scholarly journals Traumatic Diaphragmatic Hernia: Anaesthetic Consideration

2018 ◽  
Vol 6 (2) ◽  
pp. 73-75 ◽  
Author(s):  
Raghu Nandan Khadgaray ◽  
Santosh Shah ◽  
Pawan Puspa Baral
Keyword(s):  
Diaphragmatic Hernia ◽  
Anesthetic Management ◽  
Rapid Sequence Induction ◽  
Traumatic Diaphragmatic Hernia ◽  
Cardiorespiratory Function ◽  
Rapid Sequence ◽  
Life Threatening ◽  
Sequence Induction ◽  
High Level ◽  
Anaesthetic Consideration

Any type of trauma may lead to diaphragmatic hernia with blunt forces accounting for majority. Diaphragmatic hernias require a high level of suspicion to detect. Brain, pelvis, long bones, liver, spleen, and aorta are some other organs that can be severely damaged and need different anesthetic management. Gastric decompression, pre-oxygenation, rapid sequence induction and mechanical ventilation with low tidal volume after intubation were used in anesthetic management for thoracotomy and repair. Traumatic diaphragmatic hernia can be life threatening as it may compromise cardiorespiratory function.  

The Role of the Emergency Pharmacist in Trauma Resuscitation

2011 ◽  
Vol 24 (2) ◽  
pp. 146-159 ◽  
Author(s):  
Thomas R. Scarponcini ◽  
Christopher J. Edwards ◽  
Maria I. Rudis ◽  
Karalea D. Jasiak ◽  
Daniel P. Hays
Keyword(s):  
Emergency Department ◽  
Rapid Sequence Induction ◽  
Trauma Team ◽  
Pressure Control ◽  
Clinical Situation ◽  
Detailed Knowledge ◽  
Rapid Sequence ◽  
Life Threatening ◽  
Sequence Induction

The clinical pharmacist in the emergency department is now commonly incorporated as a member of the emergency department trauma team. As such, the emergency pharmacist needs to have detailed knowledge of the pharmacotherapy of resuscitation and be able to apply the skills needed to function as a valuable member of this team. In addition to the traditional skills of the discipline of clinical pharmacy, the emergency pharmacist must be familiar with the intricacies of treating life-threatening injuries in an emergent setting and be able to anticipate the direction of the patient’s care. The ability to provide valuable pharmacological interventions throughout the resuscitation and stabilization process requires familiarity with the process of resuscitation, including rapid sequence induction, analgesia and sedation, seizure prophylaxis, appropriate antibiotic and tetanus prophylaxis, intracranial pressure control, hemodynamic stabilization, and any other specific drug therapy that the clinical situation demands. This article discusses the aforementioned pharmacotherapeutic topics and describes the role of the Emergency Pharmacist on the ED trauma team.

scholarly journals Introduction of a Rapid Sequence Induction Checklist and its effect on Compliance to Guidelines and Complications

2021 ◽  
Author(s):  
Jakob Zeuchner ◽  
Jonas Graf ◽  
Louise Elander ◽  
Jessica Frisk ◽  
Mats Fredrikson ◽  
...  
Keyword(s):  
Rapid Sequence Induction ◽  
Rapid Sequence ◽  
Sequence Induction

scholarly journals Rapid sequence induction: where did the consensus go?

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Pascale Avery ◽  
Sarah Morton ◽  
James Raitt ◽  
Hans Morten Lossius ◽  
David Lockey
Keyword(s):  
Cricoid Pressure ◽  
Rapid Sequence Induction ◽  
Hospital Environment ◽  
Training Technique ◽  
Rapid Sequence ◽  
Gastric Aspiration ◽  
Sequence Induction ◽  
The Uk ◽  
Key Aspects ◽  
Risk Of Aspiration

Abstract Background Rapid Sequence Induction (RSI) was introduced to minimise the risk of aspiration of gastric contents during emergency tracheal intubation. It consisted of induction with the use of thiopentone and suxamethonium with the application of cricoid pressure. This narrative review describes how traditional RSI has been modified in the UK and elsewhere, aiming to deliver safe and effective emergency anaesthesia outside the operating room environment. Most of the key aspects of traditional RSI – training, technique, drugs and equipment have been challenged and often significantly changed since the procedure was first described. Alterations have been made to improve the safety and quality of the intervention while retaining the principles of rapidly securing a definitive airway and avoiding gastric aspiration. RSI is no longer achieved by an anaesthetist alone and can be delivered safely in a variety of settings, including in the pre-hospital environment. Conclusion The conduct of RSI in current emergency practice is far removed from the original descriptions of the procedure. Despite this, the principles – rapid delivery of a definitive airway and avoiding aspiration, are still highly relevant and the indications for RSI remain relatively unchanged.

COVID-19: Intensivmedizinische Aspekte und Langzeitfolgen

2020 ◽  
Author(s):  
Raphael Romano Bruno ◽  
Georg Wolff ◽  
Malte Kelm ◽  
Christian Jung
Keyword(s):  
Rapid Sequence Induction ◽  
High Flow ◽  
Ältere Personen ◽  
Rapid Sequence ◽  
Sind Eine ◽  
Sequence Induction ◽  
Thrombembolische Komplikationen ◽  
Invasive Beatmung

ZusammenfassungEtwa 14% der COVID-19-Patienten weisen einen schwereren und ca. 5% einen kritischen Krankheitsverlauf auf. Besonders gefährdet sind ältere Personen, männliches Geschlecht, Raucher und stark adipöse Menschen. Wird der Patient invasiv oder nichtinvasiv beatmet, so steigt die Mortalität auf 53% respektive 50% an. In der Regel beträgt die Dauer vom Beginn der Symptome bis zur Aufnahme auf die Intensivstation 10 Tage. Die mittlere Verweildauer auf der Intensivstation beträgt 9 Tage. Für die Priorisierung sind die klinische Erfolgsaussicht einer intensivmedizinischen Behandlung sowie der Wunsch des Patienten maßgebend. Zentrale Kriterien für die Aufnahme auf die Intensivstation sind eine Hypoxämie (SpO2 < 90% unter 2 – 4 Liter Sauerstoff/min bei nicht vorbestehender Therapie), Dyspnoe, eine erhöhte Atemfrequenz (> 25 – 30/min) und ein systolischer Blutdruck ≤ 100 mmHg. Der Schutz des Personals genießt bei allen Maßnahmen Vorrang. Alle aerosolgenerierenden Prozeduren sollten nur mit großer Vorsicht erfolgen. Wird unter High Flow keine adäquate Oxygenierung erreicht (SpO2 ≥ 90% oder ein paO2 > 55 mmHg), sollte über eine Eskalation nachgedacht werden (NIV, invasive Beatmung). Die Patienten sollten lungenprotektiv beatmet werden. Die Intubation sollte als Rapid Sequence Induction erfolgen. Eine ECMO kann erwogen werden. Thrombembolische Komplikationen sind sehr häufig. Antibiotika sollten nicht routinemäßig gegeben werden. Die aktuell beste Datenlage liegt für Dexamethason vor. Remdesivir kann die Rekonvaleszenz beschleunigen. Langzeitfolgen nach COVID-19 sind sehr häufig. Kardiale, pulmonale und neurologische Probleme stehen dabei im Vordergrund.

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