Airway Disasters: Volunteer Anesthesia Mishaps #3
Airway disasters during volunteer medical missions to Developing World are often preventable if you screen carefully, prepare, & communicate. Read More …
Category: Patient Safety
Halothane: Avert Volunteer Anesthesia Mishaps 1
Anesthetic mortality during volunteer medical missions overseas is 20X higher than US statistics. Article discusses risks inhalation anesthesia/Halothane. Read More …
Anesthesia Checklist: Protect Your Patients
Going through your anesthesia checklist before starting a case isn’t exciting. However the anesthesia checklist can potentially save your patient’s life by allowing you to find risks and correct them before they cause harm. I found early in my career that if I skip this step, unwelcome surprises can occur. Read More …
Clinical Calculations: Epinephrine & Local Anesthetics
Drug shortages force us to use clinical calculations to mix what we need with ingredients on hand. Clinical Calculations: Epinephrine & Local Anesthetics. Article shows how to understand drug concentrations for epinephrine and local anesthetics as well as how to perform the calculation to epinephrine and local anesthesia into different concentrations Read More …
Airway Management Review Article Published: 10 Common Pediatric Airway Problems — And Their Solutions
My review article has just been published in Anesthesiology News: 10 Common Pediatric airway Problems — And Their Solutions. The trend to only use pediatric providers has a seriously negative unintended consequence: It deprives other providers of routinely caring for children, making them less prepared for when they do inevitably have to care for a small child. This reviews the most important pediatric airway differences. Read More …
ETCO2: Valuable Vital Sign To Assess Perfusion
We routinely use ETCO2 to provide information on ventilation. But ETCO2 can also provide valuable information on the adequacy of cardiac perfusion. It can be an essential tool in ensuring optimal, high quality chest compressions during cardiac resuscitation. Read More …
Conscious Sedation: Is Your Patient Breathing?
Conscious sedation can alter respiration, which can lead to the vicious cycle of hypoventilation, hypercarbia, and hypoxia. If you don’t recognize inadequate respiration —and treat it— the patient can suffer injury or die. This article discusses the continuum of sedation and its effect on consciousness and respiration. Read More …
Bilateral Tension Pneumothorax: Harder To Diagnose
Tension pneumothorax is a life-threatening emergency. This article discusses several iatrogenic bilateral tension pneumothoraces occurring during intubation and emergency airway management. Read More …
Anatomic Dead Space Affects Hypoventilation
Having a tidal volume close to, or smaller than the patient’s dead space can lead to significant hypercarbia, hypoxia, and respiratory failure. This article discusses the concept of dead space and it’s clinical use in recognizing hypoventilation and preventing hypoxia and hypercarbia. Read More …
NITROUS OXIDE: SHOULD WE USE IT?
When I was training, we used nitrous oxide on just about every anesthetic. It was easy to use. It was inexpensive. It didn’t tend to effect hemodynamics so it was useful in less stable patients when combined with an opioid. It helped speed induction through the second gas effect. It was not metabolized so renal and liver insufficiency were of less concern.
However, a lot more is now known about the pharmacologic disadvantages, and potential harm, of nitrous oxide in certain patients. N2O interferes with the B12/folate pathway and methylates DNA. This discussion reviews some of those patients at risk of harm from nitrous oxide exposure during anesthesia. Read More …
Communication In A Crisis: A Case of Respiratory Depression In A Child:
When I’m teaching airway management to my Perioperative/OR nurses, I often recount the story of management of a young child’s postoperative respiratory depression. In addition to illustrating the importance of evaluating ventilation in addition to oxygenation, this case shows how good communication makes management of a critical event more effective. Read More …
Close Call In Honduras With A Nosebleed
During a recent volunteer medical mission to Honduras, we had a close call with a blood clot in the airway following nasal surgery. This article discusses that event. Read More …
Intubation With Airway Bleeding and Massive Emesis
During intubation, any liquid in the mouth that obscures the view of larynx not only hinders visualization, it risks aspiration. We’re used to being able to rapidly suction the mouth clear or secretions, blood, or vomit and then have a clear view of the larynx. But sometimes, either because of continued profuse bleeding or massive emesis, fluid continues to accumulate while we’re watching. How can you manage this situation and successfully intubate? This article discusses two prior cases and offers suggestions on intubation when massive emesis or blood interfere with visualization. Read More …
Avoiding Pediatric Drug Errors
Pediatric medication errors are distressingly common. This article discusses various ways to reduce the risk of administering an incorrect medication dose to a child. Read More …
Ventilation Perfusion Mismatch
There are 2 types of mismatch: dead space and shunt. Alveolar gas exchange depends not only on ventilation of the alveoli but also on circulation of blood through the alveolar capillaries. This makes sense. You need both oxygen in the alveoli, and adequate blood flow past alveoli to pick up oxygen, other wise oxygen cannot be delivered.
When the proper balance is lost between ventilated alveoli and good blood flow through the lungs, ventilation/perfusion mismatch is said to exist. The ventilation/perfusion ratio is often abbreviated V/Q. V/Q mismatch is common and often effects our patient’s ventilation and oxygenation. Read More …
Help! My Anesthesia Machine’s Not Working!
There is nothing quite as scary as being in the middle of administering an anesthetic and having your anesthesia machine fail. In my 36 years of anesthesia practice I’ve had this happen to me a few times. Knowing how to quickly troubleshoot your machine, and knowing how to protect your patient are important, potentially life-saving skills. It helps to have thought through the steps to rescue the situation before it happens to you. This article discussed the steps you should take if your machine fails. Read More …
Codeine Risk In Children, Especially Those With Sleep Apnea
Although the initial FDA warnings about potentially fatal codeine overdose in children were released in 2012, I’m recently discovered that a few of my surgeon and nursing colleagues were still unaware of the potential risks. This article reviews some of the risks of using codeine in the pediatric population as well as the patient’s at highest risk for potentially fatal respiratory depression. Read More …
Alert: We May All Be Over-Inflating Our LMA Cuffs!
The laryngeal mask airway, or LMA, is so commonly used, and so apparently safe, that it’s easy to become complacent. Research is showing that it’s apparently very common for us to over-inflate our LMA cuffs — to the potential harm of our patients. This article discusses some of the risks of overinflation, the predispositions to overinflation, and some of the strategies to avoid it. Read More …
Potential Tongue Ischemia with LMA Supreme
When we place anything in the mouth, be it an endotracheal tube, oral airway or LMA, we are typically extremely careful to protect the teeth. We take care to avoid cutting the lips with the teeth. But we often take the safety of the tongue for granted. I recently recognized a potential problem while using an LMA supreme that could have caused tongue ischemia if not recognized and corrected. Read More …
Apneic Oxygenation: Increase Your Patient’s Margin Of Safety During Intubation
Breathing room air, oxygen saturation drops precipitously to below 90% within about a minute of the start of apnea in the average healthy adult. While preoxygenation is one of the most important safety measures we can use prior to induction of anesthesia and in preparation for intubation, apneic oxygenation can allow even more time for intubation to occur. Apneic oxygenation using nasal cannula can significantly delay the onset of critical hypoxia.