ISBN-10:
0074707671
ISBN-13:
9780074707678
Pub. Date:
01/28/2000
Publisher:
McGraw-Hill Professional Publishing
Anesthesia and Emergency Situations: A Complete Management Guide / Edition 1

Anesthesia and Emergency Situations: A Complete Management Guide / Edition 1

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Overview

Aimed at medical personnel with limited training in resuscitation and anesthesia, this reference aids medical staff who are placed in a situ ation where they are required to assess, resuscitate, anesthetize or t ransfer patients who may be suffering from a variety of acute problems , including medical-surgical, obstetric and pediatric. Written by exp erts in the field, this reference is intended as an international guid eline for anesthesia use in emergency situations.

Product Details

ISBN-13: 9780074707678
Publisher: McGraw-Hill Professional Publishing
Publication date: 01/28/2000
Edition description: New Edition
Pages: 256
Product dimensions: 6.97(w) x 9.42(h) x 0.89(d)

Table of Contents

Foreword iii
List of tables
xvii
List of figures
xix
Preface xxiii
Authors and editors xxiv
Contributors xxiv
Acknowledgments xxvi
Consciousness, sleep and coma
1(15)
Introduction
1(1)
Consciousness
1(1)
Reticular activating system
2(1)
Neural reflexes
2(5)
Sleep
7(1)
General anaesthesia
8(2)
Loss of consciousness during general anaesthesia
8(1)
Recovery from general anaesthesia
9(1)
Coma
10(4)
Monitoring loss of consciousness
10(1)
Care of the unconscious patient
11(3)
Brain death
14(1)
Summary
15(1)
Preoperative patient assessment and preparation
16(16)
Introduction
16(1)
A systematic approach for best care
16(1)
Primary clinical evaluation
17(8)
Patient history
17(1)
Fourteen very important questions to ask
17(5)
Physical examination of the patient
22(3)
Secondary evaluation
25(1)
Classification of patient's physical status
25(1)
Preoperative preparation for anaesthesia and surgery
26(2)
Resuscitation
26(1)
Fasting requirements
26(1)
Administering required medication
27(1)
Pre- and postoperative triage and patient referral
28(1)
The surgeon must operate now!
28(3)
Summary
31(1)
Equipment for anaesthesia and emergency patient care
32(46)
Introduction
32(1)
Fresh gas supply
32(8)
Atmospheric air
33(1)
Oxygen concentrators
33(1)
Compressed gas cylinders
33(1)
Pressure reducing devices
34(2)
Control of fresh gas supply
36(3)
Flow meters
39(1)
Provision and control of anaesthetic vapours
40(6)
Draw-over vaporisers
42(2)
Plenum vaporisers
44(1)
Anaesthetic machines/systems
45(1)
Apparatus required for airway maintenance and breathing
46(9)
Artificial airways
47(1)
Endotracheal tubes and tracheostomy tubes
48(1)
Breathing circuits
49(5)
Waste anaesthetic scavenging systems
54(1)
Manual and automatic resuscitators
55(5)
Manual resuscitators
56(2)
Mechanical ventilators
58(2)
Suction equipment
60(1)
Patient monitoring equipment
61(4)
Philosophy and principles of patient monitoring
62(3)
Monitoring the circulation
65(3)
Colour
65(1)
Peripheral pulse
66(1)
Blood pressure monitoring---non-invasive and invasive measurement methods
66(1)
Heart rate
67(1)
Central venous pressure monitoring
67(1)
Urine output
68(1)
Monitoring pulmonary gas exchange
68(2)
Adequacy of ventilation
68(1)
Carbon dioxide
69(1)
Anaesthetic agents
69(1)
The pulse oximeter and pulse oximetry
70(1)
Monitoring body temperature
70(1)
Miscellaneous monitoring
71(1)
Peripheral nerve stimulator monitoring
71(1)
Haemoglobin level
71(1)
Blood sugar level monitoring
71(1)
Electrolyte and acid-base balance
72(1)
Other equipment associated with anaesthesia
72(5)
Vascular access equipment and fluid infusion devices
72(1)
Pressure infusion devices
73(1)
Warming devices
74(3)
Summary
77(1)
Resuscitation
78(26)
Introduction
78(1)
Resuscitation is always time critical
78(1)
Resuscitation of children
78(1)
Airway and breathing
79(12)
Aetiology
79(1)
Assessment
80(1)
Treatment
81(10)
Circulation
91(12)
Aetiology
91(1)
Assessment
92(1)
Treatment
93(1)
Intravenous fluids
93(4)
Cardiac arrest
97(6)
Summary
103(1)
Trauma and burns emergency care
104(17)
Introduction
104(1)
When to expect major problems
104(1)
What is needed in the hospital?
105(1)
Primary clinical evaluation
105(7)
Airway
105(2)
Breathing
107(2)
Circulation
109(2)
Brief neurological examination
111(1)
Exposure
112(1)
Resuscitation
112(1)
Secondary evaluation
112(4)
Head
113(1)
Neck
113(1)
Face
114(1)
Chest
114(1)
Abdomen
114(1)
Genitourinary organs
114(1)
Limbs
115(1)
Back
115(1)
Full neurological examination
115(1)
Reasses and review resuscitation
115(1)
Definitive care
116(1)
Records
116(1)
Pain relief
116(1)
Burns
116(2)
More than one patient at the same time
118(2)
Summary
120(1)
Regional anaesthesia
121(38)
Introduction
121(1)
General principles
121(6)
Preparation
121(1)
Local anaesthetics
121(1)
Sedation
122(1)
Complications
122(3)
Recommended safe limits of local anaesthetics
125(2)
Spinal anaesthesia
127(8)
Anatomy
127(1)
Equipment
128(2)
Technique
130(1)
Position
130(1)
Paraspinal anaesthetic
131(1)
Intrathecal solutions
131(1)
Local anaesthetics
131(1)
Determination of spread
132(1)
Postoperative recovery
133(1)
Side effects
133(1)
Contraindications
134(1)
Opioids and spinal anaesthesia
134(1)
Upper limb block
135(10)
Anatomy
135(1)
Interscalene block
136(2)
Supraclavicular block
138(1)
Axillary block
139(2)
Elbow blocks
141(1)
Wrist blocks
142(2)
Digital nerve block
144(1)
Lower limb blocks
145(6)
Femoral block
145(2)
Block of the lateral cutaneous nerve of the thigh
147(2)
Ankle block
149(2)
Head blocks
151(2)
Supraorbital and supratrochlear nerve blocks
151(1)
Infraorbital nerve
152(1)
Mental nerve
153(1)
Intercostal nerve block
153(2)
Anatomy
153(1)
Technique
154(1)
Complications
154(1)
Inguinal hernia field block
155(1)
Anatomy
156(1)
Technique
156(1)
Haematoma block
156(1)
Technique
157(1)
Intravenous regional anaesthesia
157(1)
Uses
157(1)
Technique
157(1)
Complications
158(1)
Summary
158(1)
General anaesthesia
159(46)
Introduction
159(1)
Preinduction check
159(4)
Patient
159(1)
Equipment
159(2)
Fluids
161(2)
Temperature inside the operating theatre
163(1)
Need for an assistant
163(1)
Induction of anaesthesia
163(14)
Establishment of the airway
166(2)
Failed intubation drill
168(1)
Induction of anaesthesia in emergency cases
168(3)
Induction of anaesthesia in the elderly
171(1)
Anaesthesia and coexisting medical conditions
172(5)
Maintenance of general anaesthesia
177(18)
Total intravenous anaesthesia
177(1)
Gaseous anaesthesia
178(3)
Muscle relaxants
181(1)
Regional and general anaesthesia
182(1)
Choosing an anaesthetic technique
183(4)
Awareness during general anaesthesia
187(1)
Common problems encountered during maintenance of general anaesthesia
187(1)
Positioning of patients
188(6)
Intraoperative administration of intravenous fluids
194(1)
Monitoring during anaesthesia
195(3)
Patient monitoring
195(2)
Monitoring the functions of the anaesthetic machine
197(1)
Reversal of anaesthesia
198(1)
Immediate postoperative care following general anaesthesia
199(3)
Transfer of patient
199(1)
Position on the trolley
199(1)
Recovery room care
200(2)
Sedation for procedures
202(2)
Conscious sedation
202(2)
Monitored anaesthesia care
204(1)
Summary
204(1)
Anaesthesia for obstetric emergencies
205(24)
Introduction
205(1)
Physiological changes in pregnancy
205(12)
Respiratory changes
205(1)
Cardiovascular changes
206(2)
Haematological changes
208(1)
Gastrointestinal changes
209(1)
Changes induced by labour pain
209(2)
Changes in response to drugs
211(2)
Pain in labour
213(4)
Resuscitation of the obstetric patient
217(1)
Options for anaesthesia
217(11)
General anaesthesia
219(3)
Spinal/epidural anaesthesia
222(3)
Field block
225(1)
Ketamine
225(3)
Summary
228(1)
Paediatric and neonatal anaesthesia and analgesia
229(23)
Introduction
229(3)
Preoperative preparation
232(4)
Fasting
232(1)
Airway
232(1)
Optimal oxygenation
233(1)
Cardiovascular stabilisation
234(1)
Thermoregulation
234(1)
Brain
235(1)
Bladder
235(1)
Bowel
235(1)
Premedication principles
236(1)
Preinduction checklist
236(1)
Induction
237(1)
Maintenance
238(1)
Postoperative period
238(1)
Some surgical procedures and anaesthesia management options
239(5)
Inguinal hernia
239(1)
Circumcision
239(1)
Tonsillectomy
239(1)
Myringotomy
240(1)
Pyloric stenosis
240(1)
Cleft lip and palate
241(1)
Bowel intussusception
241(1)
Obstructed large bowel (Hirschprung's disease and anal atresia)
242(1)
Diaphragmatic hernia
242(1)
Exomphalos
243(1)
Giant cystic hygroma with tracheal compression
243(1)
Paediatric analgesia
244(2)
Pain pathways
245(1)
Assessment of pain
245(1)
Analgesic agents and techniques
246(4)
Paracetamol
246(1)
NSAIDs
247(1)
Caudal epidural analgesia
247(1)
Local anaesthetic blocks
248(1)
Opioids
248(2)
PCAs
250(1)
Monitoring
250(1)
Nausea and vomiting
250(1)
Summary
251(1)
Pain relief in trauma, burns and surgery
252(18)
Introduction
252(1)
Psychological effects
252(1)
Physiological effects
252(1)
Primary clinical evaluation
253(1)
Common causes of acute pain
253(1)
Measurement of pain
254(1)
Determinants of analgesic requirements
255(1)
Common problems in pain management in surgical wards
256(2)
Doctors' and nurses' education
256(1)
Ordering an analgesic
257(1)
Communication with patients
257(1)
Drugs used for pain relief in adults
258(2)
Non-opioid analgesics
258(1)
Opioid analgesics
259(1)
Techniques of pain relief for adults
260(5)
Oral/sublingual/rectal opioids
260(1)
Intramuscular or subcutaneous opioids
260(2)
Intravenous opioid administration
262(2)
Nerve blocks
264(1)
Acupuncture
265(1)
Supplementation of opioid analgesia
265(1)
Pain in trauma
265(1)
Pain in burns
266(3)
Summary
269(1)
Facilities for resuscitation, trauma care and recovery from anaesthesia in small hospitals
270(13)
Introduction
270(1)
The critical care process
270(1)
Staffing and teamwork
271(1)
Trauma teams and other clinical teams
272(1)
The resuscitation area
272(1)
Equipment
273(3)
Theatre
276(2)
Recovery
278(1)
Intensive care/high dependency
279(2)
Artificial ventilation
281(1)
Transfer to another unit
281(1)
Summary
282(1)
Referral of complicated patients to specialist care
283(8)
Introduction
283(1)
Which patients to refer
284(1)
Communication with referral centre
285(1)
Modes of transport
285(1)
Accompanying staff
286(1)
Equipment
287(1)
Preparation of the patient for transport
287(2)
Patient monitoring
289(1)
Other issues
289(1)
Records
289(1)
Summary
290(1)
The role of intensive care for the perioperative management of surgical patients
291(24)
Introduction
291(10)
What is intensive care and who needs it?
291(10)
Postoperative chest problems
301(2)
Postoperative fever
303(1)
Septicaemia and septicaemic shock
304(1)
Adult respiratory distress syndrome (ARDS)
305(1)
Renal failure
306(2)
Other causes of renal failure
308(1)
Gastrointestinal failure in critically ill patients
308(1)
The perioperative management of diabetics undergoing surgery
309(5)
Common surgical problems associated with diabetes mellitis
309(1)
Effect of anaesthesia and surgery on diabetics
310(1)
Common problems of anaesthesia and surgery in diabetics
310(1)
Management principles
311(2)
Poor control
313(1)
Emergency surgery and control of ketoacidosis
313(1)
Summary
314(1)
Management of some medical emergency situations
315(16)
Introduction
315(1)
Clinical care scenarios
315(11)
Acute asthma
315(3)
Anaphylaxis
318(1)
Near-drowning
319(3)
Poisoning
322(2)
Snake bite
324(2)
Tetanus---a case for intensive care
326(3)
Respiratory support
326(1)
Circulatory support in uncomplicated cases
327(1)
Metabolic support
327(1)
General care
327(1)
Complications
328(1)
Specific treatment
329(1)
Sedation and analgesia
329(1)
Malignant hyperthermia---a rare complication of anaesthesia
329(1)
Summary
330(1)
Infection control
331(32)
Introduction
331(1)
Important definitions
331(1)
Cleaning
331(1)
Disinfection
331(1)
Sterilisation
332(1)
Asepsis
332(1)
Nosocomial infection
332(1)
General principles of infection control
332(1)
Prevention of infection in patients
333(3)
Hand washing
333(1)
Wearing of protective clothing
333(1)
Stringent aseptic technique
333(1)
Use of disposable single-use equipment
333(1)
Cleaning and sterilisation of reusable items
334(1)
Proper handling of multidose vials and ampoules
334(1)
Use of bacterial filters in breathing circuits
334(1)
Safe transfusion of blood and blood products
335(1)
Standard precautions
335(1)
Treatment for occupational exposure to infectious agents
336(1)
Cleaning, disinfection and sterilisation
336(3)
Methods of cleaning
336(1)
Methods of disinfection
337(1)
Methods of sterilisation
338(1)
Cleaning and sterilisation of individual items
339(4)
Summary
343(1)
Appendices
1 Initial dose of drugs commonly used in anaesthesia and emergencies
344(7)
2 Useful tube sizes
351(1)
3 Some laboratory values
352(2)
4 Major incidents flowchart
354(2)
5 Equipment procurement strategies
356(2)
6 Some classical X-rays
358(1)
7 Some classical ECG traces
359(1)
8 Ether in the new millennium
360(3)
Index 363

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