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Monday, September 19, 2016

A FEW FACTS ABOUT THE ADJUSTABLE PRESSURE LIMITING (APL) VALVE [๐Ÿ“–]

๐Ÿ”— When fully opened the APL valve maintains a pressure of around 1.5 cm of H2O 

๐Ÿ”— As we close the APL valve, the pressure builds up inside and there is a safety overpressure release valve is incorporated in modern APL valves, to avoid this rising to dangerous levels. This system starts opening at  a pressure of 30 cm of H2O and fully opens at 60 cm of H2O and at this point, allows the gases to escape at a rate of 50L/ min 

๐Ÿ”— When the patient inspires, the APL valve , if intact, should not allow entrainment of air from the environment 

๐Ÿ”—As the modern reservoir bags are less compliant, compared to the older latex ones, the importance of overpressure relief valves has increased

๐Ÿ”— As the APL valve will always produce a small resistance to expiration, even when maximally loosened, it helps to maintain PEEP

#Anesthesia , #Anaesthesia

AMNIOTIC FLUID EMBOLISM (AFE) : WHICH ARE THE CONSISTENT CLINICAL FEATURES @ PRESENTATION❓

๐ŸŽฏ Hypotension , Hypoxemia and DIC are hallmarks (Ⓜ️NEMO> "AFE is Highly Dangerous")

๐ŸŽฏ Hypotension & Fetal Distress occur in 100% of cases

๐ŸŽฏ DIC occur in 83% and indicate a bad prognosis 

๐ŸŽฏ Cardiac arrest occur in around 87% of patients

๐ŸŽฏ Mortality is >60% ; it has been observed that only 15% survive with intact neurological function 

๐ŸŽฏ Pulmonary Hypertension, CHF and DIC are key events in the pathogenesis

๐ŸŽฏ Pulmonary edema (occur in >90% of cases),Dyspnoea (occur in 49%) & Bronchospasm (occur in 15%) are the respiratory signs

Reference: Dedhia JD, Mushambi M. Amniotic fluid embolism. Contin Educ Anaesth Crit Care Pain. 2007; 7(5): 152–156. Gist RS, Stafford IP, Leibowitz AB et al. Amniotic fluid embolism. Anaesth Analg. 108(5): 1599–1602.