Tag Archives: tips

GAT conference take home messages

Tips:
Give IM atropine with IM sux
In obese O2 consumption is significantly greater during SV rather than IPPV
Epidural blood patch recommend 20ml
Dural puncture: inject 20ml normal saline down intrathecal catheter
NSAIDs may affect  platelets and clot strength of EBP
In difficult airway consider nasendoscopy.
AFOI topicalise. Reduce secretions by suction catheter or Yanker (also tests topicalisation)
Legal position: Prudent doctor  -> prudent patient
Coding – appropriately – gets the organisation appropriate money
Quality measures – e.g. length of stay
How to add value ? Outcome or quality / cost
In a report, if used a guideline say so
Detail discussions with patients, including apologies
References to read/watch/review:
‘Perfect storm NHS funding’
Cardiac arrest in neurosurgery patients

Cliff Reid YouTube videos
DOLS
NICE guidelines on trauma
BATLS, ATACC course
Kirkpatrick model (for simulation)

Age Anaesthesia Meeting

Take home messages:

In the elderly, hypotension is BAD. Keep MAP>55 and systolic no more than 10% less than baseline systolic. Consider running pressor infusion c.f. obstetric spinals

Always consider regional, BIS, no/less opioids (though not at expense of adequate analgesia)

Consider heavy prilocaine for hips & knee – if surgeon is experienced/quick

Oxycodone > morphine

Predict and treat delirium. HELP principles. Might be context specific therefore do better in own home. Involve geriatricians.

New anticoagulants – ideally need 73 hours but is balance of risk (given that mortality with #NOF increases per day)

Prehabilitation (exercise!). Not just walking. Remember strength training (stand from siting) and balance (stand on one leg with eyes closed)

EPOCH take home themes: data = power, engage and involve everybody, have a systems thinking approach, develop leadership & project management skills

Use frailty scoring systems e.g. Edmonton Frail Score

Airtraq tips

In a situation where the view is good but difficulty is encountered passed ETT between the cords consider the following:

Manoeuvring Airtraq (+/- head/airway) e.g. ‘drop’ it into pharynx to align angles better

Positioning of the glottis ‘target’ towards bottom right of screen

Use of bougie or wide bore NG tube (with ETT railroaded)

Alternative ETT e.g. standard instead of RAE

Caudal tips

Technique:

Identify surface landmark

enter approx 45 degrees

upon entry anlge needle more parallel

advance needle slightly

then keeping needle stable, advance the cannula. Does not need to be to hilt.

Watch/aspirate for CSF or blood

inject LA (+1-2mcg/kg clonidine) as per Armitage regime, visualising the skin/subcut tissue

Tips:

The feel of entering cuadal space is similar to the gentle LOR when piercing rubber bung on antibiotic bottle.

If after inserting needle through sacrococcygeal membrane and resistance is encountered on advancing cannula or needle or injection of LA (likely the dorsal aspect of the ventral plate of the sacrum) then withdraw cannula/needle and redirect cranially, walking off the bone if necessary. Better to enter at caudal aspect of sacral hiatus.

More reliable and consistent than nerve blocks.

Use up to approx 20kg weight/7yr

Single-breath vital capacity inhalation induction with high concentration Sevoflurane (SBVC – HC)

Single-breath vital capacity inhalation induction with high concentration sevoflurane (SBVC – HC)

 

Does exactly what it says on the tin.

 

Prime the circuit with 8% Sevo with >= 6 L /min O2 (+/- N2O).

Hold face mask against surface to build up Sevo.

Practice vital capacity breathing with patient.

Following forced expiration apply face mask and instruct to take vital capacity breath.

 

Induction complete in 50-60 sec.

 

http://bja.oxfordjournals.org/content/early/2012/09/16/bja.aes319.full.pdf

 

– PB @ LRI