Anesthesia unplugged by Gallagher, Christopher J.

By Gallagher, Christopher J.

"An fun step by step method of studying easy anesthesia strategies and systems. Written in a funny, exciting variety, Anesthesia Unplugged, 2e is helping anesthesiologists in education improve the procedural talents useful for the optimum care of the anesthetized sufferer. that includes an easy-to-navigate atlas-style presentation, the e-book covers all proper anesthesia systems, detailing indications,  Read more...

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Pneumothorax is asymptomatic in about 22% of patients. 15 • An upright end-expiratory chest x-ray is best for detecting a pneumothorax. • Tension may develop after institution of positive pressure ventilation. 20 • Chylothorax • Although rare, damage to the thoracic duct when performing a LIJ line insertion can result in a chylothorax. ) • Hemothorax • A penetrating injury to the IJ/ subclavian vein juncture can lead to a hemothorax. S H O W M E T H E M O N E Y! • Pay-for-performance (P4P) Initiatives • P4P initiatives attempt to incentivize health care providers to perform according to delineated guidelines for quality and efficiency.

12 P a rt I • • • – Posterior approach m Locate a point one third of the way from the clavicle on a line running from the sternal head of the clavicle to the mastoid process. m Advance the needle through the skin at a 30- to 40-degree angle, in an inferior and medial direction until entering the IJ vein. Administer an adequate amount of local anesthetic. , 21 gauge [G]) of adequate length to reach the tissue within the intended trajectory. – Don’t place so much local anesthetic subcutaneously so as to completely obscure your landmarks.

If that doesn’t work, we recommend that you recheck your landmarks, and consider using an US! – When making the orderly sweep, progress from each attempt to the next without hesitation. Do not persevere with the same angle and depth that just led to failure. Move on! We see residents moving in and out of the same site/ trajectory incessantly, as if not giving up will engender success! (Figure 2-2) The finder is now in the IJ. Now what? – Some professionals leave the finder in and place the larger needle or angiocatheter right next to it and approximate the same angle and direction that was successful.

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