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Tuesday, October 14, 2008
I have a new Yahoo! Mail address
Tuesday, September 30, 2008
WALEED SALLAM يريد أن يضيفك كصديق.
  |  WALEED SALLAM |
انظرإلى موقعي الجديد على شبكة الانترنت . هذا الموقع جيّد لتبادل الصور ومقاطع الفيديو والموسيقى والبلوقات. هذا وهو أيضا وسيلة رائعة للقاء اشخاص جدد والبقاء على اتصال مع اصدقائك. هذا الموقع مجاني 100% لكنه في نفس الوقت قيم للغاية. إذا ضغطت على هذا الرابط سوف يتم تحويلك إلى صفحة الإنضمام التي مجرد إكمالها سيجعلك صديق لي لكي نتواصل بسهولة. | |
| أنت تستقبل هذا البريد الإلكتروني لأن WALEED SALLAM (zwis2006@gmail.com) قد قام بدعوتك للالتحاق. إذا كنت ترغب في ألا تتصل بك PerfSpot.com مرة ثانية، برجاء الضغط هنا: http://perfspot.com/u.asp?e=zwis2006%2Eeasy%40blogger%2Ecom إذا كان لديك أي أسئلة أو تحتاج إلى مساعدة رجاء اتصل بفريق الدعم الخاص بنا: الخط المجاني (داخل الولايات المتحدة الأمريكية): 1-888-311-PERF (311-7373) اتصال مباشر (دولي):3758-273-602(1) بريد الكتروني: support@PerfSpot.com PerfSpot.com | 4800 N. Scottsdale Rd Suite 4500 | Scottsdale, AZ 85251 | USA | |
Friday, May 16, 2008
Wednesday, May 14, 2008
Difficult intubation in a case of ankylosing spondylitis: a case report.
http://www.jpgmonline.com/article.asp?issn=0022-3859;year=1998;volume=44;issue=2;spage=43;epage=6;aulast=Kamarkar --- Difficult intubation in a case of ankylosing spondylitis: a case report
Friday, May 9, 2008
Tracheal Intubation –Pediatric Protocol
The pediatric airway is particularly challenging due to the small patient size, differences in anatomy, and relatively high oxygen demand in pediatric patients. In addition, respiratory compromise is the most common antecedent event prior to a cardiorespiratory arrest. Prompt, proper management of the airway is essential in management of a critically ill pediatric patient.
Indications
1. Unconscious patient with no gag reflex requiring airway protection.
Suggested Tracheal Tube Sizes and Depth
Procedure
1. Perform patient assessment and record vital signs, level of consciousness, and
oxygen saturation.
2. Assess that patient meets criteria for this protocol.
3. Ensure there are no contraindications to use of this protocol.
4. Initiate basic life support treatment measures, including supplemental oxygen.
- these take precedence over management using this protocol
5. Ensure cervical spine immobilization is in place, if indicated.
6. Preoxygenate and ventilate with 100% O2 using bag-valve mask.
7. Second EMT applies cricoid pressure.
8. Airway is visualized directly using laryngoscope, following accepted procedure.
• do not rock or lever the laryngoscope on the patient’s teeth
9. When vocal cords have been visualized, pass tracheal tube through the cords.
10. Inflate tracheal tube cuff if using a cuffed tube.
11. Begin ventilation and confirm tube placement following accepted procedure.
• confirmation of tube placement must include end-tidal CO2 detection
• ensure the end-tidal CO2 detection device used is age- or weight-appropriate
12. Release cricoid pressure.
13. Secure tracheal tube. Do not cut tracheal tube.
14. Insert an oral airway or suitable alternative.
15. Initiate transport, unless other emergency condition requires immediate treatment.
Notes:
- Each attempt at intubation should be limited to thirty (30) seconds, with adequate oxygenation and ventilation between attempts.
- A maximum of two (2) attempts at tracheal intubation is permitted.
- Tracheal tube position must be checked frequently, and after any transfer or movement of the patient, because tube displacement occurs easily in pediatric patients.
Indications
1. Unconscious patient with no gag reflex requiring airway protection.
Suggested Tracheal Tube Sizes and Depth
Procedure1. Perform patient assessment and record vital signs, level of consciousness, and
oxygen saturation.
2. Assess that patient meets criteria for this protocol.
3. Ensure there are no contraindications to use of this protocol.
4. Initiate basic life support treatment measures, including supplemental oxygen.
- these take precedence over management using this protocol
5. Ensure cervical spine immobilization is in place, if indicated.
6. Preoxygenate and ventilate with 100% O2 using bag-valve mask.
7. Second EMT applies cricoid pressure.
8. Airway is visualized directly using laryngoscope, following accepted procedure.
• do not rock or lever the laryngoscope on the patient’s teeth
9. When vocal cords have been visualized, pass tracheal tube through the cords.
10. Inflate tracheal tube cuff if using a cuffed tube.
11. Begin ventilation and confirm tube placement following accepted procedure.
• confirmation of tube placement must include end-tidal CO2 detection
• ensure the end-tidal CO2 detection device used is age- or weight-appropriate
12. Release cricoid pressure.
13. Secure tracheal tube. Do not cut tracheal tube.
14. Insert an oral airway or suitable alternative.
15. Initiate transport, unless other emergency condition requires immediate treatment.
Notes:
- Each attempt at intubation should be limited to thirty (30) seconds, with adequate oxygenation and ventilation between attempts.
- A maximum of two (2) attempts at tracheal intubation is permitted.
- Tracheal tube position must be checked frequently, and after any transfer or movement of the patient, because tube displacement occurs easily in pediatric patients.
Thursday, May 1, 2008
case 0001
Name: H. S. Tawfeek 28y
CESAREAN SECTION
EMERGENCY - FETAL DISTRESS
GENERAL ANESTHESIA - IRRITABLE PATIENT
N.B. extravasation of 400mg Thiopental and 80mg succinylcholine
delayed action and relaxation started 10 minutes later then 100mg ketamine is administered
intubation done and anesthesia maintained with 1% halothane and no further muscle relaxant
recovery normal
GENERAL ANESTHESIA - IRRITABLE PATIENT
N.B. extravasation of 400mg Thiopental and 80mg succinylcholine
delayed action and relaxation started 10 minutes later then 100mg ketamine is administered
intubation done and anesthesia maintained with 1% halothane and no further muscle relaxant
recovery normal
Wednesday, April 30, 2008
Pudendal Nerve Block
First reported by King in 1916 for pain control during the second stage of labor, pudendal nerve block is commonly performed by obstetrician in patients without spinal or epidural analgesia.The pudendal nerve carries somatic nerve fibres from the anterior primary divisions of the second, third and fourth sacral nerves.
The technique aims at blocking the nerve distal to its formation but proximal to its division into its terminal branches (i.e., dorsal nerve of the clitoris, perineal nerve and inferior haemorrhoidal nerve) .
The technique is based on bilateral injection of 10 ml of local Anesthetic solution medial and posterior to the ischael spine after introducing the needle through vaginal mucosa and sacrospinous ligament.
Another percutaneous approach has been described but it is less commonly applied.
Careful aspiration is a must as pudendal artery lies in close proximity to the nerve1.
Complications include systemic toxicity, laceration of vaginal mucosa, vaginal and ischeorectal haematoma and subgluteal abscess.
As paracervical block, direct injection into foetal tissues and needle-stick injuries are a potential risk.
Pudendal nerve block may provide satisfactory analgesia for spontaneous vaginal delivery an outlet forceps delivery but it is entirely inadequate for mid forceps delivery, cervical repair and manual examination of the uterus .
Effects of Regional Blockade on Materno-Fetal Physiology
# Pain relief leads to a reduction in serum catecholamines by decreasing physical stress or by denervating the adrenal medulla with subsequent enhancement of uterine blood flow.
# Hypotension occurring secondary to central blockade decreases uterine blood flow as uterine perfusion pressure is dependent on maternal mean arterial pressure with minimum capacity for autoregulation.
# Avoidance of maternal hypotension prevents any derangement of umbilical artery blood flow .
# Aortocaval compression is compensated for by sympathetic hyperactivity. Regional blockade may diminish this reflex but on the other hand venous dilatation of vertebral and paraspinous veins draining into the azygous compensates for minor degree of aortocaval compression. Provided prolonged hypotension is avoided, improved foetal outcomes with epidurals are known to occur secondary to improved placental haemodynamics.
# Reduced perioperative blood loss is associated with regional anesthesia (e.g. for placenta previa) . This has been attributed to avoidance of inhalational agents (all have uterine relaxant effects to a varying degree) and reduced pelvic venous plexuses pressures due to venodilatation.
# Early ambulation is another documented benefit of regional techniques which is caused by both direct effects (avoidance of depressant effects of general anesthesia) and indirect causes (elimination of stress response by the pre-emptive effect of regional blockades).
# Pain scores postoperatively are much lower postoperatively when a regional technique is used. This is reflected as a decrease in opioid requirements which leads to better somatosensory profiles for the mother and baby .
# Avoidance of general anesthetic effects on the baby is reflected as less postpartum interventions and early feeding. This is of particular value when a long predelivery phase (e.g. patients who had previous CS) is expected.
# Epidural improves incoordinate uterine activity unless severe hypotension ensues .
# Hypotension occurring secondary to central blockade decreases uterine blood flow as uterine perfusion pressure is dependent on maternal mean arterial pressure with minimum capacity for autoregulation.
# Avoidance of maternal hypotension prevents any derangement of umbilical artery blood flow .
# Aortocaval compression is compensated for by sympathetic hyperactivity. Regional blockade may diminish this reflex but on the other hand venous dilatation of vertebral and paraspinous veins draining into the azygous compensates for minor degree of aortocaval compression. Provided prolonged hypotension is avoided, improved foetal outcomes with epidurals are known to occur secondary to improved placental haemodynamics.
# Reduced perioperative blood loss is associated with regional anesthesia (e.g. for placenta previa) . This has been attributed to avoidance of inhalational agents (all have uterine relaxant effects to a varying degree) and reduced pelvic venous plexuses pressures due to venodilatation.
# Early ambulation is another documented benefit of regional techniques which is caused by both direct effects (avoidance of depressant effects of general anesthesia) and indirect causes (elimination of stress response by the pre-emptive effect of regional blockades).
# Pain scores postoperatively are much lower postoperatively when a regional technique is used. This is reflected as a decrease in opioid requirements which leads to better somatosensory profiles for the mother and baby .
# Avoidance of general anesthetic effects on the baby is reflected as less postpartum interventions and early feeding. This is of particular value when a long predelivery phase (e.g. patients who had previous CS) is expected.
# Epidural improves incoordinate uterine activity unless severe hypotension ensues .
Tuesday, April 29, 2008
Minimum anesthetic machine check under life-threatening conditions
situations do arise in anesthesia for trauma or emergency cesarean section where there is neither time nor opportunity to fully check the anesthesia gas machine. The following checklist is suggested for these situations. It requires little if any additional time, and can add greatly to safety, and hence, peace of mind.
- High pressure test of the breathing circuit
- Ensures there are no leaks distal to common gas outlet
- Check suction
- Observe and/or palpate breathing bag during preoxygenation
- Ensures
- Adequate flow of oxygen
- Good mask fit (very important)
- The patient is breathing
- The Bag/Vent switch is on "Bag" not "Vent"
With all new machines, the electronic checklist can be bypassed in emergencies. Whether this 30 second process is acceptable must be determined by each clinical practice.
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