This document discusses the anesthetic approach for a 4 year old girl requiring a lumbar puncture who has a history of cough and fever. It recommends doing the case today with precautions to ensure safety. It also discusses causes, presentation, compression risks, evaluation, and anesthetic management of mediastinal masses in children, noting the high risk of cardio-respiratory complications during anesthesia. The objective in managing these cases is to minimize airway and cardiovascular compression through strategies like steroids, chemotherapy, radiotherapy, securing the airway, maintaining spontaneous breathing, and having facilities for decompression.
Management of pulmonary embolism in emergency departmentdrbarai
An short overview of the diagnostic approach and treatment options for Pulmonary Embolism which is a Medical Emergency. In the USA alone about 600,000 people are diagnosed with Pulmonary Embolism every year. However, this is just the tip of the iceberg as many more people have sudden head due to this notorious condition. This Power Point presentation will give you some idea based on my experience in the Emergency Departments in 3 continents of the world.
MESENTERIC ISCHEMIA- GENERALISED ABDOMINAL PAIN
#surgicaleducator #epigastricabdominalpain #pepticulcerdisease #usmle #babysurgeon #surgicaltutor
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today I have uploaded a video on Mesenteric Ischemia- a didactic lecture.
• It is one of the uncommon but life-threatening surgical problems you see in surgical wards.
• I have discussed the various causes for Generalised Abdominal Pain, epidemiology, etiology, pathology, clinical features, investigations, and treatment of Mesenteric Ischemia.
• I have also included a mind map and a treatment algorithm for Mesenteric Ischemia.
• I hope the video will be very useful and you will enjoy it.
• You can watch all my surgical teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the video.
Pulmonary embolism - Diagnosis and managementDr Vivek Baliga
Pulmonary embolism is a common problem seen in medical practice. This presentation by Dr Vivek Baliga discusses the basic aspects and evidence behind current management.
Management of pulmonary embolism in emergency departmentdrbarai
An short overview of the diagnostic approach and treatment options for Pulmonary Embolism which is a Medical Emergency. In the USA alone about 600,000 people are diagnosed with Pulmonary Embolism every year. However, this is just the tip of the iceberg as many more people have sudden head due to this notorious condition. This Power Point presentation will give you some idea based on my experience in the Emergency Departments in 3 continents of the world.
MESENTERIC ISCHEMIA- GENERALISED ABDOMINAL PAIN
#surgicaleducator #epigastricabdominalpain #pepticulcerdisease #usmle #babysurgeon #surgicaltutor
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today I have uploaded a video on Mesenteric Ischemia- a didactic lecture.
• It is one of the uncommon but life-threatening surgical problems you see in surgical wards.
• I have discussed the various causes for Generalised Abdominal Pain, epidemiology, etiology, pathology, clinical features, investigations, and treatment of Mesenteric Ischemia.
• I have also included a mind map and a treatment algorithm for Mesenteric Ischemia.
• I hope the video will be very useful and you will enjoy it.
• You can watch all my surgical teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the video.
Pulmonary embolism - Diagnosis and managementDr Vivek Baliga
Pulmonary embolism is a common problem seen in medical practice. This presentation by Dr Vivek Baliga discusses the basic aspects and evidence behind current management.
This is prepared for my project and im sharing this for useful to others.This slides contain the processing of urine specimens in microbiology.im prepared on basis of our medical college method.sometimes the methods will vary with other hospitals
PE is the obstruction of one or more pulmonary arteries by an embolic solid, fluid, or gas.
it cause by deep vein thrombosis (DVT).
for more informations read the following file.
1. PROBLEM BASED LEARNING Dr Moataz Abdelrahman Consultant Paediatric Anaesthetist Central Manchester University Hospitals Royal Manchester Children’s Hospital
2. CASE 3 A 4 year old girl weighing 15.2 Kg is on your list for a lumbar puncture. She had a history of cough over the last 8 days which is non-productive, no history of asthma and her chest is clear to auscultation. With the start of the cough she was feverish 38.2 0C and suffered a brief seizure which resolved spontaneously. Temp is now 36.8 0C. CBC normal apart from mild leukocytosis. She had a GA last year for a cystoscopy which was uneventful. What is your approach?
3. WHAT TO DO Do the case today Explain your anaesthetic Precautions Safety Postpone Reasons for delay Valid You are to convince clinicians and parents What will you achieve?
7. CAUSES Tumours of the lung, mediastinum and pleura. Primary (uncommon) Metastatic The commonest Lymphoblastic lymphoma (non-Hodgkin’s lymphoma) Hodgkin’s disease. Other lesions Vascular malformations Neurogenic tumours Germ cell tumours Cysts (bronchogenic or enteric)
8. PRESENTATION No Cardio-respiratory symptoms Respiratory Cough, dyspnoea, stridor Cardiac Orthopnoea, syncope, Superior vena cava syndrome Swelling of the upper arms, face and neck General constitutional symptoms
11. PROBLEMS Respiratory collapse Cardiovascular collapse During Induction (mainly) Maintenance Recovery Relation to preoperative manifestation???
12. The incidence of cardio-respiratory complications is high (7-20% in adults) and higher in children Mortality in relation to general anaesthesia is high in children Asymptomatic children have suffered serious morbidity or even death whilst undergoing general anaesthesia
13. EVALUATION Symptoms Signs Investigations CT ECHO PFT ? if feasible PREDICTABILITY OF AIRWAY COLLAPSE/OBSTRUCTION AND CVS COMPROMISE
15. AIRWAY - CT CXR Level of compression Degree of compression Type of lesion and extent Other lesions 30% occlusion incidence of resp complications 50% occlusion incidence of complete obstruction Static pictures may not identify dynamic compression
16. AIRWAY - PFT Difficult in children PEFR 50% of expected correlates with 50% central airway (trachea) obstruction 50% of expected PEF incidence of complete obstruction
17. ANAESTHETIC MANAGEMENT A clear strategy should be followed Multidisciplinary involvement Identify high risk patients The need for a general anaesthetic should be justified Local anaesthesia/sedation could be an alternative
18.
19. ANAESTHETIC MANAGEMENT The objective is to minimise airway and cardiovascular compression Reduce the size of the tumour Preoperative steroids for 1-5 days Preoperative chemotherapy Preoperative Radiotherapy Secure tracheal/bronchial patency Maintain spontaneous breathing Avoid muscle relaxants If IPPV high pressures may be needed + PEEP? Stinting the trachea and main bronchi Use of 2 micro-laryngosurgery tubes?
20.
21. ANAESTHETIC MANAGEMENT Inhalation technique recommended Rigid brochoscope should be available Bypass the obstruction Life saving Positioning Rt Lateral Prone Surgeon ready for sternotomy Immediate decompression Facilities should be available Cardiopulmonary bypass Sometimes not practical
22. CONCLUSION Children presenting for malignancy investigation (LP - BMA - LN Biopsy) should have a chest X-ray and any mediastinal mass detected need to be dealt with according to a specific protocol