Anesthesia advanced circulatory life support

The constellation of advanced cardiac life support (ACLS) events, such as gas embolism, local anesthetic overdose, and spinal bradycardia, in the perioperative setting differs from events in the pre-hospital arena. As a result, modification of traditional ACLS protocols allows for more specific etiology-based resuscitation. Perioperative arrests are both uncommon and heterogeneous and have not been described or studied to the same extent as cardiac arrest in the community. These crises are usually witnessed, frequently anticipated, and involve a rescuer physician with knowledge of the patient's comorbidities and coexisting anesthetic or surgically related pathophysiology. When the health care provider identifies the probable cause of arrest, the practitioner has the ability to initiate medical management rapidly. Recommendations for management must be predicated on expert opinion and physiological understanding rather than on the standards currently being used in the generation of ACLS protocols in the community. Adapting ACLS algorithms and considering the differential diagnoses of these perioperative events may prevent cardiac arrest

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Mean pressure of a finite width oil control ring with randomly spaced grooves

International audienc

Obtaining the pressure spike and maximum shear stress from optical interferometry data

In order to predict and optimise highly loaded contact performance, accurate lubricant data is crucial. The lubricant's high-pressure rheological behaviour is by far the least known parameter. However, this is the key factor to realistic modeling of non-Newtonian Elasto-Hydrodynamic lubrication. In this paper a new approach is described to extract such data from optical interferometric film thickness measurements of EHL contacts. The approach is relatively straightforward and cheap compared to out of contact rheological experiments using specialized equipment. A measured high-resolution film thickness distribution was positioned using a computed film thickness distribution as a reference. The reference is computed using the same operating conditions as the measurement. Subsequently, from the computed film thickness difference, a pressure difference file is obtained by deconvolution. Adding this pressure difference to the computed pressure file associated with the computed reference film thickness, provides a corrected pressure distribution, as it has appeared in the experimental contact. In this paper results are presented for the pressure spike region of the contact, in which significant shear stresses occur. The basic approach and its difficulties are described as well as some tricks, such as the reduction of (local) noise resulting from the ill-posedness of the deconvolution. It is shown that simple averaging over a circle segment in the pressure spike zone, results in significant noise reduction and a very good 'measured' pressure spike

Enhanced visual acuity with echogenic needles in ultrasound-guided axillary brachial plexus block: a randomized, comparative, observer-blinded study.

International audienceBACKGROUND:We prospectively evaluated the effect of insertion angle on the visibility of echogenic and nonechogenic needles in phantoms and in axillary nerve blocks in patients.METHODS:Conventional and echogenic needles were studied in phantoms at insertion angles of 0-30°, 30-45°, and ≥ 45°. Operators rated comfort and image quality during the procedure and experts blinded to the needle groups randomly analyzed videos for tip and shaft visibility, surrounding tissue visibility, sharpness of the needle surface, and percentage of time with the needle completely visible. Patients scheduled for axillary nerve block were prospectively enrolled in the clinical study. Needle insertion angles were 0-30° for the median nerve approach, 30-45° for the radial nerve, and ≥ 45° for the musculocutaneous nerve. The same needle parameters were analyzed during the procedure and on videos.RESULTS:Physician comfort and image quality were significantly better for echogenic needles for phantoms and patients at 30-45° and ≥ 45° insertion angles. Needle tip and shaft visibility at 30-45° and ≥ 45° insertion angles in phantoms and for the musculocutaneous nerve in patients were significantly improved, as well as the percentage with complete needle visualization during the procedure. Tissue visibility and needle sharpness were significantly superior for conventional needles. There were no differences concerning block parameters and adverse events.CONCLUSION:Needles with enhanced echogenicity improved physician comfort, image quality, needle visibility, and visualization time of the needle during ultrasound-guided procedures in phantoms and axillary nerve blocks using insertion angles of 30-45° and ≥ 45°