Patient Monitoring
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The document provides an introduction to patient monitoring in anesthesia. It discusses the importance of monitoring to detect potential issues and outlines the key physiological parameters that should be monitored, including circulation, ventilation, oxygenation and temperature. It also describes the various equipment and methods used for monitoring these parameters in both the past and present.
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Monitoring in anaesthesia by stanley ogochukwu okerulu
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The document discusses the components and functioning of the anesthesia machine. It describes the anesthesia machine as integrating components for anesthesia administration. The machine consists of the anesthesia machine itself, ventilator, breathing system, scavenging system, monitors and may include drug delivery systems. The document outlines the history of developments to the anesthesia machine since its original conception in 1917. It also describes the types of machines, standards, and basic schematics including electrical, pneumatic and gas supply components.
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Capnography
1) Capnography refers to the measurement of carbon dioxide in exhaled gas and can be used to monitor ventilation status.
2) It was first introduced in 1943 but the early devices were large and impractical.
3) Capnography is now widely used in healthcare to monitor patients during procedures like intubation, sedation, mechanical ventilation and general anesthesia by providing information on respiratory and perfusion status.
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Monitoring in anaesthesia by stanley ogochukwu okerulu
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Anaesthesia workstation
An anesthesia workstation integrates components for anesthesia administration into one unit. It consists of an anesthesia machine, vaporizers, ventilator, breathing system, scavenging system, and monitors. Key components include the gas supply system, which receives gases from cylinders and pipelines and regulates pressures, and the vaporizer manifold and anesthetic vaporizers. Modern workstations have additional safety features to prevent delivery of hypoxic gas mixtures and other hazards.
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Capnography
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2) It was first introduced in 1943 but the early devices were large and impractical.
3) Capnography is now widely used in healthcare to monitor patients during procedures like intubation, sedation, mechanical ventilation and general anesthesia by providing information on respiratory and perfusion status.
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Breathing circuits
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This document discusses various methods of monitoring patients under anesthesia. It outlines basic monitoring including vital signs, urine output and signs of sympathetic activity. Advanced monitoring includes instrumental monitoring of the cardiovascular, respiratory, temperature, neuromuscular and central nervous systems as well as expired gases and blood loss. Specific monitoring techniques are described for each system including electrocardiography, blood pressure, capnography, temperature, train of four testing and evoked responses. Complications of invasive lines are also noted.
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The document provides information on the history and evolution of anesthesia machines. It discusses key developments from the early prototypes in the 1900s to modern safety features. Some of the major developments include the introduction of oxygen and nitrous oxide cylinders in the late 19th century, the addition of vaporizing bottles in the early 20th century, and the introduction of the circle absorption system in the 1930s. The document outlines the essential safety features of modern anesthesia workstations, including non-interchangeable gas connections, pin index safety systems, oxygen monitors and alarms, and vaporizer interlocks. It also describes the functional anatomy of an anesthesia machine in terms of the high, intermediate, and low pressure systems.
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The document discusses pulse oximetry and capnography. Pulse oximetry uses light absorption to non-invasively measure arterial oxygen saturation by comparing absorbed and transmitted light through tissues at red and infrared wavelengths. It can detect hypoxemia but is influenced by other factors like skin pigment. Capnography measures exhaled carbon dioxide concentration using infrared absorption, with the capnogram tracing showing phases that can assess ventilation and oxygenation status. Both are important monitoring tools during medical procedures.
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2) Palpation allows for detection of systolic pressure but underestimates higher pressures and cannot determine diastolic or mean pressures.
3) Auscultation uses a blood pressure cuff and stethoscope to listen for Korotkoff sounds during cuff deflation to determine systolic, diastolic, and mean pressures.
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This document discusses the importance of monitoring patients during anesthesia. It outlines the basic monitoring requirements which include having an anesthesiologist present, checking anesthesia equipment, and monitoring the patient. Both clinical and instrumental monitoring are described in detail, with arterial blood pressure, ECG, CVP, pulse oximetry, capnography, and temperature being some of the key instrumental monitors discussed. Normal ranges and indications for each monitor are provided.
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1) Day case anesthesia, also known as ambulatory surgery or same-day surgery, allows patients to be admitted for a surgical procedure and investigation but return home the same day without an overnight hospital stay.
2) There has been a rapid expansion in the use of day case surgery over the last 30 years, with approximately 65% of surgeries in the United States now performed on an outpatient basis.
3) Day case anesthesia provides advantages like reduced costs, increased bed availability, and less risk of hospital-acquired infections compared to traditional inpatient surgery.
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This document discusses strategies to improve patient safety during anesthesia. It identifies that anesthesia can induce physiological changes that increase morbidity and mortality risks, so factors threatening safety in the operating room must be addressed. These factors include equipment issues, patient health problems, and human errors by anesthetists and surgeons. The document recommends developing preoperative plans, maintaining situational awareness during procedures, emphasizing teamwork and communication, avoiding production pressures, and fostering a learning culture where errors are reported and used to implement safety improvements.
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This document discusses airway evaluation, management of intubation, and complications. It outlines indications for intubation including resuscitation, prevention of lung soiling, and respiratory failure. Successful intubation requires a normal mandible, throat, and cervical spine alignment. Proper equipment and gadgets are also needed. Difficult airways can be predicted by history, examination of the face, jaw, and neck, and tests like Mallampatti. Securing the airway awake is recommended for expected difficult airways. Maintaining oxygenation is the primary goal, and backup plans should be in place in case of unexpected difficult intubation.
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Patient Monitoring
The document provides an introduction to patient monitoring in anesthesia. It discusses the importance of monitoring to detect potential issues and outlines the key physiological parameters that should be monitored, including circulation, ventilation, oxygenation, and temperature. It also describes the various equipment and methods used for monitoring these parameters in both the past and present.
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The document discusses various methods of patient monitoring during anesthesia, including their purposes, advantages, and limitations. It covers monitoring vital signs, standards for basic anesthesia monitoring according to the ASA, techniques like non-invasive blood pressure monitoring, ECG, pulse oximetry, capnography, and invasive arterial line monitoring. Key aspects emphasized are integrating multiple monitoring methods to evaluate oxygenation, ventilation, and circulation.
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This document discusses different types of breathing circuits used in anesthesia. It begins by introducing open, semi-closed, and closed breathing circuits. Open circuits are now obsolete and involved pouring anesthetic agents over a mask. Semi-closed circuits include Mapelson circuits A-F, with Type D (Bain) most commonly used for controlled ventilation. Closed circuits involve rebreathing of exhaled gases after carbon dioxide absorption by soda lime, making them very economical. Key components and properties of soda lime and factors affecting its carbon dioxide absorption are described.
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Patient positioning is a joint responsibility of the surgeon and anesthesiologist to balance surgical needs and risks to the patient. Key factors to consider include the procedure, patient characteristics, and physiological impacts of different positions. Common positions include supine, lateral, lithotomy and prone, each with benefits and risks requiring precautions like padding pressure points. The team must plan positioning prior to surgery based on these considerations.
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The document provides information on the management of intra-operative bronchospasm, including risk factors, triggers, diagnosis, prevention, and treatment approaches. Bronchospasm can be caused by airway irritation or anaphylaxis and presents with signs of wheezing, increased airway pressures, and falling oxygen saturation. Differential diagnoses must be ruled out. Management involves deepening anesthesia, administering bronchodilators, optimizing ventilation, and considering anaphylaxis or postponing surgery. A case example demonstrates treatment of bronchospasm potentially caused by succinylcholine-induced anaphylaxis.
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The document discusses various airway management techniques and equipment for dealing with difficult airway situations. It covers anatomical factors that can cause difficulties, techniques like awake intubation using local anesthesia, and options like bougies, laryngeal mask airways, fiberoptic intubation, retrograde intubation, and cricothyrotomy devices. It also describes the contents of an airway management cart and algorithms for dealing with difficult airways.
Neuromonitoring in anesthesia
Neuromonitoring techniques can monitor the brain's function, cerebral blood flow and intracranial pressure, and brain oxygenation and metabolism. Electroencephalography (EEG) measures electrical brain activity and is useful for detecting ischemia. Evoked potentials like somatosensory evoked potentials (SSEPs) monitor sensory pathways from stimulus to cortex. Jugular venous oximetry and near infrared spectroscopy (NIRS) provide noninvasive monitoring of cerebral oxygenation. These techniques guide anesthesia management and detect intraoperative brain injury.
monitoringinanaesthesiaro-181118165622.pptx
This document discusses various methods of monitoring patients under anesthesia. It outlines basic monitoring including vital signs, urine output and signs of sympathetic activity. Advanced monitoring includes instrumental monitoring of the cardiovascular, respiratory, temperature, neuromuscular and central nervous systems as well as expired gases and blood loss. Specific monitoring techniques are described for each system including electrocardiography, blood pressure, capnography, temperature, train of four testing and evoked responses. Complications of invasive lines are also noted.
Anesthesia workstation
The document provides information on the history and evolution of anesthesia machines. It discusses key developments from the early prototypes in the 1900s to modern safety features. Some of the major developments include the introduction of oxygen and nitrous oxide cylinders in the late 19th century, the addition of vaporizing bottles in the early 20th century, and the introduction of the circle absorption system in the 1930s. The document outlines the essential safety features of modern anesthesia workstations, including non-interchangeable gas connections, pin index safety systems, oxygen monitors and alarms, and vaporizer interlocks. It also describes the functional anatomy of an anesthesia machine in terms of the high, intermediate, and low pressure systems.
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The document discusses pulse oximetry and capnography. Pulse oximetry uses light absorption to non-invasively measure arterial oxygen saturation by comparing absorbed and transmitted light through tissues at red and infrared wavelengths. It can detect hypoxemia but is influenced by other factors like skin pigment. Capnography measures exhaled carbon dioxide concentration using infrared absorption, with the capnogram tracing showing phases that can assess ventilation and oxygenation status. Both are important monitoring tools during medical procedures.
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Low flow anaesthesia systems aim to reuse exhaled gases and minimize fresh gas flow. John Snow recognized in 1850 that most inhaled anaesthetics are exhaled unchanged, and rebreathing exhaled gases could prolong their effects. Developments over the 20th century led to widespread use of circle absorption systems. Factors like cost and pollution concerns have renewed interest in low flow anaesthesia. It requires a well-functioning circle system, gas monitoring, and attention to factors like circuit volume and gas solubility when initiating and maintaining the desired anaesthetic concentrations with minimal fresh gas flows.
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The document summarizes the key components and functions of an anesthetic machine. It describes the high pressure and low pressure systems, including gas supplies, cylinders, manifolds, regulators and flow meters. It explains the purpose and mechanisms of vaporizers and breathing circuits. Safety features like oxygen failure alarms and leak tests are also summarized.
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This document provides an overview of peripheral nerve stimulation (PNS) and ultrasound guidance for nerve blocks. It discusses the history and components of PNS, including electrical stimulation parameters and techniques. It also covers ultrasound basics like machine parts, imaging modes, and resolution. Regarding nerve blocks, it describes imaging plane options, needle visualization techniques, and the steps of ultrasound-guided blocks including scanning the nerve and choosing an in-plane or out-of-plane needle approach. Overall, the document aims to educate about the principles and procedures of PNS and ultrasound guidance for regional anesthesia.
NIBP
1) There are several methods for measuring blood pressure non-invasively, including palpation, auscultation, oscillometry, Doppler, plethysmography, tonometry.
2) Palpation allows for detection of systolic pressure but underestimates higher pressures and cannot determine diastolic or mean pressures.
3) Auscultation uses a blood pressure cuff and stethoscope to listen for Korotkoff sounds during cuff deflation to determine systolic, diastolic, and mean pressures.
Monitoring aga umar
This document discusses the importance of monitoring patients during anesthesia. It outlines the basic monitoring requirements which include having an anesthesiologist present, checking anesthesia equipment, and monitoring the patient. Both clinical and instrumental monitoring are described in detail, with arterial blood pressure, ECG, CVP, pulse oximetry, capnography, and temperature being some of the key instrumental monitors discussed. Normal ranges and indications for each monitor are provided.
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This document provides information on pulse oximetry and capnography. It discusses the history and development of pulse oximetry, how it works using spectrophotometry and plethysmography, different probe sites, standards, uses, limitations and new developments. It also briefly introduces capnography and defines key terms like capnometry, capnometer and capnograph.
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Day case anesthesia
1) Day case anesthesia, also known as ambulatory surgery or same-day surgery, allows patients to be admitted for a surgical procedure and investigation but return home the same day without an overnight hospital stay.
2) There has been a rapid expansion in the use of day case surgery over the last 30 years, with approximately 65% of surgeries in the United States now performed on an outpatient basis.
3) Day case anesthesia provides advantages like reduced costs, increased bed availability, and less risk of hospital-acquired infections compared to traditional inpatient surgery.
Patient safety in anesthesia
This document discusses strategies to improve patient safety during anesthesia. It identifies that anesthesia can induce physiological changes that increase morbidity and mortality risks, so factors threatening safety in the operating room must be addressed. These factors include equipment issues, patient health problems, and human errors by anesthetists and surgeons. The document recommends developing preoperative plans, maintaining situational awareness during procedures, emphasizing teamwork and communication, avoiding production pressures, and fostering a learning culture where errors are reported and used to implement safety improvements.
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- Many BHU alumni and faculty who have made significant contributions in fields like science, arts,
Banaras hindu university 2
1. The document proposes a project to create video packages of standard agricultural practices for major crops and incorporate them into kiosk machines available at Krishi Vigyan Kendra locations to better educate farmers.
2. The objectives are to create video packages for cereals, pulses, oilseeds and horticultural crops, incorporate them into a kiosk at a KVK near Varanasi, and get farmer feedback.
3. The proposed budget is Rs. 2 lakhs over 10 months to film practices at research centers, edit videos, incorporate them, and collect farmer responses to assess the impact of using video.
Blood Transfusion
Blood transfusion practices involve determining a patient's blood type and screening for antibodies to reduce risks of transfusion reactions like hemolytic reactions. Key indications for transfusion include maintaining hemoglobin above 6-8 g/dL and allowing blood loss within established volumes. Complications can be minimized through proper blood type matching, leukoreduction, and following guidelines for transfusion thresholds and volumes.
Opioids Drugs
The document discusses several key points about opioids:
1. It describes the endogenous opioid systems and receptors in the body, including proenkephalin, prodynorphin, pro-opiomelanocortin, and the mu, kappa, delta, and other receptors.
2. It summarizes the pharmacokinetics and pharmacodynamics of opioids like morphine and meperidine, how they work in the body to produce analgesia and other effects.
3. The main effects of opioids discussed are analgesia, respiratory depression, nausea/vomiting, and other central nervous system effects. Their use in anesthesia is also covered.
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Dr rowan molnar anaesthetics study guide part ii
Dr rowan molnar anaesthetics study guide part ii
Identification of patient requiring procedure
Referral to perioperative service
Screening for level of workup required
Pre-anaesthetic assessment/plan
Referral & investigations as required.
Admission at appropriate pre-op interval
Post-operative drug/fluid/other therapy
Appropriate post op level of care & stay
Discharge at earliest appropriate point
Dr Rowan Molnar,
Dr Rowan Molnar Anaesthetics,
Dr Rowan
anaesthesia.Monitoring 2(dr.amr)
Patient monitoring involves both non-instrumental and instrumental assessment. Non-instrumental monitoring includes visual observation of factors like respiratory pattern, bleeding, and IV lines. Instrumental monitoring provides quantitative data through devices like ECG, blood pressure cuffs, pulse oximetry, capnography, and muscle relaxation monitors. Together, non-instrumental and instrumental monitoring provide clinicians with vital information about patients' physiological status to guide care in settings like operating rooms and intensive care.
anaesthesia.Monitoring.(dr.amr)
Patient monitoring involves both non-instrumental and instrumental methods. Non-instrumental monitoring includes clinical observation of a patient's appearance, breathing, bleeding, and positioning. Instrumental monitoring provides data through devices like ECGs, which measure heart rate and rhythm, blood pressure cuffs, pulse oximeters, capnography, and temperature monitors. Direct arterial blood pressure monitoring via an intra-arterial catheter provides continuous, beat-to-beat pressure readings but carries risks like infection, while noninvasive blood pressure methods take intermittent readings and avoid invasiveness. Together, non-instrumental observation and instrumental monitoring devices provide clinicians vital information to care for patients.
4.Intensive care monitoring system .pptx
This document provides an overview of intensive care monitoring systems. It defines monitoring as repeated observations of a patient's physiological functions and life support equipment to guide treatment decisions. It discusses the history of vital sign measurements and various types of monitoring systems, including respiratory monitoring methods like pulse oximetry and transcutaneous monitoring, and cardiovascular monitoring like ECG, blood pressure, and cardiac output monitoring. Computers are now widely used in intensive care to acquire, store, analyze, and report physiological data from multiple sources to guide patient care.
Monitoring system of anaesthesia
This document discusses monitoring during anesthesia. It defines monitoring as the continuous recording of particular data to observe and regulate a process. There are two main types of monitoring - clinical monitoring done by an experienced anesthesiologist observing vital signs, and instrumental monitoring using medical devices. Standards require qualified medical staff to monitor oxygenation, ventilation, circulation, temperature, and depth of anesthesia throughout all general and regional anesthetics and recovery. A variety of devices are recommended for monitoring at different stages of anesthesia.
Monitoring.pptx
ICU monitoring involves continuous observation of critically ill patients using advanced equipment to assess vital signs and organ function. This allows for early detection of changes in condition and timely interventions, helping optimize treatment and improve outcomes. Key aspects of ICU monitoring include assessing heart rate, blood pressure, breathing, blood tests and more through various devices and trained staff who closely track data.
Anaesthesia primer
This document provides an overview of types of anaesthesia. It discusses general anaesthesia which involves inducing unconsciousness through inhalational or intravenous agents. It also discusses regional anaesthesia techniques like spinal, epidural, and intravenous regional anaesthesia. The document covers anaesthesia monitoring, fluid management, airway management, and the general steps of anaesthesia including induction, maintenance, and emergence.
Monitoring under anaesthesia-brief description for undergrads.
This document discusses the importance of monitoring patients during anesthesia. It states that the primary goal of monitoring is to keep patients as safe as possible during surgery by evaluating their oxygenation, ventilation, circulation, and temperature throughout the procedure. Proper monitoring can reduce risks such as hypoventilation, equipment malfunctions, and physiological imbalances. The document outlines the American Society of Anesthesiologists' guidelines for standard monitoring, including continuous evaluation of respiration, pulse oximetry, end-tidal carbon dioxide, electrocardiography, blood pressure, temperature, depth of anesthesia, muscle relaxation, and urine output. It emphasizes that while machines are helpful aids, the most important monitor is the presence of qualified anesthesia personnel.
Anesthesia 5th year, 6th & 7th lectures (Dr. Gona)
The document summarizes various monitoring devices used during anesthesia, including essential monitors like ECG, non-invasive blood pressure, pulse oximetry, capnography, and vapor concentration analyzers. It also discusses immediately available monitors like peripheral nerve stimulators and temperature monitors. Additional monitors that may be required in some cases include invasive blood pressure, urine output, central venous pressure, pulmonary artery pressure, and cardiac output, which can be measured using a pulmonary artery catheter.
An Introduction To Surgical Icu
The document provides an introduction to surgical intensive care units (SICU). It discusses what a SICU is, common indications for SICU admission, the main functions of monitoring and life support in SICUs. It then describes various methods of physiological, safety, and organ-specific monitoring including cardiovascular, respiratory, renal and temperature monitoring used in SICUs. It concludes by outlining different forms of life support for general care, cardiovascular, respiratory, and renal systems commonly provided in SICUs.
4. Monitoring Critical patients.pptx
Monitoring is the main intervention in intensive care unit since patients are Critically ill and most dependents.
patient monitor ppt. siva hospital nagarcoil
Siva Hospitals
Ethamozhi Puthalam Road, Eathamozhi, Tamil Nadu 629501
Healthcare is no more about bringing just medical facilities to you. Its about integrating these facilities along with technology, know-how of advancing medical sciences, hospitality; functioning as a whole with humane at its core value in serving humanity.
Siva Hospitals understands this perfectly and constantly strives to bring you the best in healthcare advancements from around the world. To find out how we could serve you, read on
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1. Basic monitoring standards established by anesthesia societies require monitoring of circulation, ventilation, and oxygenation including ECG, blood pressure, capnography, and pulse oximetry.
2. Pulse oximetry uses light absorption to measure oxygen saturation and heart rate while capnography monitors expired carbon dioxide.
3. Invasive arterial blood pressure monitoring provides direct measurement but risks include hematoma and nerve damage.
Perioprative monitoring
The ASA guidelines establish standards for basic anesthesia monitoring. Standard I requires qualified anesthesia personnel to be present throughout all general and regional anesthetics. Standard II requires the patient's oxygenation, ventilation, circulation, and temperature to be continually evaluated during all anesthetics.
The document then discusses the history and value of monitoring patients during anesthesia. It notes that 25 years ago the most basic form of monitoring was continuous palpation of the radial pulse throughout surgery. Modern monitors make monitoring easier but clinical judgment is still most valuable. Basic required monitors are ECG, SpO2, blood pressure, and sometimes capnography.
Pre operative Evaluation.pptx
A detailed pre-anaesthetic evaluation allows for the systematic validation of perioperative risks allowing us to optimise the functional and physiological status of the patient and ameliorate the perioperative complications.
The prime objective is to establish solidarity between the anaesthesiologist and the patient which warrants a mutual understanding of plans for anaesthesia technique and identifying risks associated with the plan. The secondary objective is to advise premedication drugs and perform any interventions required before surgery. An important requirement for risk assessment is to order investigations on an individual basis and obtain referrals from other specialities. Effective preoperative assessment can decrease delay and postponement of the surgery on the day of surgery.
Hemodynamic monitoring in ICU
This document discusses hemodynamic monitoring in pediatrics. It begins with definitions of hemodynamics and hemodynamic monitoring. Both invasive and noninvasive monitoring methods are described, including arterial blood pressure monitoring, central venous pressure monitoring, and pulmonary artery catheterization. Complications of invasive methods are outlined. Normal hemodynamic parameters for children are provided. The document emphasizes the importance of hemodynamic monitoring in critically ill children to guide treatment and optimize tissue perfusion and oxygen delivery.
Autonomic nervous system testing arfa sulthana
The document provides information on testing the autonomic nervous system. It discusses the challenges in testing the ANS as most structures are distant from the skin. It outlines some commonly used tests like heart rate response to the Valsalva maneuver which evaluates parasympathetic function by measuring heart rate changes during forced exhalation against closed glottis. The document also discusses indications for ANS testing and preparations patients need to make, like refraining from medications and heavy meals before tests.
Pulmonary Function Testing
What are the pulmonary function tests used?
What are the indications?
What are the contraindications?
How to perform each and prepare patients?
How to interpret and reach a diagnosis?
How to clean and calibrate devices?
Monitoring intraoperatif dan terapi cairan.pptx
The document discusses standards for basic intraoperative monitoring according to the American Society of Anesthesiologists (ASA). It states that a qualified anesthesia provider must be present during general anesthesia, regional anesthesia, and anesthesia care monitoring. It also notes that during all anesthesias, the patient's oxygenation, ventilation, circulation, and temperature must be continuously evaluated. Regional techniques and sedation for operative procedures also require minimum monitoring of pulse oximetry, non-invasive blood pressure, and electrocardiography. The document provides recommendations on monitoring various physiological parameters like respiration, oxygenation, temperature, neuromuscular function, and fluid status during anesthesia and recovery.
Thoracic anaesthesia One lung ventilation
This document provides information on pre-operative evaluation and anaesthetic considerations for thoracic surgery. It discusses evaluating patients' medical history, performing a physical exam, and ordering baseline investigations to assess pulmonary and cardiac function. Key aspects of respiratory assessment include measuring lung mechanics, gas exchange, and cardiopulmonary interaction. The lateral decubitus position, open pneumothorax, and one-lung ventilation are discussed as they impact intra-operative pulmonary physiology. Techniques for one-lung ventilation include double-lumen endotracheal tubes and bronchial blockers.
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This document discusses the history and principles of bioethics. It begins by explaining how advances in medicine raised new moral issues that ethicists worked to address. Notable cases of unethical human subject research helped establish principles like informed consent and respect for persons. Guidelines like the Nuremberg Code aimed to prevent future abuses. The document then examines key bioethical principles like autonomy, beneficence, nonmaleficence, and justice. It explores how these principles guide issues like informed consent, respecting patient values, avoiding harm, and fair allocation of resources. The challenges of applying principles to complex real-world cases are also discussed.
Physiological Changes In Pregnancy
Physiological changes in pregnancy include changes in the central nervous, respiratory, and cardiovascular systems. The minimum alveolar concentration of anesthetic gases decreases by up to 40% due to hormonal and endogenous changes. Oxygen consumption and minute ventilation increase while functional residual capacity decreases, increasing the risk of desaturation. Blood volume and plasma volume increase substantially, elevating cardiac output and stroke volume and decreasing systemic vascular resistance.
Diabetes Mellitus
The document discusses perioperative management of diabetes mellitus. It covers types of diabetes, complications, preoperative assessment and glycemic control goals. Glycemic control is important to minimize complications from hyperglycemia and hypoglycemia. For major surgery, an intravenous insulin and glucose infusion provides optimal control and prevents fluctuations in blood sugar levels. Frequent monitoring of blood glucose levels is essential in the perioperative period.
Pulmonary Embolism
- Pulmonary embolism affects approximately 500,000 individuals per year in the US, with around 50,000 deaths annually.
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- Diagnosis is suggested by symptoms like dyspnea and chest pain but requires imaging tests like CT pulmonary angiogram, ventilation-perfusion scanning, or echocardiogram to confirm the presence of emboli. Treatment involves anticoagulation with heparin or warfarin.
Shock
Shock is a condition where the cardiovascular system fails to adequately perfuse tissues. It can be caused by an impaired pump (cardiogenic shock), reduced circulating volume (hypovolemic shock), or maldistribution of blood flow (distributive shock). The main effects are cellular hypoxia, impaired metabolism, and organ damage or failure if not treated. Compensatory mechanisms aim to increase perfusion but eventually fail, leading to irreversible cellular damage and death if shock persists.
General Anesthesia
1. General anesthesia involves inducing a reversible state of unconsciousness through drugs that provide analgesia, amnesia, and muscle relaxation while maintaining vital life functions.
2. Anesthesiologists are responsible for preoperative evaluation and preparation, intraoperative management including general anesthesia and regional techniques, and postoperative care including pain management.
3. This case report describes a patient who developed arterial oxygen desaturation during percutaneous nephrolithotomy surgery under general anesthesia which was treated with corticosteroids, aminophylline, and a bronchodilator inhaler.
Emergency Medicine
This document provides an overview of emergency medicine as a specialty. It discusses the top causes of death, the reception process in emergency departments, how cases are triaged from life-threatening to non-urgent, and examples of common illnesses and injuries seen in emergency medicine including chest pain, fractures, seizures, and psychiatric illnesses. It also outlines both the appeals and challenges of working in emergency medicine as well as potential career paths within the specialty.
Diagnosis and Management of Shock
This document discusses the diagnosis and management of shock. It defines shock as impaired tissue oxygenation and perfusion that can lead to organ dysfunction and death if left untreated. The document classifies shock into 4 main categories: hypovolemic, cardiogenic, distributive, and obstructive. It then describes the key clinical features, causes, and goals of treatment for each type of shock. The general principles of shock management are also summarized, which include treating the underlying cause, restoring adequate perfusion and tissue oxygen delivery, and reducing oxygen demand through supportive care.
IV anesthetic
The document discusses ideal properties of intravenous anesthetics and summarizes the pharmacokinetics and pharmacodynamics of several commonly used IV anesthetics including barbiturates, propofol, etomidate, ketamine, benzodiazepines, and dexmedetomidine. It outlines desirable traits such as rapid onset and offset of action, minimal cardiovascular and respiratory depression, and lack of adverse effects. Each drug's mechanism of action, dosing, metabolism, indications, contraindications, and side effects are briefly described.
Muscle Relaxants
The document discusses muscle relaxants and neuromuscular blocking agents. It covers their classification, mechanisms of action, administration, and side effects. Specifically, it describes how succinylcholine causes initial muscle stimulation followed by paralysis through prolonged depolarization of motor end plates. It also notes that residual paralysis can occur in 42% of patients even after administration of reversal agents, and that a train-of-four ratio above 0.7 correlates with clinical recovery.
Pharmacodynamics
This document discusses pharmacodynamics in anesthesia. It describes how drugs affect the body through mechanisms of action, drug-receptor interactions, and dose-response relationships. Factors like age, genetics, disease states can impact pharmacodynamics. Drugs act through receptor-mediated actions, with receptors on cell membranes determining effects. Receptors include ion channels, G-protein coupled receptors, and those activating protein kinases or transcription. The efficacy and potency of drugs are also discussed in relation to agonists, antagonists, competitive vs. non-competitive antagonism. Therapeutic indices compare median effective and toxic doses. Pharmacodynamics are affected by patient factors and drug properties.
Pharmacokinetics
This document discusses several key concepts in pharmacokinetics relevant to anesthesia, including:
1) Routes of drug administration and factors affecting drug absorption such as oral bioavailability and pH.
2) Distribution of drugs in the body based on properties like lipid solubility, protein binding, and volume of distribution.
3) Metabolism of drugs through Phase I and Phase II reactions in the liver and how this can impact drug dosing.
4) Excretion of drugs and clearance from the body through renal and non-renal routes like the bile and lungs.
5) Mathematical models used to describe drug behavior over time including one-compartment and multi-compartment models.
Physics And Clinical Measurements
This document discusses various physics concepts and clinical measurements related to anaesthesia. It covers gas laws, critical temperatures, solubility, diffusion, osmosis, electricity, fluid dynamics, and blood pressure monitoring. Key points include definitions of Boyle's law, Charles' law, and Dalton's law of partial pressures. It also discusses non-invasive and invasive blood pressure monitoring techniques.
Hemodynamic Pressure Monitoring
This document discusses hemodynamic pressure monitoring, including indirect and invasive arterial pressure monitoring, central venous pressure monitoring, and pulmonary artery catheter placement and measurements. It provides details on:
- Methods for continuously monitoring arterial blood pressure, heart rate, and circulatory function during anesthesia
- Techniques for indirect and direct arterial pressure measurement
- Components, calibration, and placement of arterial pressure monitoring catheters
- Measurements obtained from central venous and pulmonary artery catheters like cardiac output, pressures, and oxygen saturation
- Potential complications of pulmonary artery catheter placement
Preoperative Evaluation
The document outlines the objectives and components of an anesthesia and CPR course for medical students. It covers pre-anesthesia assessment, orientation to anesthesia equipment, post-operative care, ICU rounds, and the role of anesthesiologists in the pre-operative period. Key topics include pre-anesthesia evaluation, anesthesia principles, medical history taking, risk stratification, airway evaluation, preoperative testing, informed consent, and documenting the preoperative visit.
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- 48. THANK-YOU
- 51. The End
Editor's Notes
- The movement from device centred to information centred ICU was reflected in the way that bed design changed with the expansion of the carevue system. As I said earlier older ICU bedspaces are quite cramped as they weren’t designed to accommodate the amount of equipment that is currently required. In this image we tried to setup a typical older ICU bed as it would have been arranged. The equipment is spread around the bed.
- Train of Four: Using TOF : Cannot reliably detect fade with visual or tactile or by other means! Cannot be used to monitor deep neuromuscular block
- First, I am wondering if you have some answers to our leader’s question? Can you tell me why ubiquitous mobile technologies may increase student satisfaction and overall retention of learning material? Some possible answers are: Convenient Self-paced learning Fits the digital native lifestyel Increase grades/active learning/ portable/ interactive/entertaining/motivating