Applied Anaesthesia Notes PDF

# BASIC LIFE SUPPORT (BLS) - Sudden cardiac arrest, heart stroke, foreign body airway obstruction etc. are included in Basic Life Support. - CPR or defibrillation is done as a treatment. ## Basic Life Support Medical Care - Basic Life Support medical care is a level of care that is done during li...

# BASIC LIFE SUPPORT (BLS) - Sudden cardiac arrest, heart stroke, foreign body airway obstruction etc. are included in Basic Life Support. - CPR or defibrillation is done as a treatment. ## Basic Life Support Medical Care - Basic Life Support medical care is a level of care that is done during life-threatening conditions. - It is done until full medical care is available. - It is provided by trained medical personnel. ## Goals - Early assessment of the patient. - To save the life of the patient. - To take rapid decisions because irreversible brain damage may occur. ## Causes - Poisoning - Drowning - Cardiac arrest - Respiratory arrest - Electric shock - Drug reaction ## Steps of Procedure 1. **Assessment** - Unconsciousness, Apnea, absent carotid pulse, dilated pupils, Cyanosis. ## Sequence of BLS/CPR 1. **Determine unconsciousness** - assess pulse for 5-10 seconds. 2. **Perform chest compression** 3. **Open airway** 4. **Check breathing** and deliver defibrillation if necessary using an automated defibrilator. ## Compression - First, the patient is taken to a safe place. - The patient is laid down on a flat, hard surface. - The patient is placed in a position where compression can be done properly. - For adults, compression starts from the carotid pulse. For children, compression starts from the femoral pulse and for infants, compression starts from the bronchael femoral pulse. - The compression is done in a rhythmic way by compressing the chest between two hands and making sure that each compression is done normally. ## Compression Characteristics | Characteristic | Adult | Children | Infant | | --------- | :---: | :---: | :---: | | Pulse | Carotid | Femoral | Bronchael femoral | ## Compression Methods | Method | 2 Hands | 1 Hand | 3 Finger to Thumbs | | -------- | :---: | :---: | :---: | | Depth | 2 Inch | 2 Inch | 1.5 Inch | | Rate | 100/min | 100/min | 100/min | | Land Mark | Center of chest between nipples | Center of chest between nipples | Center of chest below nipples line | ## Airway - After compression, the patient's airway is checked and opened. - The airway is opened using the head-tilt chin lift method, the jaw thrust maneuver and the spinal cord injury method. - If there is any secretion in the mouth, it is wiped off using the middle and index Finger to hook. - If the patient's circulation is present, compression is not done. - Instead, the patient is given 2-3 breaths and is taken to the hospital. ## Breathing - After opening the airway, the patient is given mouth-to-nose breathing. - The breathing is given for 8 seconds. - The patient's chest should be visible during breathing. - The patient is given a pinch while giving breathing. ## CPR - During CPR, 30:2 compression and ventilation is done. - For adults, it is done 15:2 and for children, it is done 15:2. - If the patient is an adult, we first call for help and then give CPR. - If the patient is a child, we first do CPR and then call for help. ## Defibrillation - Defibrillation is done when the condition of the patient does not improve because of the medical methods used. - Before defibrillation, the patient is given a therapeutic electric dose. - If the patient's condition does not improve, defibrillation is done. - Before defibrillation, the patient is stabilized in a comfortable position. - Before the procedure, the patient's body is cleared for the surface current pass and the personnel steps away from the patient's bed. - The starting dose is 200 J and then, 300 J is done. # ADVANCE CARDIAC LIFE SUPPORT - Advance Cardiac Life Support is a life support system that takes place after basic life support. - It includes other emergency treatments and interventions. - It includes medicine, ventilation and other interventions such as defibrillation. ## Advance Cardiac Life Support Protocol - Advance Life Support includes life-saving protocols and skills. - They are used in BLS to an extent. ## Indication of Advance Cardiac Life Support - Cardiac arrest - Respiratory arrest - Stroke - Myocardial infection ## Causes of Advance Cardiac Life Support - Aortic stenosis - Septal defect of heart - Airway obstruction - Arrhythmia - Severe blood loss ## Componants of Advanced Cardiac Life Support - Airway management - Ventilation - Cardiac Compression - Defibrillation - Medication - Cardiac Monitoring - During Advance Cardiac Life Support, the chest compression depth is 5 cm and the compression rate is 100-120/min. ## Drugs 1. **Amiodarone** - 300 mg IV, followed by 150 mg IV in 20 - 30 ml of N.S.O. 2. **Lidocaine** - 1-1.5 mg/kg IV 3. **Mg +** - 1-2 gm. 4. **Esmolol/Propranolol** - 1 mg IV 5. **Epinephrine** - 7 mg IV 6. **SBC** ## Crash Cart - Crash Cart means an emergency condition cart. - It is used to store drugs or transport the equipment in case of emergency. - The crash cart is placed at the central part of the pt care area to make it accessible. - The crash cart is usually a multi drawer with tools and medications that are useful in emergency situations. ## Other Names of Crash Cart - Emergency Cart - Emergency Response Cart - Code Cart - Emergency Trolley ## Purpose of Crash Cart or Emergency Cart - Providing immediate care. - Facilitating coordination of equipment. - Ensuring proper functioning of defibrillator. - Ensuring that the crash cart is properly stacked. ## Functions of Crash Cart - It has all the necessary equipment to treat a life-threatening condition. - It acts as a mobile station for the hospital. - It provides accessibility to the PT. - It has the advantage of treatment on the spot. ## Policy - The crash cart is checked every shift. - This is done by the head nurse and the technician. - The defibrillator is checked regularly by the Biomed department. - The crash cart items' expiry date is checked every month. ## Arrangement of Crash Cart - **Top Shelf:** Defibrillator, SpO2 probe, ECG strips, strips ultra sound jelly, Ambu bag for adults, and ambu bag for pediatrics. - **1st drawer:** Emergency drugs - Adrenaline, Atropine Sulphate, Adenosine, Amiodarone, Verapamil digoxin, dopamine, dobutamine, calcium gluconate, Hydrocortisone. - **2nd drawer:** Dextrose 50 %, Lidocaine 1 %, Potassium chloride, Sodium bicarbonate (SBC) - **3rd drawer:** Laryngoscope, Electrodes, Xylocaine jelly, Stylet, Oropharyngeal airway, Gauge bandage, Plaster. - **4th drawer:** ETT, Bracheostomy tube, Suction Catheter, Gloves, Airway (caro/nasal), Normal saline 10 ml # Temperature - Temperature is the degree of hotness or coldness of a specific body. - It is measured using a thermometer. - The normal temperature of the human body is 97.6°F to 99°F. - Any variation from the normal temperature indicates the physiological or pathological changes occurring in the body. - The normal body temperature depends on gender, activity, food, and environmental conditions. ## Temperature Measuring Sites - Oral - Rectal - Axillary - Ear - Skin - If the patient is under anesthesia, then the ability to balance the temperature is lost due to the hot or cold environment. ## Hyperthermia - It is the body's condition when the temperature elevates above normal. - It is also called hyperpyrexia. ## Causes of Hyperthermia - Heat stroke (most common cause) - Malignant hyperthermia - Many drugs - Thyroid storm - CNS Abnormalities ## Symptoms of Hyperthermia - Fever - Tachycardia - Excessive sweating - Fatigue - Dizziness - Headache - Low blood pressure - Death in some cases ## Diagnosis of Hyperthermia - History taking - Physical examination ## Treatment/Management of Hyperthermia - **General measures:** Cold application environmental modifications such as fluid maintenance. - **Symptomatic treatment:** Antipyretic, analgesic, antibiotic. # Hypothermia - It is the body's condition when the body's thermoregulation mechanism fails to maintain the body's temperature. - The body temperature decreases. - It is also called silent killer. - Hypothermia develops when the body is unable to produce heat. ## Causes of Hypothermia - Anesthesia - Cold environment - Excessive use of cold drinks ## Treatment/Management of Hypothermia - Maintain room temperature. - Warm IV fluid. - Airway heat rewarming. - Use heating pads. # Central Venous Pressure - Central Venous pressure is measured from right atrium or superior vena cava, thoracic cavity. - It is an important factor in critical care because it helps to determine the patient's cardiac function, fluid volume etc. - The central venous pressure is measured by inserting a catheter in a vein. - Normal range of central venous pressure is 5 - 10 cm or 18 - 12 mm Hg. - The central venous pressure monitor helps to determine the heart's pumping activity and venous return. ## Sites for CVP Insertion - Internal Juglar vein - Subdivision vein - Femoral vein - External Juglar vein ## Factors Affecting Central Venous Pressure - Decreased cardiac output - Heart failure - Plural Infusion - Pulmonary hypotension - Hyper & Hypovolemia ## Indications for CVP - Pulmonary artery catheterization - Temporary hemodialysis - Drug administration - Trauma, major surgery etc. - Respiration of air emboli. - To decrease cardiac output. ## Purpose of CVP - To estimate blood volume. - To determine the function of right side of heart. - To determine fluid balance. - To monitor the critically ill patients. - To monitor circulatory failure. ## Methods to Measure CVP 1. **Fluid filled manometer:** This is the most commonly used method to measure CVP. A fluid filled manometer is attached to the CVP catheter and the column of water or saline is used to measure CVP. This column reaches the level of right atrium to detect the right CVP. 2. **CVP process:** It is also done using a transducer to measure CVP. 3. **CVP measure:** This is done by placing a transducer at the coronary sinus site. It is also done using a multiple lumen catheter. 4. **CVP measure directly inject:** This is also done using a multiple lumen catheter to inject certain drugs. # ABG Analysis - ABG means Arterial Blood Gases. - It is a blood test that is done to determine the blood gas values. - In this test, arterial blood is taken using a syringe or needle. - The most common site for this test is the radial artery. - However, it can also be done in femoral artery in some cases. - This test is done to determine oxygen, carbon dioxide and other blood parameters. ## Information Obtained from ABG - Arterial pH. - Pressure of oxygen/oxygen concentration. - Pressure of carbon dioxide/carbon dioxide concentration. - Pressure of bicarbonate. ## Purpose of ABG Analysis - ABG analysis is done in the following patients: - Patients with COPD - Patients with pulmonary edema - Patients with ARDS - Patients with myocardial infarction - Patients with pneumonia - Patient in shock. - The main purpose of the test is to find the acid-base balance and also to determine the cardiopulmonary function. ## ABG Values - Any change in the ABG valves indicates a change in the cardiopulmonary function. ## Sampling for ABG analysis - Before ABG analysis, the radial artery patency check or Allen's test is done. - The most common artery for ABG analysis is the radial artery. - If the radial artery is not easily accessible, the brachial artery or femoral artery is used. ## Complications of ABG - Bleeding - Hematoma at the puncture site - Numbness of hands - Blood clot under the skin - Local pain. ## Equipment required for ABG - Clean tray - Gloves - Antiseptic solution - Local anesthesia - Heparin - Needle or syringe - Paper bag ## Normal Values of ABG | S. No. | Gases | Normal Values| | -------- | :---: | :---: | | 1 | pH | 7.35 - 7.45 | | 2. | Po₂ | 80 - 100 mm Hg ( 5% ) | | 3. | PCO₂ | 35 - 45 mm Hg | | 4 | HCO₃ ( bicarbonate ) | 22 - 29 med/liter | | 5. | Base excess | ± 2| # Invasive Blood Pressure Monitoring - Invasive Blood pressure monitoring determines the cardiovascular system's assessment and function. - It is the most commonly used method to directly monitor the cardiac output. ## Indications for Invasive Blood Pressure Monitoring - Major surgical procedure - Surgery of the aorta - Critical pulmonary disease - Patients with severe myocardial infarction - Patients with recent CAD - Unstable angina or chest pain - Congestive heart failure and valvular disease - Massive trauma - Inability to measure the blood pressure non-invasively ## Sites for Invasive Blood Pressure Monitoring - **Radial Artery:** - It is located in the superficial position. - It is easily identifiable and cannulatable. - It has a collateral circulation. - It is accessible during major surgeries. - The patient can be mobilized easily. ## Disadvantages of Radial Artery - Small size artery - Higher rate of catheter malfunction - Higher rate of dysfunction. ## Other Sites For Invasive Blood Pressure Monitoring - Brachial artery - Femoral artery - Axillary artery ## Factors Affecting Invasive Blood Pressure - Patient Movement - Air bubbles in cannula - Cannula placement site. ## Complications of Invasive Blood Pressure Monitoring - Arterial hemorrhage - Hemorrhage - Arterial occlusion (blockage) ## Invasive Blood Pressure Monitoring Insertion Techniques 1. **Direct cannulation.** 2. **Doppler assisted technique.** 3. **USG assisted method** # Blood Pressure - Blood pressure is the pressure exerted by blood on the blood vessels walls. ## Types of Blood Pressure - **Hypertension:** Blood pressure is above normal. The normal blood pressure is 140/90 mm Hg. This is also called high blood pressure. - **Hypotension:** Blood pressure is below normal. <start_of_image> This document covers information on Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), Temperature, Central Venous Pressure (CVP), Arterial Blood Gas (ABG) analysis, Invasive Blood Pressure Monitoring, Defibrillation, Infusions Pumps, BIS (Bispectral Index System), Difficult Airway Cart, Heimlich Maneuver, Revised Trauma Score, Aspiration Pneumonitis, Post-Anesthesia Care Unit, Triple Airway Maneuver, Neuro Muscular Monitoring, Blood Warmer Devices, and the Recovery Positions in BLS. The document also provides explanations and details about common procedures, tools, equipment and their uses in different medical scenarios, including the use of drugs, medications and other relevant medical information, in the context of critical care. This document can be a helpful reference for students, nurses, paramedics, and even physicians working in critical care settings wanting to learn more about lifesaving procedures in case of a medical emergency.