Tag: Anesthesia

PGMEE, MRCS, USMLE, MBBS, MD/MS Mapleson breathing system

Mapleson Breathing Circuit Made Easy

Epomedicine,

Anatomy of Mapleson Breathing Circuit Basically, a mapleson breathing circuit consists of following parts: 1. Face mask (towards patient end) 2. Reservoir bag (towards operator end) Accommodates fresh gas flow during expiration acting as a reservoir available for the following inspiration. Acts as a monitor of patient’s ventilatory pattern during…

Emergency Medicine Norepinephrine structure

Early vs Delayed Norepinephrine Use in Septic Shock

Epomedicine,

Norepinephrine has numerous effects in sepsis including veno-constriction (increasing preload), arterial constriction (increasing systemic vascular resistance), positive inotropy, improved cardiac output, and improved renal perfusion. This addresses all the major derangements observed in cases of septic shock. It is important to realize that MAP doesn’t necessarily equate perfusion. Increasing the…

Emergency Medicine septic shock hemodynamic changes

Septic Shock Fluid Resuscitation

Epomedicine,

Endpoints of resuscitation MAP: > or = 65 mmHg Urine output: > 0.5 ml/kg/hr; despite ↓RBF (Renal Blood Flow) it can be normal due to – Atrial natriuretic factor are elevated in sepsis Hypoproteinemia in sepsis – low plasma colloid osmotic pressure is less able to facilitate oncotic reabsorption. CVP:…

Emergency Medicine Early goal directed therapy in sepsis

Is there no role of Early Goal Directed Therapy (EGDT) in Sepsis and Septic shock?

Epomedicine,

International Surviving Sepsis Campaign has recommended Early Goal Directed Therapy for the management of severe sepsis and septic shock. Recently, three large multicenter studies – the ProCESS (Protocolized Care for Early Septic Shock), ARISE (Australasian Resuscitation In Sepsis Evaluation), and ProMISe (Protocolized Management In Sepsis) demonstrated no difference in the…

Clinical Skills and Approaches head trauma fluid

Head trauma fluid resuscitation

Epomedicine,

Peculiarities of cerebral circulation: 1. Brain and spinal cord is isolated from endothelium by BBB composed of continuous capillaries that limits movement of proteins and electrolytes 2. Fluid movement is primarily determined by osmolar gradient (in contrast to peripheral tissues – transcapillary gradient of large macromolecules) 3. Hence, administration of…

Clinical Skills and Approaches complications of transfusion

Perioperative Fluid Management

Epomedicine,

Author: Sulabh Kumar Shrestha, KISTMCTH A) RELEVANT ANATOMY AND PHYSIOLOGY Details of the body fluid compartments are described here Microvessels for fluid exchange: The Exchange Vessels – capillaries and most proximal part of the venules Sinusoidal capillaries (liver, spleen, bone marrow): freely permeable to all solutes Fenestrated capillaries (glands, glomeruli, GIT):…