AANA journal
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Anesthesia providers may be called to treat injuries from chemical weapons or spills, for which prompt treatment is vital. It is therefore important to understand the mechanism of action of nerve agents and the resultant pathophysiology and to be able to quickly recognize the signs and symptoms of nerve agent exposure. This review article addresses the different types of nerve agents that are currently being manufactured as well as the symptomatic and definitive treatment of the patient who presents with acute nerve agent toxicity. This article also reviews the physiology of the neuromuscular junction and the autonomic nervous system receptors that nerve agent toxicity affects.
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Body modification has been practiced in cultures around the world for thousands of years. The ramifications of body piercing on anesthesia practice and airway management have become more evident in recent years. This article reviews the techniques for removal of tongue jewelry and options for maintaining oral piercing patency. ⋯ Some practitioners feel that if people can eat, drink, talk, and sleep with the jewelry in place, they probably can be intubated safely without removing it. Most case reports present the opinion that tongue jewelry should be removed before oral intubation to minimize jewelry aspiration, bleeding, and medical-legal risks to the anesthetist. This article's focus is to illustrate suggested tongue jewelry removal techniques for awake and unconscious patients from the health practitioner's and body piercer's perspectives.
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Review Case Reports
Suspected amniotic fluid embolism following amniotomy: a case report.
Amniotic fluid embolism (AFE), also referred to as anaphylactoid syndrome of pregnancy, is a rare obstetric emergency that may manifest itself at any time during pregnancy. AFE is believed to occur when the constituents of amniotic fluid enter the maternal circulation, leading to varying degrees of multiorgan compromise. AFE was first described in 1926, gaining widespread recognition in 1941. ⋯ The most current diagnostic and treatment modalities are discussed, including several novel therapies. A case report of a 40-year-old parturient who suffered probable AFE following amniotomy, with the development of cardiopulmonary compromise, neurologic involvement, fetal distress, and coagulopathy, is outlined. The patient survived emergency cesarean delivery and hysterectomy with no residual physiologic deficits.
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Heart block and Q-Tc interval prolongation have been reported with several agents used in anesthesia, and the US Food and Drug Administration mandates evaluation of the Q-T interval with new drugs. Drug-induced Q-T interval prolongation may precipitate life-threatening arrhythmias, is considered a precursor for torsades de pointes, and may predict cardiovascular complications. ⋯ Although the heart block was resolved after 2 doses of atropine, prolonged P-R and Q-Tc intervals persisted into the immediate postoperative period but returned to baseline within 4 hours. Clinical implications of this report include increasing awareness of the multitude of factors affecting Q-T interval prolongation during anesthesia.
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Randomized Controlled Trial
CRNA performance using a handheld, computerized, decision-making aid during critical events in a simulated environment: a methodologic inquiry.
Directives to improve patient outcomes and enhance safety within the healthcare system have led to development of technologies to assist practitioners in a variety of activities. The purpose of this study was to explore and evaluate a method for examining the effect of computer-assisted decision making (CADM) using a handheld device on the accuracy (ie, correct diagnosis and treatment) and speed of problem solving by Certified Registered Nurse Anesthetists (CRNAs) during simulated critical patient-care events. A randomized crossover design with matched-pair sampling was used. ⋯ Time to correct diagnosis and treatment varied by scenario, taking less time with CADM for one but more with CADM for the other, likely due to differences in pace, intensity, and conduct of the 2 scenarios. We believe this study supports further exploration and application of CADM in complex patient scenarios involving anesthesia practitioners. Affirmation of environmental authenticity also validates the high-fidelity human simulation environment as an appropriate setting to conduct research in this area.