Anesthesia carries risks that can lead to patient death or injury. Several factors contribute to risks in the operating room including equipment issues, patient health factors, human performance errors, and system failures. Some key errors that can cause severe harm are airway issues, medication errors, and procedure mistakes. Maintaining vigilance, checklists, standards, training, and learning from adverse events can help improve safety. Thorough documentation and review of incidents is important for quality assurance.
The post operative period begins from the time the patient leaves the operating room and ends with the follow up visit by the surgeon. The post operative care is provided by – PACU
A basic overview on the management of intra-operative bronchospasm: the risk factors, triggers, diagnosis, prevention and management. Includes a case scenario – discussion.
Telemedicine is a upcoming topic of interest, especially in pandemic times where remote places cannot be assesed telemedicine is a great oppurtunity in such circumstances.
anesthesia through telemedicine is possible.
The post operative period begins from the time the patient leaves the operating room and ends with the follow up visit by the surgeon. The post operative care is provided by – PACU
A basic overview on the management of intra-operative bronchospasm: the risk factors, triggers, diagnosis, prevention and management. Includes a case scenario – discussion.
Telemedicine is a upcoming topic of interest, especially in pandemic times where remote places cannot be assesed telemedicine is a great oppurtunity in such circumstances.
anesthesia through telemedicine is possible.
Background: Neck flexion by head elevation using an 8 to 10 cm thick pillow and head extension has been suggested to
align the laryngeal, pharyngeal and oral axis and facilitate tracheal intubation. Presently, the laryngeal view and discomfort
for tracheal intubation were evaluated according to two different degrees of head elevation in adult patients.
Methods: This prospective randomized, controlled study included 50 adult patients aged 18 to 90 years. After induction
of anesthesia, the Cormack Lehane grade was evaluated in 25 patients using a direct laryngoscope while the patient’s head
was elevated with a 4 cm pillow (4 cm group) and then an 8 cm pillow (8 cm group). In the other 25 patients, the grades
were evaluated in the opposite sequence and tracheal intubation was performed. The success rate and anesthesiologist’s
discomfort score for tracheal intubation, and laryngeal, pharyngeal and oral axes were assessed.
Results: There were no differences in the laryngeal view and success rate for tracheal intubation between the two groups.
The discomfort score during tracheal intubation was higher in the 8 cm group when the patient’s head was elevated 4 cm
first and then 8 cm. The alignment of laryngeal, pharyngeal and oral axes were not different between the two degrees of
head elevation.
Conclusions: A pillow of 8 cm height did not improve laryngeal view and alignment of airway axes but increased the anesthesiologist
discomfort, compared to a pillow of 4 cm height, during tracheal intubation in adult patients.
Key Words: Airway management, Intratracheal intubation, Laryngoscope, Vocal cords.
Transitions of Care (OR-PACU) - Aalap Shah , MDAalap Shah
An update regarding our initiative to improve the post-operative transtion of care for patients after surgery at Harborview Medical Center in Seattle, WA
Nursing management of critically ill patient in intensive care unitsANILKUMAR BR
Critical care nursing: it is the field of nursing with a focus on the utmost care of the critically ill (or) unstable patients.
Critically ill patients : critically ill patients are those who are at risk for actual (or) potential life threatening health problems.
Admission QGeneral appearance (consciousness)
Airway: Patency Position of artificial airway (if present)
Breathing: Quantity and quality of respirations (rate, depth, pattern, symmetry, effort, use of accessory muscles) Breath sounds Presence of spontaneous breathing.
Circulation and Cerebral Perfusion: ECG (rate, rhythm, and presence of ectopy) Blood pressure Peripheral pulses and capillary refill Skin, color, temperature, moisture Presence of bleeding Level of consciousness, responsiveness.
quick Check Assessment in CCU.
Peri-operative Nursing/Anesthesia/Pain ManagementWasim Ak
The care provide during surgical intervention (pre-operative, intra-operative and post-operative period) is known as Peri-operative Nursing Care.
Peri-operative Nursing Care includes :
Pre-operative Nursing Care
Intra-operative Nursing Care
Post-operative Nursing Care.
Anesthesia means “loss of sensation with or without loss of consciousness” .
Medications that cause anaesthesia, are called Anesthetics.
Anesthesia is defined as a temporary state consisting of unconsciousness, loss of memory, lack of pain, and muscle relaxation.
Anesthesia is defined as a loss of feeling or awareness caused by drugs or other substances which keeps patient free from feeling pain during surgery or other procedures.
RESUSCIATION EQUIPMENTS IN INTENSISIVE CARE UNITSANILKUMAR BR
Intensive care unit (ICU) equipment includes patient monitoring, respiratory and cardiac support, pain management, emergency resuscitation devices, and other life support equipment .
They are designed to care for patients who are seriously injured, have a critical or life-threatening illness, or have undergone a major surgical procedure thereby requiring 24-hour care and monitoring.
Intensive care unit equipment includes
Patient monitoring devices
Life support and emergency resuscitation devices, and
Diagnostic devices.
2018 ATLS PROTOCOL
FOCUSING ON THE PRIMORDIAL MANAGEMENT OF PT IN THE APPROACH OF IMPROVING TRAUMA PT MANAGEMENT AND REDUCING MORTALITY OF TRAUMA PT AT OUR RESPECTIVE HEALTH FACILITIES AS DOCTORS AND CLINICIANS WORKING IN THE EMERGENCY DEPARTMENT.
GIVEN THE NECESSARY EQUIPMENT AND FAVOURABLE AMBIENT WORKING ENVIRONMENT WE SHOULD BE ABLE TO OFFER OUR HUMANITY RACE QUALITY SERVICES BEARING IN MIND THAT LIFE COME FIRST AND ALL THE OTHER ATTRIBUTES IN LIFE FOLLOWS
Management Of Patient Undergoing Surgerykalyan kumar
Preoperative care refers to health care provided before a surgical operation. The aim of preoperative care is to do whatever is right to increase the success of the surgery.
At some point before the operation the health care provider will assess the fitness of the person to have surgery.
During the perioperative period, specialised nursing care is needed during each phase of treatment. For nurses to give effective and competent care, they need to understand the full perioperative experience for the patient.
Perioperative refers to the three phases of surgery.
Preoperative stage
Intraoperative stage
Postoperative stage
Within these stages there are many different roles for nurses and different care needed for the patient dependent on which stage they are in.
As with any nursing care, the goal during these stages is to provide holistic and evidence based care as well as support to the individual.
There are different nursing roles throughout the perioperative process including: admissions nurse, anaesthetic nurse, circulating nurse or scout nurse, instrument or scrub nurse, post anaesthesia care unit (PACU) nurse and the surgical ward nurse. Other nurses may be included in the perioperative process such as pain management specialist nurses, diabetes educators.
Pre operative and post-operative surgical care - a brief medical study martinshaji
HAPPY PHARMACIST DAY
Preoperative information required to be provided to the patient includes postoperative activities to be expected (such as deep breathing and coughing and early mobilization); pain management; and any other specific information relevant to the type of surgery they are having and to the individual themselves.
this details all about Pre operative and post-operative surgical care
please comment
thank you ..
Dr rowan molnar anaesthetics study guide part iiDr. Rowan Molnar
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
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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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.
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The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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.
4. • Anesthetists are responsible for patient safety
during operations
• Anesthesiology is a high-risk specialty as
compared with other specialties in medicine
Why
5. The risk of anesthesia
• Anesthesia may contribute to death in about 1
per 10,000 anesthetics.
• Many other patients suffer serious and costly
nonfatal injuries such as permanent
neurologic damage (paraplegia and
vegetative).
6. • Now we can see anesthesia event can cause
severe results
• So we should find out factors threatening
patient safety in the operation room and
search for strategies to deal with them
7. There are many factors threatening
patient safety in the operation rooms
9. Patient
• Causes
– Underlying diseases: hyperthyroidism-thyroid
storm, diabetes-ketoacidosis or hyperosmolar
come
– Allergic reaction to some drug
• Strategies
– Preoperative evaluations
10. Anesthetist and Surgeon
• Human factors affecting performance such as
:fatigue noise, boredom, long hours, hunger,
tension
11. • System failures are the main reason for
accidents
– Check anesthetic machine
– Oxygen supply
– A backup O2 tank
– Never shut down audible alarms (very important)
15. • Human error is a strong contributor
– Deviations from accepted anesthesia practices
– A lapse in vigilance and no attention to detail
16. • Vigilance and attention to detail are essential
for a safety conducted anesthetic.
• Vigilance lets anesthetists find abnormal signs
as early as possible
17. • Vigilance allows the anesthetist to to remain
aware of surrounding events and signals while
performing other tasks.
20. • Preoperative visit to the patient
to let us know the patient’s
condition in detail.
• Make an anesthesia plan to let us
know clearly how to perform the
anesthesia and how to deal with
possible crisis.
• Check anesthesia machine,
monitors and other devices.
• Prepare the workspace to make
us work mare conveniently and
efficiently. Arrange equipment
and appropriate monitors in a
way that facilitates this. So we
can clearly observe the patient
and easily manipulate all devices
24. • Use systematic approach to scanning the
machine monitors, patient, surgical field, and
surroundings.
25. • If one vital sign is anomalous, quickly assess
the measurement and observing what is
happening on the surgical field.
26. C. Verify observations
Cross-check observations
Assess co varying variables
Review it with a second person.
27. D. Implement compensatory responses
If something wrong happens urgently, first
implementing time-buying measures. E.g.,
increase the fraction of inspired oxygen when
oxygen saturation falls; administer intravenous
fluids or vasopressors when hypotension
occurs.
Then search out any correctable primary
cause and treat it appropriately.
28. E. Prepare for crisis
If there is any critical events happened
(cardiac arrest, malignant hyperthermia or
difficult intubation), call for help early (WHY),
then use accepted protocols for emergencies
and resuscitation (e.g., advanced cardiac life
support, malignant hyperthermia protocols).
29. F. Enhance teamwork; communicate
To enhance teamwork and communication,
address surgeons and nurses early in the case
by knowing names. Make requests and
delegate tasks clearly and specifically by name
(e.g., “Jack, do task X and tell me when task X
is completed.”)
30. G. Compensate for stressors
Anesthetist is a stressful job. If you feel very
tires, ask for a relief.
Reduce various stressors: noise, fatigue,
interpersonal tension, etc. Optimize the work
environment.
31. H. Recognize and address production
pressures
• Patient safety must remain the highest priority
• In big hospitals, anesthetists have a greant deal of
workload. There are many operations everyday.
Anytime we can’t sacrifice patient safety in order
to emphasize production. If there is on adequate
preoperative evaluation, preparation, or
monitoring, it is unsafe to anesthetize the
patient. You must address concerns explicitly to
surgeons and cancel the operation.
32. I. Learn from close calls
Every mistake is an opportunity to learn and
improve.
Analysis and feedback of adverse events to
identify and assess system problems.
34. A. Airway errors
As we know, patients receiving general
anesthesia have no spontaneous respiration
due to use of muscular relaxants, their
respiration is controlled by machine via endo-
trecheal tube. So we must ensure oxygen
supply and avoid accidental extubation
during sugeries ( esp. a prone surgery) and
transport. Once it happens, the result is
severe. It can cause severe hypoxia and
directly threaten the patient life.
35.
36. How to avoid
• Check the system and guarantee it to function
well
• Verify an endotracheal tube by auscultating
for breath sounds bilaterally and by detecting
end-tidal CO2
• Fix the tube solidly
• Closely observe vital signs
38. B. Medication errors
• Administration of undiluted potassium by
rapid intravenous infusion can cause
ventricular fibrillation and cardiac arrest.
• Neostigmine given without an antimuscarinic
drug can cause asystole, severe bradycardia
and antrioventricular block and can be fatal.
• Succinylcholine can cause severe
hyperkalemia and dysrhythmias, may trigger
malignant hyperthermia.
39. • Medications to which a patient is allergic can
cause anaphylaxis.
• Administering the wrong blood can cause an
incompatibility reaction that can be fatal.
40. How to avoid
• Be familiar with the medication you use, know
clearly its indications and contraindications.
• Administrate the medication strictly according
to instructions.
• Know the patient’s history of allergy
• Cross-check blood type.
41. c. Procedure errors
• Inadvertent intravascular injection of local
anesthetics during a nerve block can cause
neurologic and cardiac toxicity, which can be fatal
(especially with bupivacaine).
• Avoidable epidural hematomas may develop
when spinal or epidural anesthetics are
performed in patients who have coagulopathies.
• Air embolisms may occur during the placement
or removal of central venous catheters and may
cause significant hemodynamic instability.
(decumbens position can avoid it).
42. How to avoid
• Adequate preoperative evaluation of patients
• Manipulation according to standards and
guidelines.
• Vigilance.
43. IV. Quality assurance
• The aim is improving the quality of care and
minimizing the risk of injury from anesthesia.
44. A. Documentation
• Any adverse events should be reported
truthfully, discussed, analyzed to identify
causes and assess system problems. So we can
learn from them and develop patterns to
prevent recurrence.
45. B. Standards and guidelines
• Anesthetists should be aware of their
institution’s safety policies and procedures.
These should include those for monitoring,
response to an adverse event, handoff
checklist, resuscitation protocols,
perioperative testing, and any special
procedures or practices for the use of drugs,
equipment, and supplies.
46. C. Safety training
• Anesthesia providers should obtain training in
safety to learn and maintain basic skills.
Simulation techniques should be used. In
reality, for one doctor, the opportunity to
confront a critical event is rare, the best way
to learn critical-event management skill is
using simulator. After training on simulator
repeatedly, when crisis happens, you can
manage it efficiently.
48. Standards for basic anesthetic
monitoring
1. Qualified anesthesia personnel shall be
present in the room throughout the course of
all general anesthetics, regional anesthetics,
and monitored anesthesia care.
50. 2.1 Respiratory monitor
• Oxygenation
– An oxygen analyzer
– Pulse oximeter
• Ventilation
– Clinical signs
– Capnometry
– Continual end-tidal carbon dioxide analysis must be
used with tracheal intubation.
– Some form of monitoring with an audible alarm must
be used during mechanical ventilation.
51. 2.2 Cardiac vascular monitor
• Continuous EKG
• Blood pressure and heart rate at least every 5
min
• One or more of the following
– Palpation of a pulse
– Auscultation of heart sound
– Pulse oximetry
• CVP and arterial blood pressure
52. 2.3 Temperature monitor
• When clinically significant changes in body
temperature are intended, anticipated, or
suspected.
53. Handoffs
• Periodic breaks should be given to the primary
individuals providing anesthesia.
• The following information should be clearly
presented.
54. a. Prior clinical details
• The patient’s diagnosis, surgery, allergies, past
medical and surgical history, relevant
medications, and any pertinent normal or
abnormal laboratory values or studies.
55. b. Intraoperative management
• Status of surgery, airway assessment and
management techniques, anesthetic plan and
current status, current vital signs with an
explanation for any apparent abnormalities or
trends, intravenous access and monitoring,
blood loss and volume status assessment,
anticipated need for additional medications
(e.g., narcotics, muscle relaxation or reversal,
antiemetics).
57. The anesthesiologist involved in an adverse
event should do the following:
a. Provide for continuing care of the patient.
b. Notify the anesthesia operating room
administrator as soon as possible. If a
resident or certifield registration
58.
59. • The objectives are to limit patient injury from
a specific adverse event associated with
anesthesia and to ensure that the causes of
the event are identified so that a recurrence
can be prevented.