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Monday, August 25, 2014

DIAGNOSIS OF AMNIOTIC FLUID EMBOLISM

Lower mortality can be achieved (27-37%), when early duagnosis made, and aggressive treatment implemented

Typical : Patient healthy prior to the onset of symptoms

ONSET: During or within 30 mins of labor ,cs ,dilatation and evacuation

Most important features :
DYSPNOEA-HYPOTENSION-DIC

OTHERS: Foetal distress, Seizures, Pulmonary edema, Uterine atony, Bronchospasm, Transient hypertension, Cough, Headache

Friday, August 15, 2014

Pneumoperitonium and CVP


".. Anesthesia and the Trendelenburg position increased the CVP, PCWP and pulmonary arterial pressures and decreased cardiac output. Pneumoperitoneum increased these pressures further mostly in the beginning of the laparoscopy, and cardiac output decreased towards the end of the laparoscopy. The risk of systemic CO2-embolus was increased during laparoscopy."

Ref: Acta Anaesthesiol Scand. 1995 Oct;39(7):949-55.

Thursday, August 14, 2014

Supraclavicular Nerves

See the supraclavicular n., dat divides into medial n lateral br.s, supplies skin over deltoid..and skin over anterior chest

Lesser occipital, greater auricular, transverse cervical and supraclavicular nerves contribute to Superficial Cervical Plexus

Emerge from behind the midpoint of sternocleidomastoid

Blocking the superficial plexus

Short bevelled needle inserted posterior to midpoint of sternocleidomastoid

Injection immediately deep to superficial cervial fascia

Infiltration along posterior border of sternocleidomastoid superiorly and inferiorly

You can do it with USG also. Just behind SCM at its mid point most of the time EJV crosses. It's an added block to BPB in surgeries like clavicle fixation, AC joint fixation,shoulder repair etc

15 ml of lignocaine 1.5% or ropivacaine 0.75%

Complications
External or internal jugular vein injection

Femur fractures

SURGERIES AND BLOOD LOSS

Displaced # NOF: Hemiarthroplasty
Undisplaced # : Closed Reduction n Percutaneous Pinning
Intertrochanteric #,Sub trochanteric #: Dynamic Hip Screw
Shaft#: Intra Medullary Nailing

Expected bloodloss

Undisplaced..<100 ml
Displaced...250-500
Intertrochanteric 500+
Distal femur,shaft,im nail 750+

Thursday, June 20, 2013

A CHART FOR NEUROINTENSIVE CARE ROUNDS



A chart for taking rounds in Neuro intensive care setting by the anaesthesiologist / intensivist. Can also be used in other ICU settings. Click on the link below for downloading it.......

ITS A CHART FOR NEURO MEDICINE & SURGICAL I.C.U. ... PRINT PAGE 1 ON ONE SIDE OF A SINGLE SHEET AND WILL SUFFICE FOR 7 DAYS [ONE READING PER DAY ] AND PAGE 2 ON THE OTHER SIDE OF THE SAME SHEET FOR REGISTERING INFO AT TIME OF ADMISSION AS BASELINE  [BETTER TO TAKE BACK TO BACK PRINT ON A3 SIZE SHEET] ;  DAY 8 ONWARDS USE ANOTHER SHHEET; CAN KEEP PAGE 2 UNFILLED ON SUCH PAGES IF NOTHING TO WRITE

GCS.docx - 12.8 KB

                                              




Saturday, April 13, 2013

MNEMO (anaesthesia implications)>METHERGINE "METH"

MNEMO (anaesthesia implications)>METHERGINE "METH"

1.M=MS,HTN/PIH,Heart diseases are C/I
2.Ensure it is given over 1 mins if iv. Ensure breast feeding is delayed for 12h after last dose.
3.Together don't give any other vasopressor
4.HTN & CVA are the dreaded complications

MNEMO> PENTAZOCINE "HOT DRUG"

MNEMO> PENTAZOCINE "HOT DRUG"

H.Hallucination and psychotomimetic effects
O.Overt seizures rarely, with iv route
T.Typical Opioid side effects
D.Dose: 0.5 mg/kg i.v. or 30 mg i.v. Q4H. 30 mg iv= 10 mg morphine
R. Respiratory depression, Raised Pulmonary pressures(Pulmonary HTN), Raised BP, Raised ICP, Rare diseae:Porphyria ....are CONTRAINDICATIONS
U. Upward CVP, LVEDP,PULMONARY PRESSURES
G.Give LESSER doses more FREQUENTLY to reduce side effects