Anaesthesia and resuscitation
Jan de Boer, Marcel Dubouloz in Handbook of Disaster Medicine, 2020
In disasters, inhalation anaesthesia needs to be executed in a simple way. Oxygen is often not or insufficiently available, which makes the use of a combined carrier gas with oxygen and nitrous oxide very dangerous. Nitrous oxide as a single carrier gas is lethal. In these situations the use of open air as a carrier gas is a good alternative, as this contains 21% oxygen and does not have the risk of pollution or mistakes by suppliers. As there is often the issue of (impending) absence of electricity and compressed gases, one can also not put a lot of trust in mechanical ventilation, and therefore it is safer that the patient breathes spontaneously. Because during spontaneous ventilation the volatile anaesthetic are tranported by the breathing movements of the patient only, extraordinary demands are set on vaporisers, valves and the ‘non-rebreathing valves’ in the exhaling system. Special vaporisers have been designed, like the Epstein-Macintosh-Oxford (EMO) vaporiser, which enable the delivery of a stable concentration of the volatile anaesthetic under difficult circumstances as in developing countries and disasters. Inhalation anaesthesia can be reliably given using these ‘draw-over systems’ and vaporisers. There always has to be a ‘self-inflating bag’ connected to the drawover system, so that the patient can be ventilated. If available and necessary, oxygen can be added (Fig. 1). When there is no compressed oxygen available in oxygen cylinders, ‘oxygen concentrators’ can be used, which filter the nitrogen out of the air.
History-taking model
Kaji Sritharan, Vivian A Elwell, Sachi Sivananthan in Essential OSCE Topics for Medical and Surgical Finals, 2007
ProcedureAssess the patient’s oxygen requirement. This may require interpretation of their arterial blood gases (ABG) and review of their chest X-ray.Decide on the amount of oxygen to be given, and prescribe this on the patient’s drug chart if necessary.Select the appropriate oxygen delivery device (e.g. nasal cannulae, mask, mask and reservoir bag).Connect the mask/cannulae to the oxygen tubing, and then connect the tubing to the oxygen cylinder.Adjust the oxygen flow rate and apply the mask/cannulae, ensuring that they are comfortably placed.
Total Intravenous Anesthesia
Michele Barletta, Jane Quandt, Rachel Reed in Equine Anesthesia and Pain Management, 2023
If possible, oxygen supplementation should be provided. This will maximize delivery of oxygen to the tissues and decrease the incidence of anesthesia-related hypoxemia. Anesthesia of horses is associated with a significant degree of ventilation perfusion mismatch and hypoventilation.In field anesthesia, supplementation of oxygen generally requires the foresight to bring the equipment for oxygen supplementation. This requires a compressed gas oxygen cylinder (i.e. a full E or H cylinder), a regulator (Figure 5.9), an appropriately sized endotracheal tube (Figure 5.10), a flowmeter with fresh gas tubing, and/or a demand valve (Figure 5.11). For information on how to transport compressed gas cylinders, see the OSHA website (www.osha.gov).Portable oxygen concentrators are also available that extract oxygen from ambient air (Figure 5.12). These units are generally capable of creating 90–95% oxygen.
Effective training-of-trainers model for the introduction of continuous positive airway pressure for neonatal and paediatric patients in Kenya
Published in Paediatrics and International Child Health, 2019
Bernard Olayo, Caroline Kendi Kirigia, Jacquie Narotso Oliwa, Odero Nicholas Agai, Marilyn Morris, Megan Benckert, Steve Adudans, Florence Murila, Patrick T. Wilson
Two DeVilbiss IntelliPAP (Somerset, PA, USA) CPAP machines, approximately 50 Hudson RCI nasal prongs (Durham, NC, USA) of various sizes, two pulse oximeters and supplies needed to apply CPAP (head wrap, rubber bands, safety pins) were provided to each hospital. The CPAP machines were set-up and locked to deliver five centimeters of water pressure. Oxygen, if indicated, was administered via the CPAP inspiratory limb from the available oxygen source at each hospital (oxygen concentrator, oxygen cylinder or wall oxygen). Humidification was provided through nasal saline drops to the nares as needed or through humidified oxygen. Data on demographics, diagnosis, duration, outcome and adverse events of patients placed on CPAP from 16 July 2014 to 31 March 2016 were entered onto a one-page case report form by the healthcare provider applying the CPAP. Adverse events related to the use of CPAP were recorded prospectively by the treating clinician. Aspiration pneumonia was reported if an episode of emesis was followed by worsening respiratory status, regardless of chest radiograph findings.
Maxillary mucormycosis and concurrent osteomyelitis in a post-COVID-19 patient with new onset diabetes mellitus
Published in Baylor University Medical Center Proceedings, 2023
Pallak Arora, Geetpriya Kaur, Nutan Tyagi, Madhu K. Nair
Mucormycosis is a rare fungal infection caused by a group of fungi called Mucoromycetes that decompose organic matter found in soil and dust.4 The infection is extremely rare in healthy individuals, but numerous medical conditions such as immunosuppression, diabetic ketoacidosis, corticosteroid therapy, iron overload or hemochromatosis, deferoxamine therapy, voriconazole prophylaxis for transplant recipients, severe burns, acquired immunodeficiency syndrome, and intravenous drug abuse are known risk factors.1,5 Contamination from the use of industrial oxygen, low-quality oxygen cylinders, low-quality oxygen piping system, and ordinary tap water in ventilators are also considered risk factors.4 The predisposing factor in the present case could be corticosteroid therapy or the supplemental oxygen used in the treatment of pneumonia following COVID-19 infection. Pathological changes in the pancreas have been observed in patients with severe COVID-19, indicating that SARS-CoV-2 can impair pancreatic insulin secretion. This could be one of the reasons why COVID-19 patients who do not have a history of diabetes have higher blood glucose levels, as observed in this patient who was recently diagnosed with diabetes.
Reorganizing the respiratory high dependency unit for pandemics
Published in Expert Review of Respiratory Medicine, 2021
Juan Fernando Masa, Maxime Patout, Raffaele Scala, Joao Carlos Winck
Although NIRT may be provided using a flow meter for oxygen flow, to achieve high FiO2 (i.e. close to 100%), we need high-pressure valves (on the wall). In RHDUs, two-high pressure valves per bed for oxygen and also for air is recommended [93]. Careful planning is needed to avoid strain in the hospital oxygen network to avoid risks of failing oxygen supply [94]. In Europe, most hospitals have large supplies of liquid oxygen and a back-up supply of compressed gas oxygen cylinders that allow several days of reserve. However, a large influx of severe COVID-19 patients simultaneously receiving high flows of oxygen can cause a rapid pressure drop in supply pipes, leading to a failure in the oxygen delivery system. Calculating the maximum number of patients who can be treated with high flow devices (such as HFNC, CPAP/NIV) within a facility is highly recommend as well as communication of this to the relevant clinical teams.
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