The Yale journal of biology and medicine
-
Fiberoptically guided tracheal intubation represents one of the most important advances in airway management to occur in the past thirty years. Perhaps its most important role is in management of the anticipated difficult airway. ⋯ These measures include 1) pre-operative assessment of the patient; 2) careful explanation of what lies in store; 3) "setting the stage"; 4) preparing the equipment to be used; and 5) preparing the patient (antisialogue, sedation, application of topical anesthesia to the upper airway). If these preparatory measures are carried out meticulously, the likelihood of performing a successful and comfortable awake fiberoptic tracheal intubation is greatly increased.
-
Sepsis, manifested by systemic inflammatory response syndrome (SIRS), septic shock and multiple organ dysfunction syndrome (MODS), remains the leading cause of morbidity and mortality in critically ill patients. Despite advances and our knowledge of sepsis, there remain clinical dilemmas that impact how we treat patients. ⋯ As we improve our understanding of sepsis, there is increased recognition that improvement in morbidity and survival will come not only from treating the manifestations of sepsis but also the endogenous mediators responsible for the development of these clinically important conditions. This manuscript discusses the clinical dilemmas associated with sepsis, current therapy and future directions for managing sepsis.
-
We have previously reported a standardized 10-step sequence of monoplane (transverse plane) transesophageal two-dimensional echocardiographic views and a standardized 7-step vertical plane examination, both suitable for expeditious intraoperative use by the beginning practitioner. A multiplane transesophageal examination involves transverse plane views, vertical plane views and the remaining "in-between" oblique plane views. ⋯ Each of these steps is illustrated with a two-dimensional echocardiographic image, a matching diagram and a schematic representation of the corresponding axis of interrogation. This description of oblique plane imaging, therefore, completes the components of a multiplane transesophageal examination.
-
Many variations to the axillary approach to the brachial plexus have been described. However, the success rate varies depending on the approach used and on the definition of success. Recent work describes a new approach to regional anaesthesia of the upper limb at the humeral/brachial canal using selective stimulation of the major nerves. ⋯ No complications were described. Initial experience confirms the high success rate described using the Dupré technique. This technically straightforward approach with minimal complications can be recommended for regional anaesthesia of the upper limb.