Life Saving Anaesthetic Skills for Emergency Obstetric Care
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Dr. Keshaw Kumar ABSTRACT Anatomy
Original Research Paper VOLUME-6 | ISSUE-4 | APRIL - 2017 • ISSN No 2277 - 8179 | IF : 4.176 | IC Value : 78.46 Anatomy KEYWORDS: Cardiac Vein, Mammals, Cardiac Veins of Mammals Heart. Department of Anatomy Government Allopathic Medical College Dr. Keshaw Kumar Banda (U.P.) India ABSTRACT Hearts of human, buffalo, pig, goat and dog (25 of each) were procured from various sources and preserved in 10% formalin. Cardiac veins were dissected to observe their commencement, course, termination and tributaries in all these mammals. In goat, small cardiac vein was absent and small venules drained right atrium and venticle into right atrium separately. In buffalo, pig and dog small cardiac vein ran into coronary sulcus with the circumflex branch of right coronary artery to open into right atrium separately. Only in human small cardiac vein drained into right extremity of coronary sinus. Marginal vein travelling the left border of heart from apex to coronary sinus was present only in goat. Only in dog middle and great cardiac veins were formed by union of venae comitantes of posterior interventricular and anterior interventricular arteries respectively near the coronary sulcus. In rest of the mammals middle cardiac vein travelled in posterior interventricular sulcus and great cardiac vein in anterior interventricular sulcus. In all the mammals studied great cardiac vein opened into left extremity of coronary sinus. In human and buffalo, middle cardiac vein opened into coronary sinus near its right extremity while in pig, goat and dog it opened into right atrium near the right extremity of coronary sinus. In all the mammals studied coronary sinus was present between left atrium and ventricle on the back of heart and commenced as continuation of great cardiac vein to open into right atrium near the crux of heart. -
Spring 2009 Student Journal
Volume 8 Number 1 Spring 2009 The International Student Journal of Nurse Anesthesia TOPICS IN THIS ISSUE MS & ECT Cardioprotection of Volatile Agents Hyperthermic Chemotherapy Intubating LMA Pierre Robin Syndrome Alpha Thalassemia Latex Allergy & Spina Bifida Distorted Upper Airway Volunteerism – Honduras INTERNATIONAL STUDENT JOURNAL OF NURSE ANESTHESIA Vol. 8 No. 1 Spring 2009 Editor - in - Chief Ronald L. Van Nest, CRNA, JD Associate Editors Vicki C. Coopmans, CRNA, PhD Julie A. Pearson, CRNA, PhD EDITORIAL BOARD & SECTION EDITORS Pediatrics Janet A. Dewan, CRNA, MS Northeastern University Obstetrics Greg Nezat, CRNA, PhD Navy Nurse Corps Anesthesia Program Research & Capstone Joseph E. Pellegrini, CRNA, University of Maryland PhD Regional / Pain Christopher Oudekerk, CRNA, Uniformed Services Universi- DNP ty of the Health Sciences Cardiovascular Michele Gold, CRNA, PhD University of Southern Cali- fornia Thoracic/ Fluid Balance Lori Ann Winner, CRNA, MSN University of Pennsylvania Unique Patient Syndromes Kathleen R. Wren, CRNA, PhD Florida Hospital College of Health Sciences Equipment Carrie C. Bowman Dalley, Georgetown University CRNA, MS Pharmacology Maria Magro, CRNA, MS, University of Pennsylvania MSN Pathophysiology JoAnn Platko, CRNA, MSN University of Scranton Special Surgical Techniques Russell Lynn, CRNA, MSN University of Pennsylvania 1 Airway & Respiration Michael Rieker, CRNA, DNP Wake Forest University Baptist Medical Center ,Nurse Anesthesia Program, Univer- sity of North Carolina at Greensboro Neurology & Neurosurgery -
Authors Conducted an E-Mail Survey of Anesthesiologists in the US in 2010
Appendix 2: Reference 1 Methods: Authors conducted an e-mail survey of Anesthesiologists in the US in 2010. Results: “Five thousand anesthesiologists were solicited; 615 (12.3%) responses were received. Twenty-four percent of respondents had installed an AIMS, while 13% were either installing a system now or had selected one, and an additional 13% were actively searching. Larger anesthesiology groups with large case loads, urban settings, and government affiliated or academic institutions were more likely to have adopted AIMS. Initial cost was the most frequently cited AIMS barrier. The most commonly cited benefit was more accurate clinical documentation (79%), while unanticipated need for ongoing information technology support (49%) and difficult integration of AIMS with an existing EMR (61%) were the most commonly cited problems.” [Trentman TL, Mueller JT, Ruskin KJ, Noble BN, Doyle CA. Adoption of anesthesia information management systems by US anesthesiologists. J Clin Monit Comput 2011;25:129–35.] Reference 2 Joint Commission Report. 60 [Kohn L, Corrigan JM, Donaldson MS. To Err is Human: Building a Safer Health System. Report from the Committee on Quality of Health Care in America. Washington DC: The Joint Commission journal on quality improvement, 1999:227–34.] Reference 3 Excerpt: “The Department of Health and Human Services (DHHS) released two proposed regulations affecting HIT (www.healthit.hhs.gov). The first, a notice of proposed rule- making (NPRM), describes how hospitals, physicians, and other health care professionals can qualify for billions of dollars of extra Medicare and Medicaid payments through the meaningful use of electronic health records (EHRs). The second, an interim final regulation, describes the standards and certification criteria that those EHRs must meet for their users to collect the payments. -
Medical Science
Volume : 5 | Issue : 7 | July 2016 • ISSN No 2277 - 8179 | IF : 3.508 | IC Value : 69.48 Original Research Paper Original Research Paper Volume : 5 | Issue : 7 | July 2016 • ISSN No 2277 - 8179 | IF : 3.508 | IC Value : 69.48 Medical Science Duplication of Both The Circumflex Arteries KEYWORDS : Coronary artery, Cir- and Both The Interventricular Arteries in cumflex artery Interventricular artery, Human Heart Heart. Department of Anatomy, Government Allopathic Medical College, Banda (U.P.) Dr. Keshaw Kumar INDIA. ABSTRACT The heart obtained from the cadavers (156) were dissected in order to study anomalies in human coronary arteries. Only in one heart duplication of both the circumflex arteries as well as both the interventricular arteries was found. INTRODUCTION cumflex artery immediately after reaching the back of heart Congenital anomalies of coronary arteries were discussed (fig-3). The right superior circumflex artery travelled into by Abbott (1927)1, Blake et al (1964)2, Hallman et al (1966)3 coronary sulcus and continued as nodal artery at the crux and Ogden (1970)4. The anomalous origin of left coronary of heart after giving a slender superior posterior interven- artery from the pulmonary artery was observed by As- tricular artery which sank into the musculature of heart af- kenazi and Nadas (1975)5, George and Knowlan (1959)6, ter traversing 1.5 cm distance in the posterior interventricu- Keith (1959)7 Wesselhoeft et al (1968)8 and Flamm et al lar sulcus (fig-3). The right inferior circumflex artery took (1968)9 while Ott et al (1978)10 found origin of circumflex an oblique course running inferior to coronary sulcus on artery from right pulmonary artery. -
Northwest Arkansas Regional Ems Protocols
Regional Protocol PROTOCOL SECTION NORTHWEST ARKANSAS REGIONAL EMS PROTOCOLS 2019 REVISION 2019 a Regional Protocol PROTOCOL SECTION TABLE OF CONTENTS……………………………………………………………………………….b - e INTRODUCTORY STATEMENT………………......……………………………………………….........f PARTICIPATING AGENCIES………………………………………………………………………….…………..g 2019 DEPARTMENT MEDICAL DIRECTORS & SIGNATURE………………..…………………………........h SECTION ONE - PROTOCOLS GENERAL PROTOCOLS UNIVERSAL PATIENT CARE ................................................................................................................... 1 CHEMICAL EXPOSURE (HAZMAT) ......................................................................................................... 2 CHEMICAL SEDATION FOR VIOLENT PATIENT .................................................................................... 3 PAIN MANAGEMENT ............................................................................................................................... 4 SPINAL RESTRICTION ............................................................................................................................ 5 VASCULAR ACCESS ............................................................................................................................... 6 RESPIRATORY OXYGEN ADMINISTRATION……….…………………………………………………………..…………………..7 GENERAL AIRWAY MANAGEMENT………………….……………………………………..…………………….8 ADVANCED AIRWAY MANAGEMENT….……………………………………………………..…………………..9 PHARMACOLOGICAL ASSISTED INTUBATION (PAI)………………….……………………………………..10 ALLERGIC REACTION—ANAPHYLAXIS….……………………………………………………………………..11 -
A Comparison of Wilson Risk Sum Score and Combination of Modified Mallampati Classification, Hyomental Distance Ratio, Ratio Of
Jebmh.com Original Research Article A Comparison of Wilson Risk Sum Score and Combination of Modified Mallampati Classification, Hyomental Distance Ratio, Ratio of Height to Sternomental and Thyromental Distances for Predicting Difficult Laryngoscopy in Indian Population Deepak Kumar1, Saurabh Bhargava2, Ravindra Singh Sisodiya3, Deepak Tiwari4 1Department of Anaesthesia, National Institute of Medical Sciences and Research Centre, Jaipur, Rajasthan, India. 2, 4 Department of Emergency Medicine, National Institute of Medical Sciences and Research Centre, Jaipur, Rajasthan, India. 3Department of Anaesthesia, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India. ABSTRACT BACKGROUND A few patients of apparently normal appearance unexpectedly present with great Corresponding Author: difficulties during intubation which may lead to potentially serious consequences. Dr. Deepak Tiwari, Thus, we worked on this area with the aim to determine the ability to predict 109 Avar Faculty Block, Nims University, Shobha Nagar, difficult visualisation of larynx using the following preoperative airway predictors: Delhi-Jaipur Highway, MMC (Modified Mallampati Classification), RHSMD (Ratio of Height to Sternomental Jaipur - 302013, Distance), RHTMD (Ratio of Height to Thyromental) and HMDR (Hyomental Rajasthan, India. Distance Ratio) and comparison of these with WRSS (Wilson Risk Sum Score), in E-mail: [email protected] isolation and in combination. DOI: 10.18410/jebmh/2020/620 METHODS A double-blind, prospective study was carried out on 300, ASA grade I or II How to Cite This Article: patients posted for elective surgery in supine position under general anaesthesia. Kumar D, Bhargava S, Sisodiya RS, et al. A comparison of Wilson risk sum score Different parameters were recorded in pre-op period and Cormack-Lehane grading and combination of modified Mallampati and difficulty of intubation was recorded at the time of intubation. -
FACULTY of NURSING S By
FACULTY OF NURSING SCIENCES By- SUDHA BENJAMINI Associate Professor Faculty of Nursing B.Sc. Nursing MEDICAL SURGICAL NURSING UNIT: V NURSING MANAGEMENT OF PATIENT WITH BLOOD AND CARDIO VASCULAR PROBLEMS OBJECTIVES At the end of the this class student will be able to Define the valvular stenosis Enumerate the Etio-pathophysiology, Discuss the clinical manifestation of valvular stenosis Explain in detail about medical, surgical, Nursing management of valvular stenosis INTRODUCTION Structural disorders of the heart preset many challenges for patient, family and health care team. according to the valve or valves affected and the type of functional alteration Includes - Stenosis, regurgitation The session will discuss the heart valves disorders like stenosis of the heart valves like Mitral stenosis, Aortic stenosis, tricuspid stenosis and pulmonic stenosis. MITRAL VALVE STENOSIS MEANING Stenosis is the term for a valve that doesn't open properly. The flaps of a valve thicken, stiffen, or fuse together. As a result, the valve can't completely open. Thus, the heart has to work harder to pump blood through the valve, and the body may suffer from a reduced supply of oxygen MITRAL STENOSIS DEFINITION Mitral stenosis: Mitral stenosis is a narrowing of the mitral valve opening. Mitral stenosis restricts blood flow from the left atrium (lower right chamber) to the left ventricle (lower left chamber). MITRAL VALVE : ANATOMY Posterior Tricuspid Bicuspid valve (mitral) valve Right Left sideof sideof heart heart Aortic Pulmonary valve valve MITRAL VALVE : ANATOMY MITRAL STENOSIS • In normal adults, the area of the mitral valve orifice is 4-6 cm2. • In mitral stenosis, the area of valve orifice decreases. -
Thyromental Distance Ratio in Predicting Difficult Intubation
THE EFFECTIVENESS OF EXTENDED MALLAMPATI TEST, HYOMENTAL DISTANCE RATIO AND NECK CIRCUMFERENCE – THYROMENTAL DISTANCE RATIO IN PREDICTING DIFFICULT INTUBATION BY EZIKE AMECHI CHUKWUDUM DEPARTMENT OF ANAESTHESIA UNIVERSITY OF CALABAR TEACHING HOSPITAL CALABAR, NIGERIA A DISSERTATION SUBMITTED TO NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA IN PARTIAL FULFILLMENT OF THE FINAL FELLOWSHIP OF THE MEDICAL COLLEGE IN ANAESTHESIA (FMCA) EXAMINATION REQUIREMENT MAY 2017 1 SUPERVISORS ATTESTATION We hereby affirm that we supervised this study carried out by Dr. Amechi Chukwudum Ezike titled EFFECTIVENESS OF EXTENDED MALLAMPATI SCORE, HYOMENTAL DISTANCE RATIO AND NECK CIRCUMFERENCE- THYROMENTAL DISTANCE RATIO IN PREDICTING DIFFICULT INTUBATION , in partial fulfillment for the requirement of the award of the Fellowship of the National Postgraduate Medical College of Nigeria. First Supervisor……………………………………………… Date…………………………….. Prof. Atim I. Eshiet (MBBCh, DA, FMCA, FICS, FWACS) Consultant Anaesthetist, University of Calabar Teaching Hospital, Calabar, Nigeria. Second Supervisor …………………………………… Date……………………………… DR. Iniabasi Udoh Ilori (MBBCh; DA; FWACS). Consultant Anaesthetist, University of Calabar Teaching Hospital, Calabar, Nigeria. 2 CERTIFICATION I affirm that this dissertation titled ‘Effectiveness Of Extended Mallampati Score, Hyomental Distance Ratio And Neck Circumference-Thyromental Distance Ratio In Predicting Difficult Intubation’ was carried out by Dr. Ezike Amechi Chukwudum and supervised by consultants in the Department of Anaesthesiology, University of Calabar Teaching Hospital. This is in partial fulfillment of the requirement for the award of the Fellowship of the National Postgraduate Medical College of Nigeria. …………………………………………… Date………………………. DR. OBOKO OKU (MBBCh; DA; FWACS). The Head, Department of Anaesthesiology, University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria. 3 DECLARATION I hereby declare that this work is original unless otherwise stated. -
Dcanesthesiamanualvo
ii Any or all parts of this manual may be reproduced, provided the parts reproduced are free- not for sale. For commercial purposes, no part of this manual may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher. The intent of this manual is to be freely used, copied, and distributed in Developing Countries for the teaching and promotion of basic anesthesia knowledge/skills. The purpose of this manual is to provide developing countries with a copyright free basic anesthesia manual. This manual can be freely copied and translated into a native language for the promotion of basic anesthesia knowledge/skills. Contributors with credited pictures and illustrations have graciously given permission for their material to be used for this specific purpose. The author and publishers of this manual cannot accept liability from the use of this manual or errors in translation. It is up to each translator to ensure that the translation is correct. Knowledge about the art and science of anesthesia continues to change. It is up to each anesthesia provider to continue to learn and upgrade their knowledge. This manual only contains basic knowledge and is not a replacement for more comprehensive anesthesia information. iii “Every prudent man acts out of knowledge.” Proverbs 13:15 Soli Deo Gloria iv Acknowledgements This project would not have been possible without the help of many. The World Health Organization and Michael B. Dobson MD kindly gave permission to utilize illustrations from the publication Anaesthesia at the District Hospital, WHO, Geneva, 2000 for two earlier editions, published in Afghanistan and Cambodia. -
Airway Assessment Authors: Dr Pierre Bradley Dr Gordon Chapman Dr Ben Crooke Dr Keith Greenland
Airway Assessment Authors: Dr Pierre Bradley Dr Gordon Chapman Dr Ben Crooke Dr Keith Greenland August 2016 Contents Part 1. Introduction 3 Part 2. The traditional approach to normal and difficult airway assessment 6 Part 3. The anatomical basis for airway assessment and management 36 Part 4. Airway device selection based on the two-curve theory and three-column assessment model 48 DISCLAIMER This document is provided as an educational resource by ANZCA and represents the views of the authors. Statements therein do not represent College policy unless supported by ANZCA professional documents. Professor David A Scott, President, ANZCA 2 Airway Assessment Part 1. Introduction This airway assessment resource has been produced for use by ANZCA Fellows and trainees to improve understanding and guide management of airway assessment and difficult airways. It is the first of an airway resource series and complements the Transition to CICO resource document (and ANZCA professional document PS61), which are available on the ANZCA website. There are four components to this resource: Part 1. Introduction. Part 2. The traditional approach to normal and difficult airway assessment. Part 3. The anatomical basis for airway assessment and management: i) The “two-curve” theory. ii) The “three-column” approach. Part 4. Airway device selection based on the two-curve theory and three-column assessment model. OVERVIEW The role of airway assessment is to identify potential problems with the maintenance of oxygenation and ventilation during airway management. It is the first step in formulating an appropriate airway plan, which should incorporate a staged approach to manage an unexpected difficult airway or the institution of emergency airway management. -
Short Thyromental Distance: a Predictor of Difficult Intubation Or An
Anesthesiology 2006; 104:1131–6 © 2006 American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Short Thyromental Distance: A Predictor of Difficult Intubation or an Indicator for Small Blade Selection? Mukesh Tripathi, M.D., M.N.A.M.S.,* Mamta Pandey, M.D., P.G.D.H.H.M.† Background: Short thyromental distance (TMD; < 5 cm) has oropharyngeal structure,2 external anatomical airway been correlated with difficult direct laryngoscopic intubation in structures,3 and the size of the mandibular space.4 How- adult patients. The authors hypothesized that a smaller Macin- ever, some of these individual markers have been cri- tosh curved blade (No. 2 MCB) would improve the predicted 5 difficult laryngoscopy in short-TMD patients over that with a tiqued, and scoring systems including multiple variables 6,7 standard Macintosh curved blade (No. 3 MCB). have been proposed, with increased complexity of Methods: In a preliminary study of 11 consenting adults (7 assessment in clinical practice. Small thyromental dis- Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/104/6/1131/361138/0000542-200606000-00006.pdf by guest on 28 September 2021 females and 4 males), American Society of Anesthesiologists tance (TMD) Յ 6 cm is a simple, clinically used param- < physical status I and TMD 5 cm, lateral neck radiographs were eter that has been shown to correlate with a difficult recorded during laryngoscopy with a No. 2 and No. 3 MCB in 8 sequential fashion. In a prospective clinical study, laryngo- laryngoscopy and tracheal intubation. However, some scopy and tracheal intubation were evaluated in 83 adult pa- have questioned whether a small TMD, in isolation, is a tients with TMD < 5cm by randomly assigning them to two reliable predictor of a difficult laryngoscopy.9–11 In fact, groups for the blade used at first intubation. -
Can Thyromental Distance Be Measured Accurately?
Journal of Clinical Monitoring and Computing https://doi.org/10.1007/s10877-017-0090-3 ORIGINAL RESEARCH Can thyromental distance be measured accurately? Bin Wang1 · Hui Peng2 · Weidong Yao1 · Ling Guo1 · Xiaoju Jin1 Received: 22 June 2017 / Accepted: 6 December 2017 © The Author(s) 2017. This article is an open access publication Abstract Using the thyromental distance (TMD) measured based on the ultrasonographic location of the thyroid cartilage prominence as the criterion, we investigated the accuracy of TMD measurement by surface landmark identification of the thyroid carti- lage prominence. Twenty-nine anesthetist resident volunteers were recruited, including 10 first-year residents, 9 second-year residents and 10 third-year residents. Each volunteer measured the other 28 volunteers’ TMD. Then, the thyroid cartilage prominence of each volunteer was identified by ultrasonography of the junction of the vocal cord and thyroid cartilage, and the TMD was measured precisely. The error of the TMD measurement was determined by the minimal detectable differ- ence (MDD) compared to the ultrasound measurement. A difference of greater than 5.4 mm between the TMD measured by volunteers and that based on ultrasound localization was defined as a measurement error. The measurement error rate of females’ TMD was significantly higher than that of males’ (50 vs 10%, P < 0.001). The error rates of anesthetist residents of first-year, second-year and third-year were 34, 27, and 31%, respectively, and were not significantly different. The error of TMD measurement by surface landmark identification is often, especially for women. More clinic experience don’t improve it. Keywords Airway management · Thyroid cartilage · Anatomic landmarks · Accuracy · Ultrasonography · Volunteers 1 Introduction in a normal adult [12–14], whereas others have considered cut-off points of 7.0 cm [7], 6.0 cm [15], 5.5 cm [16] and Managing a difficult airway remains a significant problem even 4 cm [10].