When you see beyond monitor. A very nice lecture tells you Why we do diagnostic errors ..with a plenty of real clinical examples…good resource for all residents in all levels to review the basics of Hemodynamic monitoring…and more…
I spent more than two month preparing this lecture….it is all about anaesthesia residents teaching….
I hope that you will like it
Ahmad M. Abou Leila
Certified registered nurse of anesthesiologyJada Baker
To become a Certified Registered Nurse of Anesthesiology (CRNA), one must complete a Bachelor of Science in Nursing, work as an intensive care nurse for 1 year, and complete a 24-36 month Nurse Anesthesiology program. Top CRNA programs include Duke, Wake Forest, and ECU. As a CRNA, one is responsible for reviewing medical histories, accurately monitoring anesthesia levels, and ensuring patient safety. Entry level CRNA positions require a BSN, while higher positions may require a master's or PhD. The average CRNA salary is $182,000 annually, with the top 25% earning over $218,000. Strong interpersonal skills like empathy and communication are important due
Nurse anesthetists have advanced education and clinical experience, with a median salary of $156,610. To become one requires getting a nursing degree, 2 years of critical care experience, and 2 additional years of specialized education. The author is motivated to pursue this career path due to the salary and opportunities it provides to support his family. He plans to obtain the necessary education through Southern University, CAMC, Marshall University, and potentially Mountain State University. As a nurse anesthetist, one is responsible for administering anesthesia, monitoring patients, and ensuring safety during medical procedures. It is an in-demand career that offers employment in various healthcare settings.
An anesthesiologist administers anesthesia to patients undergoing surgery to relieve their pain and calm their nerves. The job involves monitoring patients' vital signs during surgery, deciding on appropriate treatments, and prescribing medication. It requires four years of undergraduate education, four years of medical school, and three to eight years of residency training. While the training is lengthy, it is a growing field with higher than average pay of around $186,000 annually. A related occupation is pediatrician, which also involves extensive schooling but treats children instead of surgical patients.
The document describes how anesthesia has changed from 1985 to the present and may change in the future. It outlines the therapeutic armamentarium, monitoring techniques, airway management strategies, and models of patient care that were used in 1985 compared to 1998 and 2010. It speculates that by 2020 new anesthetic agents such as dexmedetomidine and nicotinic analgesics as well as advanced monitoring like EEG-guided systems may become standard, and outpatient procedures will grow more common.
Management of the patient with suspected perioperative nerve injuryEdward R. Mariano, MD
At the conclusion of the activity participants should be able to: discuss potential risks for perioperative nerve injury; estimate occurrence rates of various regional anesthesia complications; evaluate the patient with suspected nerve injury and recommend appropriate testing.
The medical specialty of anesthesiology is founded on patient experience and patient safety. Having major surgery would be a very different experience without anesthesia. Before the advent of safe anesthesia techniques, the world of surgery was basically limited to amputations and other attempts at life-saving maneuvers. Dr. Bigelow’s publication describing the safe administration of ether changed everything, and the New England Journal of Medicine called this the most important article in its history. With this article, the science and clinical practice of anesthesiology, as well as the modern era of surgery, were born. Understanding and appreciating the rich history of anesthesiology will help guide the future direction of this specialty. Physician anesthesiologists have the skills necessary to take the quality of perioperative medicine to the next level, combat the opioid epidemic, and redesign the surgical experience,
Certified registered nurse anesthetists (CRNAs) administer anesthesia to patients during medical procedures and monitor their vital signs. They work in hospitals, surgical centers, and other medical facilities. CRNAs were pioneers in developing anesthesia techniques and were the first to provide anesthesia services in the US in the late 1800s. Today, CRNAs earn an average salary of $168,500. Becoming a CRNA requires obtaining a bachelor's degree in nursing, becoming a registered nurse, gaining critical care experience, obtaining a master's degree from an accredited nurse anesthesia program, and passing a national certification exam. There is currently a shortage of CRNAs due to an increasing number of medical procedures requiring anesthesia and fewer graduates from nurse anesthesia programs
Certified registered nurse of anesthesiologyJada Baker
To become a Certified Registered Nurse of Anesthesiology (CRNA), one must complete a Bachelor of Science in Nursing, work as an intensive care nurse for 1 year, and complete a 24-36 month Nurse Anesthesiology program. Top CRNA programs include Duke, Wake Forest, and ECU. As a CRNA, one is responsible for reviewing medical histories, accurately monitoring anesthesia levels, and ensuring patient safety. Entry level CRNA positions require a BSN, while higher positions may require a master's or PhD. The average CRNA salary is $182,000 annually, with the top 25% earning over $218,000. Strong interpersonal skills like empathy and communication are important due
Nurse anesthetists have advanced education and clinical experience, with a median salary of $156,610. To become one requires getting a nursing degree, 2 years of critical care experience, and 2 additional years of specialized education. The author is motivated to pursue this career path due to the salary and opportunities it provides to support his family. He plans to obtain the necessary education through Southern University, CAMC, Marshall University, and potentially Mountain State University. As a nurse anesthetist, one is responsible for administering anesthesia, monitoring patients, and ensuring safety during medical procedures. It is an in-demand career that offers employment in various healthcare settings.
An anesthesiologist administers anesthesia to patients undergoing surgery to relieve their pain and calm their nerves. The job involves monitoring patients' vital signs during surgery, deciding on appropriate treatments, and prescribing medication. It requires four years of undergraduate education, four years of medical school, and three to eight years of residency training. While the training is lengthy, it is a growing field with higher than average pay of around $186,000 annually. A related occupation is pediatrician, which also involves extensive schooling but treats children instead of surgical patients.
The document describes how anesthesia has changed from 1985 to the present and may change in the future. It outlines the therapeutic armamentarium, monitoring techniques, airway management strategies, and models of patient care that were used in 1985 compared to 1998 and 2010. It speculates that by 2020 new anesthetic agents such as dexmedetomidine and nicotinic analgesics as well as advanced monitoring like EEG-guided systems may become standard, and outpatient procedures will grow more common.
Management of the patient with suspected perioperative nerve injuryEdward R. Mariano, MD
At the conclusion of the activity participants should be able to: discuss potential risks for perioperative nerve injury; estimate occurrence rates of various regional anesthesia complications; evaluate the patient with suspected nerve injury and recommend appropriate testing.
The medical specialty of anesthesiology is founded on patient experience and patient safety. Having major surgery would be a very different experience without anesthesia. Before the advent of safe anesthesia techniques, the world of surgery was basically limited to amputations and other attempts at life-saving maneuvers. Dr. Bigelow’s publication describing the safe administration of ether changed everything, and the New England Journal of Medicine called this the most important article in its history. With this article, the science and clinical practice of anesthesiology, as well as the modern era of surgery, were born. Understanding and appreciating the rich history of anesthesiology will help guide the future direction of this specialty. Physician anesthesiologists have the skills necessary to take the quality of perioperative medicine to the next level, combat the opioid epidemic, and redesign the surgical experience,
Certified registered nurse anesthetists (CRNAs) administer anesthesia to patients during medical procedures and monitor their vital signs. They work in hospitals, surgical centers, and other medical facilities. CRNAs were pioneers in developing anesthesia techniques and were the first to provide anesthesia services in the US in the late 1800s. Today, CRNAs earn an average salary of $168,500. Becoming a CRNA requires obtaining a bachelor's degree in nursing, becoming a registered nurse, gaining critical care experience, obtaining a master's degree from an accredited nurse anesthesia program, and passing a national certification exam. There is currently a shortage of CRNAs due to an increasing number of medical procedures requiring anesthesia and fewer graduates from nurse anesthesia programs
Given that the patient had a coronary stent placed only 4 weeks ago, continuing both clopidogrel and aspirin would be associated with significant risk of bleeding if he were to undergo emergent neurosurgery. The optimal management would be:
1. Consult cardiology to discuss discontinuing clopidogrel 5-7 days prior to surgery while continuing aspirin. This balances the risks of bleeding vs stent thrombosis.
2. Consider bridging with a short-acting P2Y12 inhibitor like cangrelor on the day of surgery only to further reduce stent thrombosis risk.
3. Monitor the patient closely in the perioperative period for signs of bleeding or stent thrombosis.
Discontinuing both antiplatelets
This document provides an overview of responding to emergency medical calls as a paramedic. It discusses gathering key information from callers, developing a differential diagnosis based on symptoms, performing a focused physical exam, considering clinical scenarios and protocols for treatment. Specific examples covered include responding to calls for abdominal pain, chest pain, shortness of breath and headaches. Clinical decision making for emergency childbirth, seizures, allergic reactions and cardiac arrest are also reviewed. The document emphasizes developing an assessment and treatment plan tailored to the patient's condition.
This document provides an overview of pediatric cardiology. It discusses innocent murmurs, various types of congenital heart disease including septal defects, shunts, and obstructive lesions. It also covers acquired conditions like Kawasaki disease and endocarditis. Specific congenital defects discussed in detail include atrial septal defects, ventricular septal defects, patent ductus arteriosus, coarctation of the aorta, and tetralogy of Fallot. Management strategies for different conditions are presented. The document concludes with sample board review questions related to pediatric cardiology.
CPR involves procedures to manually preserve brain and heart function until medical treatment can restore normal heart rhythm. It includes chest compressions, rescue breathing, and defibrillation if needed. The major goals of CPR are to provide oxygen to vital organs and restore spontaneous blood circulation until definitive medical treatments take over. CPR procedures involve opening the airway, providing rescue breaths, performing chest compressions, and using a defibrillator to restore a normal heart rhythm if indicated. Ongoing care after CPR aims to optimize cardiovascular and respiratory function and prevent further cardiac arrests.
CPR involves procedures to manually maintain heartbeat and breathing when these functions have stopped. It provides oxygen to vital organs until medical treatment can restore normal heart function. CPR consists of opening the airway, providing rescue breaths, and external chest compressions to circulate blood. The goals are to keep oxygenated blood flowing to the brain and heart until definitive treatments like defibrillation can be applied. CPR is used to treat cardiac arrest from conditions like heart attacks, drug overdoses, and respiratory issues.
Posterior circulation strokes can be difficult to diagnose due to vague symptoms like dizziness. Two case studies are presented where patients initially presented with dizziness but were found to have posterior circulation strokes. Initial exams revealed additional concerning findings, and imaging confirmed large vessel occlusions requiring thrombolysis or thrombectomy. While outcomes vary, posterior circulation strokes require close monitoring given risks of deterioration.
Any diseased condition of the myocardium which leads to cardiac failure is known as cardiomyopathy. A longitudinal case study of biventricular non-compaction, treated with constitutional homeopathic medicines over four years is shared. Consideration of miasms, importance of intra-uterine history and various avenues of homeopathic prescribing in cardiac conditions are explained. Prescribing clues of the homeopathic remedy Pneumococcin are also shared.
This document presents the case of a 70-year-old woman admitted to the ICU with hypotension, hypoxia, abdominal tenderness and distension. She developed intra-abdominal hypertension with an intra-abdominal pressure of 26 mmHg. Imaging revealed occlusion of the superior mesenteric artery near its origin with infarction of the right kidney and spleen. Her condition was too poor for surgery, so medical management was initiated for her intra-abdominal hypertension and multiple organ dysfunction.
Upper airway obstruction can be acute or chronic, partial or complete. A 5-year-old child presented with difficulty breathing, stridor, and choking for 30 minutes after playing with coins. On examination, the child's airway was obstructed and emergency tracheostomy was required. Investigations like X-rays of the neck and chest were done. The child's condition improved after tracheostomy and oxygen supplementation. Upper airway obstruction can be caused by foreign bodies, infections, tumors, and laryngeal spasms. Manual maneuvers, instrumentation, and surgery may be used as treatment depending on the severity and cause of obstruction.
This document outlines dental emergency procedures. It discusses common dental emergencies, risk factors during dental treatment, life-threatening events like airway obstruction or circulatory issues, and the SPRABCD approach for assessment and management: Stop procedure, Response, Position, Airway, Breathing, Circulation/Cardiac monitoring, and Dysfunction of CNS. It emphasizes being prepared with staff, equipment and training, properly assessing patients, intervening early for possible complications, and definitive emergency management.
The document describes a scenario of being on call on the pediatric wards. It introduces two patients, Luis and Ryan, who are exhibiting signs of shock such as pallor, tachypnea, and diaphoresis. The document then provides an overview of shock, its signs and symptoms, and the initial steps of fluid resuscitation and obtaining additional help.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Jim Jacob Roy
In this presentation , SBP ( spontaneous bacterial peritonitis ) , which is a common complication in patients with cirrhosis and ascites is described in detail.
The reference for this presentation is Sleisenger and Fordtran's Gastrointestinal and Liver Disease Textbook ( 11th edition ).
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
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Given that the patient had a coronary stent placed only 4 weeks ago, continuing both clopidogrel and aspirin would be associated with significant risk of bleeding if he were to undergo emergent neurosurgery. The optimal management would be:
1. Consult cardiology to discuss discontinuing clopidogrel 5-7 days prior to surgery while continuing aspirin. This balances the risks of bleeding vs stent thrombosis.
2. Consider bridging with a short-acting P2Y12 inhibitor like cangrelor on the day of surgery only to further reduce stent thrombosis risk.
3. Monitor the patient closely in the perioperative period for signs of bleeding or stent thrombosis.
Discontinuing both antiplatelets
This document provides an overview of responding to emergency medical calls as a paramedic. It discusses gathering key information from callers, developing a differential diagnosis based on symptoms, performing a focused physical exam, considering clinical scenarios and protocols for treatment. Specific examples covered include responding to calls for abdominal pain, chest pain, shortness of breath and headaches. Clinical decision making for emergency childbirth, seizures, allergic reactions and cardiac arrest are also reviewed. The document emphasizes developing an assessment and treatment plan tailored to the patient's condition.
This document provides an overview of pediatric cardiology. It discusses innocent murmurs, various types of congenital heart disease including septal defects, shunts, and obstructive lesions. It also covers acquired conditions like Kawasaki disease and endocarditis. Specific congenital defects discussed in detail include atrial septal defects, ventricular septal defects, patent ductus arteriosus, coarctation of the aorta, and tetralogy of Fallot. Management strategies for different conditions are presented. The document concludes with sample board review questions related to pediatric cardiology.
CPR involves procedures to manually preserve brain and heart function until medical treatment can restore normal heart rhythm. It includes chest compressions, rescue breathing, and defibrillation if needed. The major goals of CPR are to provide oxygen to vital organs and restore spontaneous blood circulation until definitive medical treatments take over. CPR procedures involve opening the airway, providing rescue breaths, performing chest compressions, and using a defibrillator to restore a normal heart rhythm if indicated. Ongoing care after CPR aims to optimize cardiovascular and respiratory function and prevent further cardiac arrests.
CPR involves procedures to manually maintain heartbeat and breathing when these functions have stopped. It provides oxygen to vital organs until medical treatment can restore normal heart function. CPR consists of opening the airway, providing rescue breaths, and external chest compressions to circulate blood. The goals are to keep oxygenated blood flowing to the brain and heart until definitive treatments like defibrillation can be applied. CPR is used to treat cardiac arrest from conditions like heart attacks, drug overdoses, and respiratory issues.
Posterior circulation strokes can be difficult to diagnose due to vague symptoms like dizziness. Two case studies are presented where patients initially presented with dizziness but were found to have posterior circulation strokes. Initial exams revealed additional concerning findings, and imaging confirmed large vessel occlusions requiring thrombolysis or thrombectomy. While outcomes vary, posterior circulation strokes require close monitoring given risks of deterioration.
Any diseased condition of the myocardium which leads to cardiac failure is known as cardiomyopathy. A longitudinal case study of biventricular non-compaction, treated with constitutional homeopathic medicines over four years is shared. Consideration of miasms, importance of intra-uterine history and various avenues of homeopathic prescribing in cardiac conditions are explained. Prescribing clues of the homeopathic remedy Pneumococcin are also shared.
This document presents the case of a 70-year-old woman admitted to the ICU with hypotension, hypoxia, abdominal tenderness and distension. She developed intra-abdominal hypertension with an intra-abdominal pressure of 26 mmHg. Imaging revealed occlusion of the superior mesenteric artery near its origin with infarction of the right kidney and spleen. Her condition was too poor for surgery, so medical management was initiated for her intra-abdominal hypertension and multiple organ dysfunction.
Upper airway obstruction can be acute or chronic, partial or complete. A 5-year-old child presented with difficulty breathing, stridor, and choking for 30 minutes after playing with coins. On examination, the child's airway was obstructed and emergency tracheostomy was required. Investigations like X-rays of the neck and chest were done. The child's condition improved after tracheostomy and oxygen supplementation. Upper airway obstruction can be caused by foreign bodies, infections, tumors, and laryngeal spasms. Manual maneuvers, instrumentation, and surgery may be used as treatment depending on the severity and cause of obstruction.
This document outlines dental emergency procedures. It discusses common dental emergencies, risk factors during dental treatment, life-threatening events like airway obstruction or circulatory issues, and the SPRABCD approach for assessment and management: Stop procedure, Response, Position, Airway, Breathing, Circulation/Cardiac monitoring, and Dysfunction of CNS. It emphasizes being prepared with staff, equipment and training, properly assessing patients, intervening early for possible complications, and definitive emergency management.
The document describes a scenario of being on call on the pediatric wards. It introduces two patients, Luis and Ryan, who are exhibiting signs of shock such as pallor, tachypnea, and diaphoresis. The document then provides an overview of shock, its signs and symptoms, and the initial steps of fluid resuscitation and obtaining additional help.
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1. When you see beyond
monitors..
The Diagnosis errors and Diagnosis game
Ahmad Abou Leila
PGY5 –Anesthesiology
American University of Beirut
Ahmad M. Abou Leila
2. Take our monitoring skills to the next level.
1
Integrate the clinical skills with the monitoring
2 skills
Why we do Diagnosis errors?
3
How to avoid the Dx errors
4
Ahmad M. Abou Leila
25. Availability bias
“Dx according to what available
in our Brain
Less available pathology less Dx”
Representativeness Confirmation Bias
“miss the atypical features”
outcome bias
“choosing Dx with good Premature closure
outcomes avoid dx with bad
outcome”
Overconfidence Bias Diagnosis
momentum
Ahmad M. Abou Leila
26. Obese patient ..Lap chole..
Post operative he developed tachycardia and hypotension
JP drain ZERO ..
He was Treated as hypovolemic
(voluven,blood,Aline)
Ahmad M. Abou Leila
28. Availability bias
We see a lot of hypovolemia …ready
available in our minds
Out come bias
Obese patient ..Lap chole.. Hypovolemia better prognosis than PE
Post operative he developed
tachycardia and hypotension
It is Hypovolemia
Premature closure
JP drain ZERO ..
He was Treated as
hypovolemic Insert A-line and volume administration
(voluven,blood..etc) Confirmation Bias and Dx momentum
Death
Ahmad M. Abou Leila
29. After Spinal anesthesia in asthmatic patient
Patient become Dyspneic and desaturation
The resident explanation
“it is false reading”
Ahmad M. Abou Leila
32. “it is false reading”
premature closure..
Ahmad M. Abou Leila
33. 38 y/o female patient
Preclampsia…
C/S under GA…
Everything is fine
Post Operative she developed severe Dyspnea
What is your differential ?
Ahmad M. Abou Leila
34. Pulmonary embolism
Aspiration
Tocolytic pulmonary edema
Pre-eclampsia Pulmonary edema
Anxiety
Ahmad M. Abou Leila
35. Not every Postoperative Nausea…..Do EGK to rule out MI
Never get the habit of MED student after Brugada lesson
Every ST elevation has to rule out brugada
Base-rate neglect Bias
the tendency to ignore the true prevalence of a disease
Tendency to Diagnose “exotic “ things
Ahmad M. Abou Leila
36. To write goo differential list ..you have to answer three questions
Ahmad M. Abou Leila
37. What is the most common cause?
What is the most serious cause?
What is the most likely cause?
Ahmad M. Abou Leila
39. What is the most common Hpovolemia(bleeding)
cause? Epidural anesthesia
Pulmonary embolism
What is the most serious
Mediastinal shift
cause?
What is the most likely cause?
Ahmad M. Abou Leila
48. During transfer of TOF baby after DX cardiac CATH
Baby become cyanotic and saturation dropped to 60
Baby had normal breathing pattern(no labored breathing or obstruction)
Ahmad M. Abou Leila
56. After CSE for Multigravida patient
the OB resident informed you that
there is significant FHR
abnormalities …..
What you think ?
Patient Placed Right side up and BP
normal…
Still FHR abnormal
What you think ?
Rule out Uterine Hypertonus
Ahmad M. Abou Leila
57. Logistic regression analysis showed the type of analgesia
as the only independent predictor of uterine hypertonus
(odds ratio 3.526, 95% confidence interval 1.21-10.36; P=.022).
Combined spinal-epidural analgesia
is associated with a significantly greater incidence of FHR abnormalities
related to uterine hypertonus compared with epidural analgesia
Ahmad M. Abou Leila
67. Aorta
Brachial artery
As you go Further
Pulse amplification
Taller systolic peak
Lower diastolic pressure
Dorsalis pedis
Ahmad M. Abou Leila
68. Measured SBP in In Shock
radial and DP Vasoconstriction
False sense of
Is 20mmHg Peripheral pulse
security
higher than Higher then
central Aorta central
Ahmad M. Abou Leila
69. Systolic pressure monitoring
Reflects Not Change with site Not
blood flow Peripheral augmentation related to autoregulation
initial upstroke
Ahmad M. Abou Leila
70. CPP MAP-ICP
SVR MAP-CVP/CO
coronary Diastolic pressure-LVEDP
Abdomen MAP-IAP
Systolic Blood pressure didn’t appear in autoregulation
Ahmad M. Abou Leila
71. Mean Arterial Blood Pressure
MAP Indicator of blood flow
MAP Main Determinants of autoregulation
Not affected by Reflected waves
MAP
No peripheral augmentation
Not affected by over Damping and
MAP
underdamping
Ahmad M. Abou Leila
72. Lowest MAP without
hypoperfusion
Severe HTN :65
MAP Treated HTN:53
Normal :43
Ahmad M. Abou Leila
107. Oxygen saturation in the central line
ScVO2 is lower SVO2 by
2%-3%
ScVO2 =SVC SVO2=SVC+IVC
SVC sampling Brain consumption is IVC more oxygen
Central line higher than rest of SVO2 more
body…SVC less O2
ScVO2 less
Ahmad M. Abou Leila
109. Current evidence and consensus-based guideline for monitoring and
treatment of cardiac surgery patients during the postoperative period in
ICU recommends an
ScvO2 > 70%
SvO2 > 65%
Ahmad M. Abou Leila
110. ScVO2 European Multicenter study
73 Critical care 2006,10 R185
Deflaviis et al
ScVO2
>70 Minerva anesthesiology 2006
ScVO2 Pearse et al
75 Critical care 2009,9 R694-699
SVO2 Polonen et al
>70 Anes-Analgesia 2000,90:1052-1059
Ahmad M. Abou Leila
111. Why venous oximetry?
60% of patient udergoing major surgeries
develop intestinal ischemia
SVO2 or ScVO2 directed therapy associated
with less postoperative complications and
mortality
Small increase with SVO2 associated with
significant decrease in the mortality
Ahmad M. Abou Leila
119. Tests to assess
recovery
Tests to assess
Depth
Ahmad M. Abou Leila
120. TOF% 30 40 50 60 70 80 90
Head lift
5sec
Tongue
Depressor
test
V or T Fade
TOF detection
V or T
DBS
Fade detection Safe
extubation
50 HZ Fade No
Tetanus detection
residual
100 HZ
paralysis
Fade detect
Tetanus
Always Use quantitative test
Ahmad M. Abou Leila
121. TOF% 30 40 50 60 70 80 90
Safe
extubation
No
residual
paralysis
Debaene B, Plaud B, Dilly MP, Donati F. Residual paralysis in
the PACU after a single intubating dose of nondepolarizing
muscle relaxant with an intermediate durationAhmad M.
of action. Abou Leila
Anesthesiology 2003;98:1042–8
122. TOF% 30 40 50 60 70 80 90
Safe
extubation
No
residual
paralysis
AhmadReversaltooffour hoursLeilasingle intubating dose
Caldwell JE.
M. residual neuromuscular block with
neostigmine at one Abou after a
of vecuronium. Anesth Analg 1995;80:1168–74
123. Patient A Co-oximetry results
What will be the SPO2
Oxy Hb 70%
reading in these two
Reduced Hb 10 %
Carboxy Hb 20% patients?
Both SPO2= 90
SPO2 reads only oxy and
reduced
And reads the COHB as Oxy
Patient B Co-oximetry results HB
Oxy Hb 50%
Reduced Hb 10 %
Carboxy Hb 40%
Ahmad M. Abou Leila
125. Oxygen saturation Gap
SPO2-SaO2>5
Abnormal Hb not measured by SPO2
Ahmad M. Abou Leila
126. Link the monitor data to the patient physiology…number alone are meaningless
Before you make your diagnoses ASK your self” what else might this be?” what did I miss”
Remember the three questions “the Most common” ”The most dangerous” and the most likely”
Don’t be overconfident…ask for feedback
The most important ting to improve your Diagnosing skills is
Read and practice
Ahmad M. Abou Leila