Saturday, May 25, 2013

Managment of Ascites

2:34 PM

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13 comments

Ascites is our topic today so we will start by Ascites definition

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Ascites and paracentesis

Definition of Ascites:

Ascites is the collection of excess free fluid in the peritoneal cavity.

Causes of Ascites:

Hepatic :

Liver Cirrhosis.
Hepatic tumors (hepatocellular carcinoma)

Malignant Disease:

Hepatocellular carcinoma
Abdominal or pelvis tumors that may be primary or secondary tumors
Primary mesothelioma

Cardiac:

Congestive Cardiac failure or right heart faliure
Constrictive pericarditits.
Tricuspid incompetence (regurge)

Renal:

Nephrotic syndrome.

Peritonitis:

Tuberculosis.
Spontaneous bacterial peritonitis.

Venous obstruction:

Budd-Chiari syndrome.
Veno-occlusive disease.
Hepatic portal vein obstruction.
Inferior vena cave obstruction.

Gastrointestinal:
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Pancreatitis
Bile ascites

Management of Ascites:
Watch this video (paracentesis):

General Investigations:
1. Urine Dipstick: strongly positive for protein in nephrotic syndrome.
2. Complete Blood Count: Raised white cell count may indicate an infection
3. Urea and Electrolytes: Elevated urea and creatinine may indicate a renal etiology
4. LFT’s :in hepatic faliure.
5. Chest X-ray: Findings suggestive of cardiac failure are cardiomegaly.
6. Ultrasound Abdomen: detect any intra abdominal masses that are not palpable on clinical examination. OR fatty deposits in the liver in the presence of cirrhosis.
7. Abdominal Paracentesis: Aspiration of the ascitic fluid is very useful to help determine the underlying cause. A sample should be sent to microbiology clinical chemistry and pathology.
8.Ascitic fluid Examinations.
9.Others:
A. Echocardiography
B. Liver biopsy
C. Renal Biopsy
D. Portal venography

Chest Tube Insertion

1:23 PM

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Chest tube is a flexible plastic tube that is inserted through the chest wall and into the pleural Space or mediastinum.
Indication of chest tube insertion:

trauma in the chest such as RTA.
pneumothorax OR hemothorax.
pleural effusion due to bleeding into the chest, buildup of fatty fluid, abscess or pus buildup in the lung or the chest, or heart failure
Flail chest

Contraindications of chest tube insertion:

1. Infection over insertion site

2. Uncontrolled bleeding diathesis

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Materials

1. Chest tube with or without trocar; OR Fuhrman catheter

2. Chest tube suction unit , tubing, wall suction hookup

3. Chest tube tray to include scalpel blade and handle, large Kelly clamps, needle driver, scissors

4. Packet of 0 or 1.0 silk suture on a curved needle

5. Tape, gauze.

6. 2% lidocaine with epinephrine injection, 20 cc syringe, 23-gauge needle for infiltration

7. Sterile prep solution; mask, gown and gloves.

More Videos Recommended For You:

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Location (Safety triangle):
1) lateral border of the pectoralis major muscle
2) anterior border of the latissimus dorsi
3) Imaginary horizontal level of the nipple
Area of insertion 4th to 6th intercostal space anterior to Mid-axillary line

Endotracheal intubation from Advanced Trauma Life Support(ATLS)

1:39 AM

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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.