Abdominal ultra sound

CHECK LIST ON ABDOMINAL ULTRA SOUND

Liver                    Size, margins, echogenecity, mass lesions, portal veins, hepatic veins

                       
Gall bladder         Size, calculi, sludge, cholecystitis

Bile ducts             Normal or dilated

Pancreas               Size, echogenecity, masses, calcification, duct dilatation

Spleen                  Size, mass lesions

Kidneys                Size, position, echo pattern, calculi, hydronephrosis, mass lesions

Oxygen therapy and Interpretation of blood gases

Oxygen therapy

• Different modes of O₂ therapy

-          nasal prongs

-          face mask

-          venturi mask

-          ET tube/LMA

• Ordinary face mask provides a FiO₂ of about 35%
• Addition of an reservoir bag can increase the FiO₂> 70% 
• Venturi mask can provide a FiO₂ up to about 60%
• Anaesthetic circuit can provide a FiO₂ close to 100%

Ventilation

Initiation of mechanical ventilation 

Objective of this station is to familiarize with clinical assessment of the patient before initiation of mechanical ventilation.

 Clinical parameters include:

• Level of consciousness and patients ability to cooperate
• Use of accessory muscles of respiration
• Restlessness, anxiety, sweating and posture preferred by the patient
• Presence of cyanosis
• Altered chest wall movements
• Pulse rate and rhythm disturbances
• Oxygen saturation
• Assess for effectiveness of cough reflex and phonation
• Examination of lungs

Note: The decision to initiate mechanical ventilation should be made considering multiple parameters and not a single parameter. Especially normal saturation does not mean ventilation is normal. (Misnomer of most of clinicians).

Management of Shoulder Dystocia

The HELPERR Mnemonic

Basic and immediate intervention in management of shoulder dystocia.

H - Call for help.

This refers to activating the pre-arranged protocol or requesting the appropriate personnel to respond with necessary equipment to the labor and delivery unit.

E - Evaluate for episiotomy.

Episiotomy should be considered throughout the management of shoulder dystocia but is necessary only to make more room if rotation maneuvers are required. Shoulder dystocia is a bony impaction, so episiotomy alone will not release the shoulder. Because most cases of shoulder dystocia can be relieved with the Mc Roberts maneuver and supra pubic pressure, many women can be spared a surgical incision.

Electrocardiography (ECG)

Introduction

• The ECG is a basic investigation that is widely used in medicine
• You are guided through a module based on your objectives.
• This package teaches you the important fundamentals of recording a 12-lead ECG and labeling the ECG.
• Numerous patient cases are provided for evaluation while your understanding of material will be tested at the end of the module

Normal activation of the heart

• The resting potential is maintained by ionic gradients across the cells with a higher sodium concentration outside and higher potassium concentration inside
• Following a stimulus, a rapid inward movement of sodium occurs causing a loss of the negative internal potential. This is called as depolarization.
• This is followed by repolarization, a slower process than depolarization where the potassium moves out of the cell