis
Tension pnumothorax
Cardiac Arrest in the Operating Room: Resuscitation and Management for the
Anesthesiologist: Part 1. 2017 International Anesthesia Research Society
19. Prevention, pre-cardiac arrest issues, general
principles of management
Patients in the operating room are monitored extensively - should be no
delay in diagnosing a cardiac arrest.
However, recent data - delays of 2 minutes or more in identifying the need
for and initiation of defibrillation in the operating room
A high-risk patient will often receive invasive blood pressure monitoring -
invaluable in the event of a cardiac arrest
Cardiac arrest in the operating room. J. Andres. European society of
anesthesiology
Cardiac Arrest in the Operating Room: Resuscitation and Management for the
Anesthesiologist: Part 1. 2017 International Anesthesia Research Society
20. If there is a strong possibility of a cardiac arrest- apply self-adhesive defibrillation
patches before the induction of anaesthesia.
Asystole and VF should be detected in the operating room immediately.
However, the onset of PEA might not be so obvious and capnography, pulse
oximetry and pulse check or arterial line analysis may be required to establish a
diagnosis.
A patient can deteriorate within minutes or hours in the intraoperative setting, and
effective monitoring and correction of physiological variables (hypovolemia,
hypoxemia, hypercarbia, dysrhythmias, heart pump failure) and surgical intervention
are the key to intraoperative prevention and treatment
Cardiac arrest in the operating room. J. Andres. European society of
anesthesiology
21. To prevent a cardiac arrest an anaesthesiologist needs to control all the factors
that affect cardiac output:
Preload
Aterload and contractility
Avoiding auto-PEEP and gas trapping in patients with
obstructive lung diseases
It is important to recognize when a patient is compromised or that a crisis
situation has developed and to ensure timely and appropriate action with a
positive therapeutic response.
Eg: a case of prolonged hypotension with systolic pressure of less than 90 mmHg
Cardiac arrest in the operating room. J. Andres. European society of anesthesiology
22. Recognizing when to start CPR in the operating room may be even more difficult
than might appear outside the operating room for a variety of reasons:
false alarms from monitoring systems
ECG lead disconnections
Hypotension and bradycardia
Above are common occurrences in the operating room and might be overlooked.
Achieving optimal monitoring might not be possible for some patients – for
example in cases of morbid obesity.
Cardiac arrest in the operating room. J. Andres. European society of anesthesiology
23. Which patients are more prone to cardiac arrest during the
perioperative period?
The following factors are associated with increased perioperative complications:
male gender
Chronic heart failure,
Hypotension (systolic blood pressure less than 90 mmHg)
Chronic obstructive lung disease
Renal failure
Cancer and major surgery
Cardiac arrest in the operating room. J. Andres. European society of anesthesiology
25. Cardiac Arrest in the Operating Room: Resuscitation and Management for the Anesthesiologist: Part 1.
2017 International Anesthesia Research Society
26. Cardiac arrest in Neurosurgery:
From
“Management of cardiac arrest during neurosurgery in adults:
Guidelines for healthcare providers “
Working Group of the Resuscitation Council (UK), Neuroanaesthesia Society of Great Britain and Ireland and
Society of British Neurological Surgeons
Date of first publication: August 2014 Date of Review: July 2019
27.
28. Specific factors influencing CPR in neurosurgical
patients
These can be divided into three main groups:
The surgical procedure.
The position of the patient.
Performing CPR on a patient with an open wound.
29. The surgical procedure
Anterior hypothalamus
Brain stem
Cerebello-pontine angle
Pituitary
Trigeminal nerve
Neuro-endoscopy
use of irrigation fluid of the wrong temperature
All are associated with arrhythmias, usually severe bradycardia with
associated hypotension or asystole.
30. The position of the patient
Neurosurgery is carried out with the patient in one of four positions;
Supine
Lateral
Prone
Sitting.
Patients head is fixed
(Mayfield skull clamp).
31. Chest compressions/Debrillation with the head in the
Mayfield® skull clamp
Risks : injury to the scalp, skull and cervical spine as the torso is moved against a fixed head.
Recommendation: removal
“A faster and safer process may be to release the clamp from the operating table rather than
trying to release the head from the pins “
Commence CPR whilst the surgeon supports the patient’s head.
If defibrillation is required, then either the support for the head (‘horse-shoe’ type) must be
attached to the operating table or the patient moved bodily along the table to provide a
secure rest for the patient’s head.
32. Lateral position
Can perform chest compressions in the lateral position but, its efficacy is unknown.
Therefore the patient should be turned supine as quickly and safely as possible.
If defibrillation is indicated in the left or right lateral position, application of the pad
over the cardiac apex or below the right clavicle respectively, is likely to be impeded.
Therefore use of the anteroposterior position is recommended;
one pad over the left precordium and the other just inferior to the left scapula.
33. Prone position
There is no immediate need to turn the patient to the supine position
CPR should be started with the patient in the prone position.
(effective or superior than CPR on chest -In studies on small groups of patients
patients in ICU)
the patient’s head is fixed in pins - remove.
Patients with the frame (e.g. Wilson frame, Relton-Hall frame) or pillows –
remove (no effective chest).
Defibrillation in the prone position - pads can be applied either postero-
(one in the left mid-axillary line, the other over the right scapula) or bi-axillary
axillary positions.
34. Sitting position
Chest compression – not possible
Defibrillation- accessible
The head will need to be removed from any fixed support, or if a clamp has
been used, it should be removed or released from the operating table.
35. Performing CPR on a patient with an open wound
Any patient with an open wound, who requires CPR, with or without the
to be turned into the supine position, should have any instruments removed
to prevent accidental tissue injury.
Protect the wound with a saline-soaked swab and then cover it with an
adhesive dressing.
Once this has been achieved, turn the patient supine.
However, following successful resuscitation, control of bleeding from the
surgical site, particularly a posterior one, may be problematic.
36. Specific roles: when turning to supine
Scrub practitioner – soak a large swab in saline and obtain an adhesive dressing
Lead surgeon – remove instruments, apply pack and dressing, and support the patient’s
head
Surgical assistant – if the head is held by the Mayfield® clamp, disconnect, unlock and rotate
it out of the way to gain more access to allow the patient’s head to be turned in line with
trunk
Anesthetist – ensure ventilator tubing is free to allow the patient to be turned without
accidental extubation. Ensure all vascular lines, monitoring, catheters, etc. are free to allow
disconnection if required, before turning
Anaesthetic assistant – release any devices used to secure limbs.
37. Specific roles: when turning to supine
The theatre floor staff should:
collect the horse-shoe head rest and make it available to surgical team
obtain a trolley or bed
get additional staff to help with turning of the patient
collect a defibrillator if one is not already in the operating theatre
38. Turning the patient on to a bed or trolley
The lead surgeon takes responsibility for the patient’s head and coordinates the turn.
The trolley/bed is placed alongside the operating table, and the brake applied.
Three members of staff stand on the far side of the patient.
Three members of staff stand along the side of the trolley/bed with their arms placed on the top of the
trolley/bed.
If possible the operating table is tilted laterally to assist with the turn.
The anaesthetist disconnects the ventilator tubing from the tracheal tube and any intravascular lines as
necessary.
The anaesthetist informs the surgeon that the patient is ready to be turned.
The surgeon then gives the command for the staff against the side of the operating table to roll the patient
to the outstretched arms of the staff against the trolley/bed.
Once supine, chest compressions must be resumed without delay.
The anaesthetist reconnects the ventilator tubing and vascular lines.
The ECG, arterial pressure and etCO2 monitors are checked.
Use etCO2 and/or arterial waveform to ensure quality of chest compressions and detect signs of ROSC.
39. Post-resuscitation management
Immediate surgical management
The surgical and nursing team should ‘re-scrub’.
Re-drape the patient or apply additional draping to minimise any further wound contamination.
Irrigate the wound with copious volumes of warm (body temperature) normal saline or lactated
Ringer’s solution.
Haemostasis should be secured.
Consider further surgical options:
- Continue with the planned procedure
- change the goals of surgical procedure
- abandon surgery and expedited wound closure.
Consider peri-operative imaging (ultrasound or MRI/CT) to assess for intraparenchymal
haemorrhage, over drainage of CSF causing cortical collapse or a subdural haematoma.
Consider antibiotic therapy to minimise the risk of infection due to wound contamination.
There should be close liaison with the intensive care team regarding specific post- resuscitation
required.