As with most trauma patients, this patient should be considered a to have a full stomach. Therefore, the prudent approach for the anesthetist would be to plan for a rapid sequence induction, using a short-acting muscle relaxant such as succinylcholine. The patient’s clinical picture indicates that there is still some occult bleeding and she remains hypotensive despite resuscitation. Therefore, versed, propofol, and large amounts of inhalational agent should be avoided. Small doses of versed can worsen hypotension. Inhalational agent such as Desflurane or Sevoflurane should be kept to less than 1 MAC. Opioids, ketamine and etomidate in decreased doses are better choices when attempting to optimize intubating conditions. According to Barash (2013), …show more content…
In addition to the pelvic ring injury and associated hemorrhage, visceral injuries may also occur. Patients may have posterior or perineal wounds or rectal trauma that are treated with a colostomy. Extra-peritoneal bladder tears are repaired. The trauma patient above is noted to have blood in her vaginal vault and foley catheter. Therefore, the anesthetist can safely assume that she sustained colon and bladder damage secondary to the pelvic fracture. As a result, the patient will undergo emergent external fixation requiring a team approach to help mange the care of this complex, and critically ill …show more content…
Therefore, the prudent approach for the anesthetist would be to plan for a rapid sequence induction, using a short-acting muscle relaxant such as succinylcholine. The patient’s clinical picture indicates that there is still some occult bleeding and she remains hypotensive despite resuscitation. Therefore, versed, propofol, and large amounts of inhalational agent should be avoided. Small doses of versed can worsen hypotension. Inhalational agent such as Desflurane or Sevoflurane should be kept to less than 1 MAC. Opioids, ketamine and etomidate in decreased doses are better choices when attempting to optimize intubating conditions. According to Barash (2013), metabolic disturbances in the acute trauma patient cannot reliably prevent recall. However, scopolamine, (0.6 mg), and midazolam, if the patient can tolerate it, given before airway management may decrease the likelihood of this complication. Intraoperative use of the bispectral index (BIS) monitor and, whenever possible, titrating anesthetics to bispectral bispectral index levels < 60 may prevent recall in trauma
The patient is a 72-year-old female who arrived to the emergency department in cardiac arrest. Emergency medical services reports the patient was last seen eating breakfast at her nursing home and was found an hour later face down and unresponsive. After it was determined the patient was in asystole, an intravenous catheter was started and two rounds of Epinephrine was administered. Upon arrival to the emergency department the patient had pulseless electrical activity with sinus tachycardia on the monitor. Airway management was in process with a bag valve mask on 100% oxygen and chest compressions in progress. After intubation and stabilization the
There is no question that the alarming rate of deaths related to opioid overdose needs to be addressed in this county, but the way to solve the problem seems to remain a trial and error approach at this point. A patient is injured, undergoes surgery, experiences normal wear and tear on a hip, knee or back and has to live with that pain for the rest of their life or take a narcotic pain medication in order to improve their quality of life and at least be able to move. The above patients are what narcotic pain medications were created for, a population of people that use narcotic pain medications for fun is what is creating a problem. Narcotics are addictive to both populations, however taking the narcotic for euphoric reasons is not the intention of the prescription that the physician is writing. The healthcare system needs to find a way to continue to provide patients that experience chronic pain with the narcotics that work for them while attempting to ensure the Drug Enforcement Agency (DEA) doesn’t have to worry about a flood of pain pills hitting the streets by granting access to the population with a substance abuse problem.
Use of daily spontaneous breathing trials to assess the patient’s ability to sustain ventilation, oxygenation, and breathing.
Toxic doses of lidocaine can cause seizures and respiratory arrest. Furthermore, whenever lidocaine is used, equipment for cardiopulmonary resuscitation must be available for use.
This Anaesthetic case study would describes and discussed the scenario of a patient through the anaesthetic role of their surgical procedure. It will include and discuss the anaesthetic safety procedures equipment and drug interventions used to ensure this particular patients maximum safety and comfort before and during the procedure. The case study will include pre and peri-operative assessment in order to describe the involvement contribution of various specialties in the holistic care of the critical care patient. This assignment will focus only on the anaesthetics side of the procedure but will also highlight the importance of the triad of anaesthesia and discuss the administration, maintenance and reversal of
Although when it happens, there can be a devastating impact on patients as well as to the multidisciplinary theatre team involved. Consequently, the DAS has produced a consensus set of guidelines for managing failed intubations in adult and paediatric patients, but there are as yet no such nationally-agreed guidelines in obstetrics, therefore each obstetric unit should have their own flowchart with regards to management of failed intubation (Brien and Conlon, 2013). Furthermore, in light of the latest DAS guidelines, several aspects of clinical anaesthetic practise have changed over recent years (Frerk at al, 2015). Amongst the changes are the use of new drugs such as rocuronium and suggamadex and using electronic video-laryngoscopes (Frerk et al, 2015). Further work had also looked at extending the period of apnoea without causing desaturation by optimising the preoxygenation process and adequate patient positioning (Frerk et al, 2015). As a result, updated guidelines for difficult intubations in adult patients were published in 2015; these guidelines provide a flowchart to be used when endotracheal intubation proves difficult or impossible and focus on the central importance of oxygenation while reducing the amount of airway interventions in order to minimize trauma to the delicate airway (Frerk et al, 2015). The main message of the revised guidelines is
Opioid abuse has become so widespread in Baltimore that on March 1, 2017, the governor of Maryland, Larry Hogan, declared a state of emergency. The rise in the number of opioid-related overdoses in the Baltimore have skyrocketed in the past few years. According to the Maryland Department of Health and Mental Hygiene, 1089 people, a majority from Baltimore, died of a fentanyl overdose in 2015. In 2016, the number rose to 1856 deaths. (Maryland Department of Health and Mental Hygiene 14). The spike in overdose deaths can be contributed to the increased use of Fentanyl. Fentanyl is 50 times more potent and costs less than a third of heroin (Adwanikar; Duncan). Drug dealers mix fentanyl with heroin to make their product less expensive to produce
Milwaukee is currently facing an epidemic. This epidemic is the usage of opioids. Every year, the death toll grows from opioids usage. Opioid overdoses are America's leading killer. People are becoming more and more addicted to them and it is causing the user to overdose on the drugs. There are many types of opioids with different usages. This causes short and long term effects which can later lead the body to experience withdrawal from the drugs.
On arrival to UKMC the patient received a Glasgow Coma Score of 3, which is an indication that intubation is needed. Bipap therapy was attempted but failed, due to respiratory failure. This was confirmed by arterial blood gases. After being assessed by the team at UKMC, the patient was intubated for respiratory failure, as well as shock of an unclear etiology. Rapid sequence intubation drugs, Etomidate and Succinylcholine where administered prior to intubation. A 7.5 endotracheal tube was used
Opioid abuse is a crisis that is plaguing America, in 2015 there we an estimated 15,000 deaths due to prescription opioids*. People are dying, and families are being ripped apart, a radical change needs to occur in order to save lives. Although there are many ways to attempt to solve this problem, here are three solutions that could potentially save lives; decriminalize all drugs, limit prescribed painkillers, and provide access to Narcan (naloxone).
2. What is the priority nursing diagnosis for Marie, who is experiencing residual effects of epidural anesthesia?
Trauma patients often present paramedics with difficult situations to handle. These patients most likely have multiple injuries that the paramedic must treat including internal and external injuries. The main concern in treating trauma patients is controlling the pain that the patient may be experiencing while not compromising the patients hemodynamic and respiratory state. The most common drugs used in pain management in the pre-hospital setting often cause undesirable side effects, such as respiratory depression, hypotension, apnea, and bradycardia. All of these side effects combined with a trauma patient who is already compromised can lead to a much bigger issue. What if there was a drug that could treat the pain, calm the patient, and not cause the nasty side effects of traditional pain management? Ketamine provides us the answer to this question.
Description: Ketamine is a nonbarbiturate, sedative hypnotic used parenterally to provide anesthesia for short diagnostic and surgical procedures. It is also used as an inducing agent, as an adjunct to supplement low-potency anesthetics such as nitrous oxide, and as a supplement to local and regional anesthesia. Ketamine can be used concomitantly with muscle relaxants without complication because it does not provide muscle relaxation of its own. It is a fairly short-acting agent that provides a profound, rapid, dissociative state and a short recovery time.
Learning about the potential complications of epidural reinforced my knowledge in being able to choose the right anaesthetic monitoring equipment. Knowing that Spinal and epidural anaesthesia can cause unpredictable and profound arterial hypotension necessitate the use of adequate monitoring like the; Pulse oximetry, ECG and Blood pressure cuff. This knowledge will help me to be able to select appropriate monitoring devices during epidural catheter insertion. Also it goes without saying that an epidural must be performed in a work area that is equipped for airway management and resuscitation.
Vasoplegic syndrome is a severe vasodilatory shock characterised by hypotension, tachycardia, normal or elevated cardiac output, decrease in systemic vascular resistance, poor or no response to fluid resuscitation and vasopressor administration [1]. Though it is commonly seen during cardiac surgery, it is also been reported during non cardiac surgery [2,3]. The incidence of vasoplegic syndrome is 8-10% in cardiac surgery [4], and its risk factors include intravenous heparin, beta-blockers, calcium channel blockers, renin angiotensin system antagonists, protamine use, myocardial dysfunction, diabetes mellitus, presence of pre-cardiopulmonary bypass hemodynamic instability, increased duration of cardiopulmonary bypass and ventricular device insertion [5]. We present a case of successful management of vasoplegic syndrome the developed perioperatively following Whipple’s procedure.