Endotracheal intubation from Advanced Trauma Life Support(ATLS)

How to Intubate a patient? is our topic Today to intubate or orotracheal intubation.

we will use youtube video to learn you How you can intubate a patient?

Indication for Orotracheal intubation(ETT): Respiratory arrestwhatever the cause. Respiratory failureas in multiple medical diseases. Airway obstruction commonly in Foreign body. Need for prolonged ventilatory supportin ICU. Class III or IV hemorrhage with poor perfusion Severe flail chest or pulmonary contusion Multiple trauma, head injury and abnormal mental statusas in Road trafic accident. Inhalation injury with erythema/edema of the vocal cords Protection from aspiration.

--> Endotracheal intubation Definition:  is the placement of a tube into the trachea.
Steps for intubation:

• Open the airway to give oxygen before intubation(using Ambu bage connected with oxygen)
• Remove blockages from the airway or secretion by suction machine.
• Try to get a better view of the upper airway to put ETT.
• Put the ETT in the trachea in clear vision.
• Protect the lungs in certain patients.
• careful from Bleedind or infection.
• Be sure that ETT putted in correct position using stethoscope.

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ATLS cricothyroidotomy

 ACLS Guidelines updated video

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Drug allergy and Food Allergy

Drug allergy unwanted side effect to certain medication.Food allergy same like Drug Allergy in effect,commonly skin reaction (rash).nousea ,vomiting, Diarrhea and swelling In mouth and throat. Drug allergy commonly occured secand time use of the medicine not first use.
Drug allergy is ife-threatening conditin but rare to couse Death.
Skin reactions of Drug allergy is measles-like rash so we must take good history for prober diagnosis and wright managment.
we should know that skin allergy may be occured after days or weeks from the first dose of the drug.(NB: good history)
Systemic symptomes and signs such as Rapid or irregular heart beat,Fainting.low Blood pressure and Chest tightness, wheezing, throat tightness

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Now You can watch This Video and we hope that is informative:

Advice you to Read This topic if you are interested by Drug allergy and Food Allergy
http://life4u.ahlamontada.com/t51-atopic-dermatitis-in-emergency-medicine#68

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NB:
# Commenest drugs couse allergy such as codeine, morphine, nonsteroidal antiinflammatory drugs (NSAIDs, such as ibuprofen or indomethacin), and aspirin.
# Antibiotics such as penicillin, sulfa drugs, and tetracycline.
# Antiseizure medications such as phenytoin (Dilantin) or carbamazepine (Tegretol).
# Certain food allergies such as to eggs, soybeans, or shellfish

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Bronchial Asthma video from A-Z

Bronchial Asthma  common in USA about 20 million Americans have asthma.So we here will discus How we can deal with Allergy and what we should know about Bronchial Asthma by reading this topics and watching video from youtube also within days we will discus all allergy diseases in details so you can add your E-mail below to follow our blog.

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Bronchial Asthma Triggers:

Bronchial asthma triggers may include:

• Smoking and passive smoking.
• Infections such as colds, flu, or pneumonia
• Allergens such as food, pollen, mold, dust mites, and pet dander and others
• Excessive Exercise
• Air pollution and toxins,dust
• Weather, especially extreme changes in temperature
• Drugs (such as aspirin, NSAID, and beta-blockers)
• Food additives (such as MSG)
• Emotional stress and anxiety
• Perfumes and fragrances
• Acid reflux
• Rare: Singing, laughing, or crying

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Signs and Symptoms of Bronchial Asthma

One or more of the following signs and symptoms:

• Shortness of breathing
• Tightness of chest
• Wheezing (patient can hear that in sever asthma)
•  cough or a cough that keeps you awake at night.

Specially in:

*At  night or early morning

*Exercise – cold air

*Genetic Atopy (Ç IgE)

*Respiratory infections

*After asprin or B-blockers

Diagnosing Bronchial Asthma

Asthma tests may include:

• Spirometry: A lung function test to measure breathing capacity and how well you breathe. You will breathe into a device called a spirometer.
• Peak Expiratory Flow (PEF): Using a device called a peak flow meter, you forcefully exhale into the tube to measure the force of air you can expend out of your lungs. Peak flow monitoring can allow you to monitor how well your asthma is doing at home.
• Chest X-ray: Your doctor may do a chest X-ray to rule out any other diseases that may be causing similar symptoms as pneumonia.

Treating Bronchial Asthma

Aim of Treatment

*Relievers (Quick)

*Controllers (long term)

*Patient education

 Relievers

-Short-acting inhaled β2-agonists

–Salbutamol,   Terbutaline

-Long-acting oral β2-agonists

–Salmetrol,  Formroterol

-Anti-cholinergics

–Ipatropium, Tiotropium give synergestic bronchodilatation BUT of more benefit in COPD

Preventers  

Inhaled corticosteroids

=Budesonide/ beclomethasone/ fluticasone – use any

=Start (400-1000 mcg/day approx. in 2 divided doses)

=Maintain for 3 months

=Taper slowly and keep at 200 mcg

=Safe for long-term use (years)

Famous available drugs :

lClenil modulite = Beclomethasone

Symbicort = Budesonide  + Formoterol

Pulmicort = budesonide

Seretide  = Fluticasone + Salmeterol

Flixotide = fluticasone

Foradil = formoterol

Atrovent = ipratropium bromide

Spiriva = tiotropium

Leukotrine receptor antagonist 

Benefit in exercise induced asthma – ch  rhinitis

Can be used alone - Not as effective as inhaled steroid

May be first-line for 2 to 5 yr. olds.

Montelukast (singulair)  - Zafirlukast

4 mg, 5 mg, 8 mg tabs available & sachets

Can be add on to ICS, IBD inhalers

 

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Step Up and Down  

1- Inhaled SABA  prn

2- Add inhaled steroid at 200-800 mcg/d (400 appropriate)

3- Add LABA : A- Good Control àcontinue    

                          B- Inadequate àincrease C/S 

                          C- No response à stop LABA increase C/S  & if still less controlled à+ trial leuktrienes or SR theophylline

4- Trial :  - C/S 2000 mcg/d   - Leuk     - SR theoph.  . Oral SABA 

5- Daily Steroid tab at lowest dose OR anti IgE . Continue maximum dose inhaled steroids .

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Hernia Repair Surgery with mesh video

The hernia means a protrusion of a body tissue through a wall of a cavity due to weakness in the abdominal wall.
The peritoneum protrudes through the opening and this defect causes a bulging of the abdominal wall.

See this video about hernial repair with mesh:

The patient with abdominal hernia complain of pain ,tenderness and swelling in the abdomen in the groin area. 

 

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Herniotomy: 

Removal of hernia sac without any repair of the inguinal sac.

hernioplasty:

herniotomy is combined with a reinforced repair of the posterior inguinal canal wall with autogenous (patient's own tissue) or heterogeneous material such as prolene mesh

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The different types of abdominal hernias are:

Epigastric, umbilical, incisional, lumbar, internal, inguinal, hiatal, and Spigelian hernias

This video explain Direct and Indirect scrotal hernia

 

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And this is educational Hernia Repair Inguinal:

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Lower Leg Amputation Surgery (Amputated Leg) video

Amputation is acut or removal of apart of a body extremity by trauma, prolonged constriction, or surgery. As a surgical measure,Amputation is still often viewed as a failure of treatment , it is aimed to control pain or a disease process in the affected limb or extremity, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventative surgery for such problems. A special case is that of congenital amputation, a congenital disorder, where fetal limbs have been cut off by constrictive bands. In some countries, amputation of the hands, feet or other body parts is or was used as a form of punishment for people who committed crimes. Amputation has also been used as a tactic in war and acts of terrorism; it may also occur as a war injury. In some cultures and religions, minor amputations or mutilations are considered a ritual accomplishment. Unlike some non-mammalian animals (such as lizards that shed their tails, salamanders that can regrow many missing body parts, and hydras, flatworms, and starfish that can regrow entire bodies from small fragments), once removed, human extremities do not grow back, unlike portions of some organs, such as the liver. A transplant or a prosthesis are the only options for recovering the loss.

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 Contraindications:
 The decision to perform an amputation often comes after all other options have been exhausted. It is a final decision that cannot be reversed once initiated. The only contraindication to amputation is poor health that impairs the patient's ability to tolerate anesthesia and surgery. However, the diseased limb is often at the center of the patient's illness, leading to a compromised medical status. The removal of the diseased limb is necessary to eliminate systemic toxins and save the patient's life. 
SEE THIS SAMPLE VIDEO:

 

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Indications:

Although safer equipment exists and improvements in limb salvage surgery have been made, traumatic limb loss continues to occur because of industrial and motor vehicle accidents. These accidents involve high-grade open fractures with associated nerve injury, soft tissue loss, and ischemia and unreconstructable neurovascular injury. In this setting, limb salvage may initially be successful, only to end in an infected painful extremity that affects the patient's activities of daily living and work. Attempts at limb salvage are often made with less-than-favorable results, leaving the patient with an extremity that is less functional than a prosthesis would be and resulting in workdays lost and expense in treatment. 

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The goal in treating malignant bone tumors is to remove the lesion with the lowest risk of recurrence. Limb salvage surgery has replaced amputation as the primary treatment for bone tumors. To recommend limb salvage, the risk of local recurrence must be equal to that of amputation, and the salvaged limb must be functional.
Congenital absence and limb malformations account for a small percentage of amputations. These situations are evaluated on an individual basis because these limbs are often functional and amenable to orthotic management or limb reconstruction. When considering amputation, a higher and more functional level than the patient's current level should be obtainable.
Whatever the indication for amputation, the goal remains length preservation and surgical reconstruction that maintains the most functional limb possible. 

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Clinical examination of Thyroid examination video

Thyroid gland is situated in front of the neck and it responsible of secretion of thyroid Hormone.
Thyroid gland stimulated by pitutary gland by TSH (Thyroid stimulating hormone)and FT3 and FT4. 
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Functions of the thyroid gland:
The thyroid plays an important role in regulating the body's metabolism and calcium balance. and secrete T4 and T3 hormones which stimulate every tissue in the body to produce proteins and increase the amount of oxygen used by body cells. The harder the cells work, the harder the organs work. The calcitonin hormone works together with the parathyroid hormone to regulate calcium levels in the body.

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This is anather video to explain how you can examine the thyroid gland
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Forceps in Childbirth (delivery) video

Forceps are a surgical instrument that like a pair of tongs and used in surgery for grabbing,delivary, maneuvering, or removing various things within or from the body. used also to assist the delivery of a baby as an alternative to the ventouse method
and the video you will see explain how it used in delivery






Technique

The cervix must be fully dilated and retracted and the membranes ruptured. The urinary bladder should be empty, perhaps with the use of a catheter. High forceps are never indicated in this era. Mid forceps can occasionally be indicated but require operator skill and caution. The station of the head must be at least +2 in the lower birth canal. The woman is placed on her back, usually with the aid of stirrups or assistants to support her legs. A mild local or general anesthetic is administered (unless an epidural anesthesia has been given) for adequate pain control. Ascertaining the precise position of the fetal head is paramount, and though historically was accomplished by feeling the fetal skull suture lines and fontanelles, in the modern era, confirmation with ultrasound is essentially mandatory. At this point, the two blades of the forceps are individually inserted, the posterior blade first, then locked. The position on the baby's head is checked. The fetal head is then rotated to the occiput anterior position if it is not already in that position. An episiotomy may be performed if necessary. The baby is then delivered with gentle (maximum 30 lbf or 130 Newton[6]) traction in the axis of the pelvis


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