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Pretest 03: luftvg & procedursedering
Version 181007
TOC \o "1-3" DEL I: FRDIGHETER PAGEREF _Toc400560550 \h 2
1-Head-tilt/chin-lift, jaw-thrust och triple maneuver PAGEREF _Toc400560551 \h 2
2-Svalgtub och nskantarell PAGEREF _Toc400560552 \h 3
3-Larynxmask PAGEREF _Toc400560553 \h 4
4-Endotrakeal intubation PAGEREF _Toc400560554 \h 5
5-Rapid Sequence Intubation PAGEREF _Toc400560555 \h 6
6-Coniotomi PAGEREF _Toc400560556 \h 9
7-Nlcricotyrotomi PAGEREF _Toc400560557 \h 10
8-Fiberlaryngoskopi PAGEREF _Toc400560558 \h 11
9-Misslyckad endotrakeal intubation PAGEREF _Toc400560559 \h 12
DEL II: SYMPTOM & TILLSTND PAGEREF _Toc400560560 \h 13
1-Stridor PAGEREF _Toc400560561 \h 13
2-Frmmande kropp i vre luftvgen PAGEREF _Toc400560562 \h 14
3-Anafylaxi PAGEREF _Toc400560563 \h 15
4-Angiodem PAGEREF _Toc400560564 \h 17
5-Krupp PAGEREF _Toc400560565 \h 18
6-Epiglottit PAGEREF _Toc400560566 \h 19
7-vriga halsinfektioner PAGEREF _Toc400560567 \h 20
8-Bakre nsbldning PAGEREF _Toc400560568 \h 21
DEL III: PROCEDURSEDERING PAGEREF _Toc400560569 \h 22
1-Procedursedering genomfrt av akutlkare PAGEREF _Toc400560570 \h 22
2-American Society of Anaesthetics (ASA) Physical Status Classification PAGEREF _Toc400560571 \h 23
3-LEMON Law PAGEREF _Toc400560572 \h 24
4-Utrustning & Personal PAGEREF _Toc400560573 \h 25
5-Monitorering PAGEREF _Toc400560574 \h 25
6-Midazolam PAGEREF _Toc400560575 \h 26
7-Propofol PAGEREF _Toc400560576 \h 27
8-Fentanyl PAGEREF _Toc400560577 \h 28
9-Alfentanil (Rapifen) PAGEREF _Toc400560578 \h 29
10-Ketalar PAGEREF _Toc400560579 \h 30
REFERENSER PAGEREF _Toc400560580 \h 31
DEL I: FRDIGHETER
1-Head-tilt/chin-lift, jaw-thrust och triple maneuver
a) Vad r det gemensamma syftet med head-tilt/chin-lift, jaw-thrust och triple airway maneuver? (HYPERLINK "http://swesem.org/category/Utbildning/Utbildningsmaterial"SWESEMS UTBILDNINGSMATERIAL Luftvgsmanvrar basala Anteckning 2)
b) Nr r jaw-thrust (utan head-tilt) att fredra ver head-tilt/chin-lift? ( HYPERLINK "http://swesem.org/category/Utbildning/Utbildningsmaterial" SWESEMS UTBILDNINGSMATERIAL Luftvgsmanvrar basala Anteckning 3)
c) Varfr br man undvika att hyperextendera huvudet hos spdbarn? ( HYPERLINK "https://www.emsworld.com/article/10322897/beyond-basics-pediatric-assessment" https://www.emsworld.com/article/10322897/beyond-basics-pediatric-assessment)
d) Var stter man hnderna och fingrarna vid jaw-thrust? (HYPERLINK "http://swesem.org/category/Utbildning/Utbildningsmaterial"SWESEMS UTBILDNINGSMATERIAL Luftvgsmanvrar basala Jaw-thrust; se ven HYPERLINK "http://www.nejm.org/doi/full/10.1056/NEJMicm0910490" Albrecht 2010 ADDIN EN.CITE Albrecht20101831[1]1831183117Albrecht, E.Schoettker, P.Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.Images in clinical medicine. The jaw-thrust maneuverN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicinee32363212010/11/19HumansJawRespiration, Artificial/*methods2010Nov 180028-47932108338110.1056/NEJMicm0910490NLMeng[1])
e) Vad menas med the triple airway maneuver? ( HYPERLINK "http://swesem.org/category/Utbildning/SWESEMs-utbildningsmaterial" SWESEMS UTBILDNINGSMATERIAL Luftvgsmanvrar basala Anteckning 4)
f) Hur positionerar man en patient med uttalad obesitas fr att optimera luftvgen? (Murphy HYPERLINK "https://link.springer.com/article/10.1007/s12630-013-9991-x" 2013 {Murphy, 2013 #2538} Figure; se ven Roberts 6th Chapter 03 s41 Figure 3-2)
2-Svalgtub och nskantarell
a) Nr r svalgtub och nskantarell indicerade och kontraindicerade? (HYPERLINK "http://swesem.org/category/Utbildning/Utbildningsmaterial"SWESEMS UTBILDNINGSMATERIAL Luftvgsmanvrar basala; fr mer om skerheten av nskantarell vid trauma, se HYPERLINK "https://www.ncbi.nlm.nih.gov/pubmed/?term=15911941" Roberts 2005 ADDIN EN.CITE ADDIN EN.CITE.DATA [2], HYPERLINK "https://www.ncbi.nlm.nih.gov/pubmed/?term=16858116" Ellis 2006 ADDIN EN.CITE Ellis20062364[3]2364236417Ellis, D. Y.Lambert, C.Shirley, P.Intracranial placement of nasopharyngeal airways: is it all that rare?Emerg Med JEmergency medicine journal : EMJEmerg Med JEmergency medicine journal : EMJEmerg Med JEmergency medicine journal : EMJ6612382006/07/22Airway Obstruction/*therapyCraniocerebral Trauma/*therapyFacial Injuries/therapyHead Injuries, Penetrating/etiologyHumansIntubation, Intratracheal/*adverse effects/methodsMale2006Aug1472-020516858116PMC256418510.1136/emj.2006.036541NLMeng[3], HYPERLINK "https://www.ncbi.nlm.nih.gov/pubmed/?term=17384400" Steinbruner 2007 ADDIN EN.CITE Steinbruner20072363[4]2363236317Steinbruner, DavidMazur, RobertMahoney, Peter F.Intracranial placement of a nasopharyngeal airway in a gun shot victimEmergency Medicine Journal : EMJEmerg Med JEmergency medicine journal : EMJ311-3112442007BMJ Group1472-0205
1472-0213PMC2658253http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658253/10.1136/emj.2007.046490PMC[4])
SvalgtubNskantarellIndikationer
Kontraindikationer
b) Hur bedmer man om storleken av svalgtuben r rtt? (HYPERLINK "http://swesem.org/category/Utbildning/Utbildningsmaterial"SWESEMS UTBILDNINGSMATERIAL Luftvgsmanvrar basala Anteckning 15)
c) Hur infr man svalgtuben hos vuxna? Hos barn? (HYPERLINK "http://swesem.org/category/Utbildning/Utbildningsmaterial"SWESEMS UTBILDNINGSMATERIAL Luftvgsmanvrar Anteckning 16)
d) Hur bedmer man om storleken av nskantarellen r rtt? (HYPERLINK "http://swesem.org/category/Utbildning/Utbildningsmaterial"SWESEMS UTBILDNINGSMATERIAL Luftvgsmanvrar basala Anteckning 12)
e) Hur infra man nskantarellen? (HYPERLINK "http://swesem.org/category/Utbildning/Utbildningsmaterial"SWESEMS UTBILDNINGSMATERIAL Luftvgsmanvrar basala Anteckning 14)
f) Vad gr man EFTER infrandet av svalgtub eller nskantarell? ( HYPERLINK "http://swesem.org/category/Utbildning/Utbildningsmaterial" SWESEMS UTBILDNINGSMATERIAL Luftvgsmanvrar basala Anteckning 6)
3-Larynxmask
a) Vilka r indikationerna fr larynxmask (laryngeal mask airway, LMA) / intubating laryngeal mask airway, ILMA (t ex Fastrach)? ( HYPERLINK "http://swesem.org/category/Utbildning/SWESEMs-utbildningsmaterial" SWESEMS UTBILDNINGSMATERIAL Larynxmask Anteckningar 3-6; se ven Roberts 6th ed Chapter 03 s61 Fig 3-14)
b) Nr r LMA / ILMA kontraindicerade? ( HYPERLINK "http://swesem.org/category/Utbildning/SWESEMs-utbildningsmaterial" SWESEMS UTBILDNINGSMATERIAL Larynxmask Anteckning 7)
c) Beskriv hur man infr en LMA (Roberts 6th Chapter 03 s56 Fig 3-10; ven HYPERLINK "http://www.nejm.org/doi/full/10.1056/NEJMvcm0909669" Lighthall 2013 ADDIN EN.CITE Lighthall20131832[5]1832183217Lighthall, G.Harrison, T. K.Chu, L. F.From the Palo Alto Veterans Affairs Hospital, Palo Alto (G.L., T.K.H.), and the Stanford University School of Medicine, Stanford (G.L., T.K.H., L.F.C) - both in California.Videos in clinical medicine: Laryngeal mask airway in medical emergenciesN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicinee26369202013/11/15Cardiopulmonary Resuscitation/instrumentation/*methodsEmergenciesHeart Arrest/therapyHumans*Laryngeal Masks/adverse effects2013Nov 140028-47932422463910.1056/NEJMvcm0909669NLMeng[5])
d) Vad menas med den skallade "Chandy" manver och up-down manver och vad r syftet med dessa? (Roberts 6th Chapter 03 s54 Fig 3-9)
4-Endotrakeal intubation
a) Nr r endotrakeal intubation indicerad p akuten? ( HYPERLINK "https://emedicine.medscape.com/article/80222-overview" https://emedicine.medscape.com/article/80222-overview; Rosen's 9th Chapter 1 s3-4)
b) Titta p videon (HYPERLINK "http://www.nejm.org/doi/full/10.1056/NEJMvcm063574"Kabrhel 2007 ADDIN EN.CITE Kabrhel2007642[6]64264217Kabrhel, C.Thomsen, T. W.Setnik, G. S.Walls, R. M.Department of Emergency Medicine, Massachusetts General Hospital, Boston, USA.Videos in clinical medicine. Orotracheal intubationN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicinee15356172007/04/27Critical Illness/therapyEmergency TreatmentHumansIntubation, Intratracheal/adverseeffects/contraindications/instrumentation/*methodsLaryngoscopesProtective Clothing2007Apr 261533-4406 (Electronic)
0028-4793 (Linking)17460222Interactive Tutorialhttp://www.ncbi.nlm.nih.gov/pubmed/1746022210.1056/NEJMvcm063574eng[6]) och beskriv frberedelsen infr intubation (se ven HYPERLINK "http://swesem.org/category/Utbildning/SWESEMs-utbildningsmaterial" SWESEMS UTBILDNINGSMATERIAL Endotracheal intubation)
c) Vad menas med krikoidtryck? Vilka r frdelar, nackdelar och evidensgrad med krikoidtryck? (Sellick's maneuver)? (Roberts 6th Chapter 04 s72 + s74; HYPERLINK "https://www.ncbi.nlm.nih.gov/pubmed/?term=26556848" Frerk 2015 ADDIN EN.CITE Frerk20152536[7]2536253617Frerk, C.Difficult Airway Society intubation guidelines working, groupMitchell, V. S.Difficult Airway Society intubation guidelines working, groupMcNarry, A. F.Difficult Airway Society intubation guidelines working, groupMendonca, C.Difficult Airway Society intubation guidelines working, groupBhagrath, R.Difficult Airway Society intubation guidelines working, groupPatel, A.Difficult Airway Society intubation guidelines working, groupO'Sullivan, E. P.Difficult Airway Society intubation guidelines working, groupWoodall, N. M.Difficult Airway Society intubation guidelines working, groupAhmad, I.Difficult Airway Society intubation guidelines working, groupDifficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adultsBJA: British Journal of AnaesthesiaBJA: British Journal of Anaesthesia827-848115620150007-0912http://dx.doi.org/10.1093/bja/aev37110.1093/bja/aev371[7] s830). Hur appliceras krikoidtryck?
d) Vad menas med BURP manvern? (Roberts 6th ed Chapter 04 s74)
e) Vad menas med Cormack & Lehane Grade 1, 2, 3 och 4?
f) Hur gr intubationen till med hjlp av en Bougie? (Roberts 6th Chapter 04 s75-6; HYPERLINK "https://www.youtube.com/watch?v=iJlwnET5NgY" https://www.youtube.com/watch?v=iJlwnET5NgY; HYPERLINK "https://www.youtube.com/watch?v=TrHZAPLPKwU" https://www.youtube.com/watch?v=TrHZAPLPKwU)
g) Vilken r det mest plitliga sttet att bekrfta att tuben ligger i trakean? (Roberts 6th ed Chapter 04 s80-1)
h) Hur fungerar GlideScope? HYPERLINK "https://www.youtube.com/watch?v=7jb2tbqQ6VQ" https://www.youtube.com/watch?v=7jb2tbqQ6VQ HYPERLINK "https://www.youtube.com/watch?v=4VAMBj2kc2Y" https://www.youtube.com/watch?v=4VAMBj2kc2Y
HYPERLINK "https://www.youtube.com/watch?v=NEtcm6Q3mDg" https://www.youtube.com/watch?v=NEtcm6Q3mDg
5-Rapid Sequence Intubation
a) Vilka sex "P" ingr vid Rapid Sequency Intubation (Roberts 6th ed Chapter 05 s107-8)
b) Vilka lkemedel och doser skulle du anvnda fr att intubera fljande patienter? (Roberts 6th ed Chapter 05)
Patient #1
versikt36 rig kvinna (60 kg), trafikolycka, frontalkrocka p en 90 vgAHematom p pannan
Normala andningsljud
Munhlan inspekteras uaBSyresaturation 94% med 10 liter syrgas
Andningsfrekvens 24
Nedsatta andningsljud bilateralt
Multipla revbensfrakturCBlodtryck 110/70
Hjrtfrekvens 115
Regelbunden rytm
Bckenringen palperas stabilDPupiller 3 mm liksida, dlig reaktion fr ljus
Obegripliga ljud vid smrtstimulering
Undandrar alla fyra extremiteter fr smrtaE35,9C
NrlkemedelDosPremedicineringSederingParalys
Patient #2
versikt80 rig man (85 kg), hittat medvetsls i hemmetAInget tecken p trauma till huvudet, halsen eller nacken
Normala andningsljud
Munhlan inspekteras uaBSyresaturation 96% med 10 liter syrgas via mask
Andningsfrekvens 22
Normala liksidiga andningsljud
Underskning av brstkorgen uaCBlodtryck 190/110
Hjrtfrekvens 55
Smala QRS komplex, regelbunden rytmDH pupill 6 mm, ingen reaktion fr ljus
V pupill 3 mm, reagerar fr ljus
Reagerar ej muntligt vid smrtstimulering
H arm + ben undandrar fr smrtstimulering
V arm + ben reagerar ej fr smrtstimuleringENormal ytlig kroppsunderskning
37,6C
NrlkemedelDosPremedicineringSederingParalys
Patient #3
versikt24 rig man (70 kg) med astma och tilltagande andningsbesvr x 1,5 dygnAInget tecken p trauma till huvudet, halsen eller nacken
Inspiratoriska och expiratoriska stridor
Munhlan uaBSyresaturation 89% med 15 liter syrgas via mask
Andningsfrekvens 24
Nstan ohrbara andningsljud vid lungauskultation
Ytligt andningsdjup; inget tecken p trauma till brstkorgenCBlodtryck 130/90
Hjrtfrekvens 140
Smala QRS komplex, regelbunden rytmDPupiller 4 mm bilateralt, reagerar normalt fr ljus
RLS 1, ++ orolig
Inga fokala neurologiska bortfallEYtlig kroppsunderskning ua
37,4C
NrlkemedelDosPremedicineringSederingParalys
6-Coniotomi
a) Nr r coniotomi indicerad? (HYPERLINK "http://www.nejm.org/doi/full/10.1056/NEJMvcm0706755"Hsiao 2008 ADDIN EN.CITE Hsiao20081833[8]1833183317Hsiao, J.Pacheco-Fowler, V.Department of Emergency Medicine, New York-Presbyterian Hospital, New York, USA. james_j_hsiao@yahoo.comVideos in clinical medicine. CricothyroidotomyN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicinee25358222008/05/30Airway Obstruction/*surgeryCricoid CartilageHumansMembranes/surgeryPostoperative CareRespiration, ArtificialThyroid CartilageTracheostomy/instrumentationTracheotomy/adverse effects/contraindications/instrumentation/*methods2008May 290028-47931850911610.1056/NEJMvcm0706755NLMeng[8] 0:48; se ven videon HYPERLINK "http://www.youtube.com/watch?v=JzlvgtPIof4""Just a routine operation", HYPERLINK "http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2292761/" Macdonald 2008 ADDIN EN.CITE Macdonald20081834[9]1834183417Macdonald, J. C.Tien, H. C.Department of Critical Care Medicine, University of Ottawa, Ottawa, Ont.Emergency battlefield cricothyrotomyCmajCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienneCmajCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienneCmajCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne1133-517892008/04/23AdultBlast Injuries/complicationsCricoid Cartilage/*surgeryEmergency Treatment/*methodsHumansMaleMilitary MedicineThyroid Cartilage/*surgery2008Apr 220820-394618427086PMC229276110.1503/cmaj.080036NLMeng[9])
b) Hur genomfr man en conitomi nr man kan knna igen anatomin? ( HYPERLINK "https://www.youtube.com/watch?v=SbhEyGIf9Y4" Scalpel-Bougie-Tube; se ven HYPERLINK "https://www.youtube.com/watch?v=EGktLfqwUFk" https://www.youtube.com/watch?v=EGktLfqwUFk)
c) Hur genomfr man en conitomi nr man inte kan knna igen anatomin? (HYPERLINK "https://www.youtube.com/watch?v=0c6GPV_8t2U"Fat Neck Scalpel-Finger-Cannula)
d) Se sammanfattande beskrivning HYPERLINK "https://www.ncbi.nlm.nih.gov/pubmed/?term=26556848" Frerk 2015 ADDIN EN.CITE Frerk20152536[7]2536253617Frerk, C.Difficult Airway Society intubation guidelines working, groupMitchell, V. S.Difficult Airway Society intubation guidelines working, groupMcNarry, A. F.Difficult Airway Society intubation guidelines working, groupMendonca, C.Difficult Airway Society intubation guidelines working, groupBhagrath, R.Difficult Airway Society intubation guidelines working, groupPatel, A.Difficult Airway Society intubation guidelines working, groupO'Sullivan, E. P.Difficult Airway Society intubation guidelines working, groupWoodall, N. M.Difficult Airway Society intubation guidelines working, groupAhmad, I.Difficult Airway Society intubation guidelines working, groupDifficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adultsBJA: British Journal of AnaesthesiaBJA: British Journal of Anaesthesia827-848115620150007-0912http://dx.doi.org/10.1093/bja/aev37110.1093/bja/aev371[7] s835-6. Vad menas med "laryngeal handshake"?
7-Nlcricotyrotomi
a) Nr r nlcricotyrotomi att fredra ver coniotomi? (Roberts 6th ed Chapter 06 s130, ven HYPERLINK "http://swesem.org/category/Utbildning/SWESEMs-utbildningsmaterial" SWESEMS UTBILDNINGSMATERIAL Coniotomi och nlcricothyrotomi Anteckning 23)
b) Andy Heart rekommenderar att man, vid en "Can't Intubate Can't Oxygenate" situation, frst frsker genomfra en Cannula Cricothyroidotomy. Hur gr det till? ( HYPERLINK "https://www.youtube.com/watch?v=6LDEMmOcSB8" Cannula Cricothyroitodomy)
c) Du infr en nl genom membran cricotyroidea hos ett 3 rigt barn med en supraglottisk frmmande kropp som du inte har lyckats f bort med MaGill tng. Du vljer att oxygenera och ventilera barnet med hjlp av en Rubens blsa. Hur kopplar du blsan till kanylen? (Roberts 6th ed Chapter 06 s131 Fig 6-13; se ven HYPERLINK "http://swesem.org/category/Utbildning/SWESEMs-utbildningsmaterial" SWESEMS UTBILDNINGSMATERIAL Coniotomi och nlcricothyrotomi s1 och Anteckning 28)
d) Hur resonerar du kring oxygenering om patienten r 8 r gammal? Vilken utrustning anvnder du? (Roberts 6th ed Chapter 06 s131 Fig 6-14; se ven HYPERLINK "http://swesem.org/category/Utbildning/SWESEMs-utbildningsmaterial" SWESEMS UTBILDNINGSMATERIAL Coniotomi och nlcricothyrotomi s1 och Anteckning 29)
e) Hur framgngsrik r jet ventilation i praktiken?
f) P akuten har vi Melker kit. Hur anvnder man den efter framgngrik cannula cricothyroidotomy? ( HYPERLINK "https://www.youtube.com/watch?v=R9l3H5Q6-SY" Melker insertion)
8-Fiberlaryngoskopi
a) En 40 rig man sker till akuten pga ont i halsen, feber, svrighet att svlja och heshet. Beskriv hur du skulle underska svalget med hjlp av fiberlaryngoskopet ( HYPERLINK "http://swesem.org/category/Utbildning/SWESEMs-utbildningsmaterial" SWESEMS UTBILDNINGSMATERIAL Fiberlaryngoskopi; se ven HYPERLINK "http://www.nejm.org/doi/full/10.1056/NEJMvcm0706392"Holsinger 2008 ADDIN EN.CITE Holsinger20081835[10]1835183517Holsinger, F. C.Kies, M. S.Weinstock, Y. E.Lewin, J. S.Hajibashi, S.Nolen, D. D.Weber, R.Laccourreye, O.Department of Head and Neck Surgery, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-4009, USA. holsinger@mdanderson.orgVideos in clinical medicine. Examination of the larynx and pharynxN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicinee235832008/01/18HumansLaryngeal Diseases/*diagnosisLaryngoscopesLaryngoscopy/contraindications/*methodsPharyngeal Diseases/diagnosisPharynx2008Jan 170028-47931819985710.1056/NEJMvcm0706392NLMeng[10] 5. Flexible Nasolaryngoscopy 04:47)
b) Vad orsakade troligen demet hos patienten i HYPERLINK "http://www.nejm.org/doi/full/10.1056/NEJMicm1009578" Watanabe 2011 ADDIN EN.CITE Watanabe20111836[11]1836183617Watanabe, K.Nakaya, M.Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.Images in clinical medicine. Laryngopharyngeal edemaN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicinee55364252011/06/24AgedAnesthetics, Local/*adverse effectsEdema/etiology/*pathologyEpinephrine/adverse effectsFemaleHumansHypopharynx/*pathologyLidocaine/adverse effectsPharyngeal Diseases/etiology/*pathology2011Jun 230028-47932169630410.1056/NEJMicm1009578NLMeng[11]?
9-Misslyckad endotrakeal intubation
a) Vilken algoritm rekommenderas av Difficult Airway Society (DAS) vid en misslyckad endotrakeal intubation? ( HYPERLINK "https://www.ncbi.nlm.nih.gov/pubmed/?term=26556848" Frerk 2015 ADDIN EN.CITE Frerk20152536[7]2536253617Frerk, C.Difficult Airway Society intubation guidelines working, groupMitchell, V. S.Difficult Airway Society intubation guidelines working, groupMcNarry, A. F.Difficult Airway Society intubation guidelines working, groupMendonca, C.Difficult Airway Society intubation guidelines working, groupBhagrath, R.Difficult Airway Society intubation guidelines working, groupPatel, A.Difficult Airway Society intubation guidelines working, groupO'Sullivan, E. P.Difficult Airway Society intubation guidelines working, groupWoodall, N. M.Difficult Airway Society intubation guidelines working, groupAhmad, I.Difficult Airway Society intubation guidelines working, groupDifficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adultsBJA: British Journal of AnaesthesiaBJA: British Journal of Anaesthesia827-848115620150007-0912http://dx.doi.org/10.1093/bja/aev37110.1093/bja/aev371[7] Fig 1 & Fig 2).
DEL II: SYMPTOM & TILLSTND
1-Stridor
a) Vilken r differentialdiagnos av stridor hos barn? (HYPERLINK "https://www.ncbi.nlm.nih.gov/pubmed/?term=23939212"Bjornson 2013 ADDIN EN.CITE Bjornson20131837[12]1837183717Bjornson, C. L.Johnson, D. W.Croup in childrenCmajCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienneCmajCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienneCmajCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne1317-23185152013/08/14AdolescentAdrenal Cortex Hormones/therapeutic useChildChild, PreschoolCroup/*diagnosis/drug therapy/therapyDecision Support TechniquesDiagnosis, DifferentialEpinephrine/administration & dosage/therapeutic useHumansInfantInfant, NewbornNebulizers and VaporizersPhysical ExaminationSeverity of Illness Index2013Oct 150820-394623939212PMC379659610.1503/cmaj.121645NLMeng[12] s2 Box 2)
2-Frmmande kropp i vre luftvgen
a) I vilket sammanhang br man misstnka frmmande kropp i vre luftvgen? ( HYPERLINK "http://www.lakartidningen.se/Functions/OldArticleView.aspx?articleId=19036" Nilsson 2012 ADDIN EN.CITE Nilsson20121838[13]1838183817Nilsson, O.Norlander, T.Linder, A.Bada oron-, nas- och halskliniken, Falu lasarett, Falun. olof.nilsson@ltdalarna.se[Foreign body in the airways]LakartidningenLakartidningenLakartidningenLakartidningenLakartidningenLakartidningen2361-510951-522013/02/02Adult*Airway Obstruction/diagnosis/etiology/therapyBronchoscopesBronchoscopy/methodsChild*Foreign Bodies/complications/diagnosis/therapyHeimlich ManeuverHumansRisk Factors2012Dec 19-2013 Jan 8Frammande kropp i luftvagarna.0023-7205 (Print)
0023-720523367552NLMswe[13] s2362 Klinisk Bild)
b) En trerig pojke har pltsligt blivit andftt. Pappan berttar att barnet lekte med en liten boll innan han blev dligt. Du arbetar prehospitalt. Hur hanterar du fljande situationer? ( HYPERLINK "http://swesem.org/category/Utbildning/SWESEMs-utbildningsmaterial" SWESEMS UTBILDNINGSMATERIAL Frmmande kropp luftvg)
SituationtgrderVid medvetande, pratar, effektiv hostaMedvetandesnkt, ofrmga att prata, tilltagande cyanos, ineffectiv hostaMedvetsls (se t ex ( HYPERLINK "http://www.nejm.org/doi/full/10.1056/NEJMicm041055" Zarrin-Khamed 2005 ADDIN EN.CITE Zarrin-Khameh20051830[14]1830183017Zarrin-Khameh, N.Lyon, R. E.Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA.Images in clinical medicine. Asphyxia due to an inhaled foreign bodyN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicine2110352202005/05/20Airway Obstruction/etiologyAsphyxia/*etiologyChild, PreschoolFatal OutcomeForeign Bodies/complications/*diagnostic imagingHumansInhalationMaleOropharynx/*diagnostic imagingRadiographyTrachea/diagnostic imaging2005May 190028-47931590186410.1056/NEJMicm041055NLMeng[14]).
c) Hur genomfr man Heimlich manvern? (Roberts 6th Chapter 03 s41-2 Fig 3-3)
3-Anafylaxi
a) Definitionsmssigt r anafylaxi ett syndrom, dvs en kombination av olika symtom. Vilka symtom krvs fr att uppfylla definitionen av anafylaxi? ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=22744267" Simons 2012 ADDIN EN.CITE ADDIN EN.CITE.DATA [15] s393 Fig 1)
b) Frsta linjens behandling av anafylaxi r adrenalin IM. Fyll i fljande tabell. ( HYPERLINK "http://www.lakartidningen.se/Functions/OldArticleView.aspx?articleId=6975" Glen 2007 ADDIN EN.CITE Glen2007277[16]27727717Glen, T.Gttberg, L.Karolinska Universitetssjukhuset Huddinge. theo.gulen@karolinska.seAnafylaxi--en potentiellt livshotande systemisk reaktion. Tidig egenbehandling och akut adekvat sjukvardsbehandling av stor betydelse.LkartidningenLkartidningenLakartidningenLakartidningenLakartidningenLakartidningen1982-610426-272007/07/21Adrenergic Agonists/administration & dosage/therapeutic useAdult*Anaphylaxis/diagnosis/drug therapy/etiology/immunologyChildDiagnosis, DifferentialEmergenciesEpinephrine/administration & dosage/therapeutic useHumans2007Jun 27-Jul 10Anafylaxi--en potentiellt livshotande systemisk reaktion. Tidig egenbehandling och akut adekvat sjukvardsbehandling av stor betydelse.0023-7205 (Print)
0023-7205 (Linking)17639788Reviewhttp://www.ncbi.nlm.nih.gov/pubmed/17639788swe[16])
Dos hos vuxna?
(s1984 Fakta 5)Dos hos barn?
(s1984 Fakta 5)Lsning (1 mg/ml eller 0,1 mg/ml)?
(s1984 Fakta 5)Var ges injektionen?
(s1984 Fakta 5)Varfr rekommenderas emot subkutan injektion?
(s1984)
Hur ofta kan man upprepa injektionen?
(s1985 Fakta 6)r det farligt att ge adrenalin intramuskulrt i ondan till en fr vrigt frisk person? (s1984)
c) Vid mycket svr anafylaxi kan adrenalin IV vara aktuell. Fyll i fljande tabell ( HYPERLINK "http://www.lakartidningen.se/Klinik-och-vetenskap/Medicinens-ABC/2015/10/Chock-pa-akuten/" Mokhtari 2015 ADDIN EN.CITE Mokhtari20151533[17]1533153317Mokhtari, A.Dryver, E.Skane's University Hospital - VO Internmedicin Lund, Sweden Skane's University Hospital - VO Internmedicin Lund, Sweden.
Skane's University Hospital - Akutkliniken Lund, Sweden Skane's University Hospital - Akutkliniken Lund, Sweden.ABC om Chock p akutenLakartidningenLakartidningenLakartidningenLakartidningenLakartidningenLakartidningen1122015/12/152015ABC om - Chock pa akuten.1652-7518 (Electronic)
0023-7205 (Linking)26661260http://www.ncbi.nlm.nih.gov/pubmed/26661260swe[17])
Vilka komplikationer kan frekomma vid behandling med adrenalin intravenst?Lsning (1 mg/ml eller 0,1 mg/ml)? (s5)
Dos hos vuxna? (s5)
d) Hur kan man ge 100 ug adrenalin IV ver 10 minuter om man har tillgng till en 10 ml spruta, adrenalin 0,1 mg/ml och koksalt lsning?
e) Frutom adrenalin kan vriga lkemedel vara aktuella vid behandling av anafylaxi. Fyll i fljande tabell. ( HYPERLINK "http://www.lakartidningen.se/Functions/OldArticleView.aspx?articleId=6975" Glen 2007 ADDIN EN.CITE Glen2007277[16]27727717Glen, T.Gttberg, L.Karolinska Universitetssjukhuset Huddinge. theo.gulen@karolinska.seAnafylaxi--en potentiellt livshotande systemisk reaktion. Tidig egenbehandling och akut adekvat sjukvardsbehandling av stor betydelse.LkartidningenLkartidningenLakartidningenLakartidningenLakartidningenLakartidningen1982-610426-272007/07/21Adrenergic Agonists/administration & dosage/therapeutic useAdult*Anaphylaxis/diagnosis/drug therapy/etiology/immunologyChildDiagnosis, DifferentialEmergenciesEpinephrine/administration & dosage/therapeutic useHumans2007Jun 27-Jul 10Anafylaxi--en potentiellt livshotande systemisk reaktion. Tidig egenbehandling och akut adekvat sjukvardsbehandling av stor betydelse.0023-7205 (Print)
0023-7205 (Linking)17639788Reviewhttp://www.ncbi.nlm.nih.gov/pubmed/17639788swe[16])
BehandlingarIndikationerDoserNebuliserad adrenalinVentolin (s1985)Ringer (s1985)Glukagon (s1985)Atropin (s1985)Betapred (s1985 Fakta 6)Tavegyl (s1985 Fakta 6)4-Angiodem
a) Patienten vars bild visas av HYPERLINK "http://www.nejm.org/doi/full/10.1056/NEJMicm050510"Westra 2006 ADDIN EN.CITE Westra20061839[18]1839183917Westra, S. W.de Jager, C. P.Jeoen Bosch Ziekenhuis, Hertogenbosch, The Netherlands.Images in clinical medicine. Angioedema of the tongueN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicine29535532006/07/21AgedAngioedema/*chemically induced/pathologyAngiotensin-Converting Enzyme Inhibitors/*adverse effectsCaptopril/*adverse effectsHumansMaleTongue Diseases/*chemically induced/pathology2006Jul 200028-47931685527010.1056/NEJMicm050510NLMeng[18] dyker upp p akuten. Du misstnker angiodem. Vilka r de vanligaste lkemedlen associerade med angiodem? ( HYPERLINK "https://www.ncbi.nlm.nih.gov/pmc/?term=PMC4989802" Misra 2016 ADDIN EN.CITE Misra20161845[19]1845184517Misra, LopaKhurmi, NarjeetTrentman, Terrence L.Angioedema: Classification, management and emerging therapies for the perioperative physicianIndian Journal of AnaesthesiaIndian Journal of Anaesthesia534-5416082016IndiaMedknow Publications & Media Pvt Ltd0019-5049
0976-2817PMC4989802http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989802/10.4103/0019-5049.187776PMC[19] Classification of angioedema)
b) Hur behandlas histamin-utlst angiodem? (HYPERLINK "https://www.ncbi.nlm.nih.gov/pmc/?term=PMC4989802"Misra 2016 ADDIN EN.CITE Misra20161845[19]1845184517Misra, LopaKhurmi, NarjeetTrentman, Terrence L.Angioedema: Classification, management and emerging therapies for the perioperative physicianIndian Journal of AnaesthesiaIndian Journal of Anaesthesia534-5416082016IndiaMedknow Publications & Media Pvt Ltd0019-5049
0976-2817PMC4989802http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989802/10.4103/0019-5049.187776PMC[19] Medication management in the acute setting patient with known angioedema)
c) Vad r mekanism vid ACE-hmmareutlst angiodem? ( HYPERLINK "http://ww2.lakartidningen.se/07engine.php?articleId=18066" Kongstad 2012 ADDIN EN.CITE ADDIN EN.CITE.DATA [20] s758)
d) Vad r mekanism vid hereditr angiodem? ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=18768946" Zuraw 2008 ADDIN EN.CITE ADDIN EN.CITE.DATA [21] s1029)
e) Svr bradykinin-utlst angioedema kan behandlas med Berinert( och Firazyr(. Hur fungerar dessa preparat? ( HYPERLINK "http://www.fass.se" FASS)
5-Krupp
a) Vilka r de typiska symtom hos ett barn med krupp? (Rosen's 9th Chapter 167 s2075, HYPERLINK "https://www.ncbi.nlm.nih.gov/pubmed/?term=23939212"Bjornson 2013 ADDIN EN.CITE Bjornson20131837[12]1837183717Bjornson, C. L.Johnson, D. W.Croup in childrenCmajCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienneCmajCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienneCmajCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne1317-23185152013/08/14AdolescentAdrenal Cortex Hormones/therapeutic useChildChild, PreschoolCroup/*diagnosis/drug therapy/therapyDecision Support TechniquesDiagnosis, DifferentialEpinephrine/administration & dosage/therapeutic useHumansInfantInfant, NewbornNebulizers and VaporizersPhysical ExaminationSeverity of Illness Index2013Oct 150820-394623939212PMC379659610.1503/cmaj.121645NLMeng[12] s1)
b) Vilka fynd skiljer mild, mttlig, svr och livshotande krupp frn varandra? (HYPERLINK "https://www.ncbi.nlm.nih.gov/pubmed/?term=23939212"Bjornson 2013 ADDIN EN.CITE Bjornson20131837[12]1837183717Bjornson, C. L.Johnson, D. W.Croup in childrenCmajCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienneCmajCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienneCmajCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne1317-23185152013/08/14AdolescentAdrenal Cortex Hormones/therapeutic useChildChild, PreschoolCroup/*diagnosis/drug therapy/therapyDecision Support TechniquesDiagnosis, DifferentialEpinephrine/administration & dosage/therapeutic useHumansInfantInfant, NewbornNebulizers and VaporizersPhysical ExaminationSeverity of Illness Index2013Oct 150820-394623939212PMC379659610.1503/cmaj.121645NLMeng[12] s3 + Box 3)
c) Nr r syrgasbehandling rekommenderar, och hur? (HYPERLINK "https://www.ncbi.nlm.nih.gov/pubmed/?term=23939212"Bjornson 2013 ADDIN EN.CITE Bjornson20131837[12]1837183717Bjornson, C. L.Johnson, D. W.Croup in childrenCmajCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienneCmajCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienneCmajCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne1317-23185152013/08/14AdolescentAdrenal Cortex Hormones/therapeutic useChildChild, PreschoolCroup/*diagnosis/drug therapy/therapyDecision Support TechniquesDiagnosis, DifferentialEpinephrine/administration & dosage/therapeutic useHumansInfantInfant, NewbornNebulizers and VaporizersPhysical ExaminationSeverity of Illness Index2013Oct 150820-394623939212PMC379659610.1503/cmaj.121645NLMeng[12] s3)
d) Nr r nebuliserad adrenalin rekommenderad, och i vilken dos? (HYPERLINK "https://www.ncbi.nlm.nih.gov/pubmed/?term=23939212"Bjornson 2013 ADDIN EN.CITE Bjornson20131837[12]1837183717Bjornson, C. L.Johnson, D. W.Croup in childrenCmajCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienneCmajCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienneCmajCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne1317-23185152013/08/14AdolescentAdrenal Cortex Hormones/therapeutic useChildChild, PreschoolCroup/*diagnosis/drug therapy/therapyDecision Support TechniquesDiagnosis, DifferentialEpinephrine/administration & dosage/therapeutic useHumansInfantInfant, NewbornNebulizers and VaporizersPhysical ExaminationSeverity of Illness Index2013Oct 150820-394623939212PMC379659610.1503/cmaj.121645NLMeng[12] s4 Figure 1)
e) Vilket tillstnd br vervgas hos ett barn med hg feber som inte svarar p nebuliserad adrenalin? (HYPERLINK "https://www.ncbi.nlm.nih.gov/pubmed/?term=23939212"Bjornson 2013 ADDIN EN.CITE Bjornson20131837[12]1837183717Bjornson, C. L.Johnson, D. W.Croup in childrenCmajCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienneCmajCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienneCmajCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne1317-23185152013/08/14AdolescentAdrenal Cortex Hormones/therapeutic useChildChild, PreschoolCroup/*diagnosis/drug therapy/therapyDecision Support TechniquesDiagnosis, DifferentialEpinephrine/administration & dosage/therapeutic useHumansInfantInfant, NewbornNebulizers and VaporizersPhysical ExaminationSeverity of Illness Index2013Oct 150820-394623939212PMC379659610.1503/cmaj.121645NLMeng[12] s2)
f) Nr r corticosteroider rekommenderade, och i vilken dos? (HYPERLINK "https://www.ncbi.nlm.nih.gov/pubmed/?term=23939212"Bjornson 2013 ADDIN EN.CITE Bjornson20131837[12]1837183717Bjornson, C. L.Johnson, D. W.Croup in childrenCmajCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienneCmajCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienneCmajCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne1317-23185152013/08/14AdolescentAdrenal Cortex Hormones/therapeutic useChildChild, PreschoolCroup/*diagnosis/drug therapy/therapyDecision Support TechniquesDiagnosis, DifferentialEpinephrine/administration & dosage/therapeutic useHumansInfantInfant, NewbornNebulizers and VaporizersPhysical ExaminationSeverity of Illness Index2013Oct 150820-394623939212PMC379659610.1503/cmaj.121645NLMeng[12] s4 Figure 1)
g) Nr br patienten lggas in? (HYPERLINK "https://www.ncbi.nlm.nih.gov/pubmed/?term=23939212"Bjornson 2013 ADDIN EN.CITE Bjornson20131837[12]1837183717Bjornson, C. L.Johnson, D. W.Croup in childrenCmajCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienneCmajCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienneCmajCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne1317-23185152013/08/14AdolescentAdrenal Cortex Hormones/therapeutic useChildChild, PreschoolCroup/*diagnosis/drug therapy/therapyDecision Support TechniquesDiagnosis, DifferentialEpinephrine/administration & dosage/therapeutic useHumansInfantInfant, NewbornNebulizers and VaporizersPhysical ExaminationSeverity of Illness Index2013Oct 150820-394623939212PMC379659610.1503/cmaj.121645NLMeng[12] s6)
6-Epiglottit
a) En minneshjlp fr att knna igen epiglottit r feber + 4 D:
- Dypn
- Dysfagi (+ halsont och smrta vid svljning)
- Dysfoni
- Dregel
Hur mnga av dessa 5 symtom hade patienten i HYPERLINK "http://ww2.lakartidningen.se/old/mainframe.php?di=0348&ar=-1"HSAN fallet 945/03? ("Kvinna med epiglottit avled-lkare varnas)
b) Vem drabbas av epiglottit nufrtiden i Sverige, barn eller vuxna? (HYPERLINK "http://www.lakartidningen.se/Functions/OldArticleView.aspx?articleId=8104"Isakson 2007 ADDIN EN.CITE ADDIN EN.CITE.DATA [22] s3532 Fig 1)
c) Hur ser epiglottis ut vid epiglottit? ( HYPERLINK "http://www.nejm.org/doi/full/10.1056/NEJMvcm0706392" \l "figure=preview.gif" Holsinger 2008 ADDIN EN.CITE Holsinger20081835[10]1835183517Holsinger, F. C.Kies, M. S.Weinstock, Y. E.Lewin, J. S.Hajibashi, S.Nolen, D. D.Weber, R.Laccourreye, O.Department of Head and Neck Surgery, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-4009, USA. holsinger@mdanderson.orgVideos in clinical medicine. Examination of the larynx and pharynxN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicinee235832008/01/18HumansLaryngeal Diseases/*diagnosisLaryngoscopesLaryngoscopy/contraindications/*methodsPharyngeal Diseases/diagnosisPharynx2008Jan 170028-47931819985710.1056/NEJMvcm0706392NLMeng[10] 01:40, se ven bilder p google)
d) Patienter med epiglottit intuberas som regel. Vilken antibiotika rekommenderas i Sverige? HYPERLINK "http://www.lakartidningen.se/Functions/OldArticleView.aspx?articleId=8104" Isakson 2007 ADDIN EN.CITE ADDIN EN.CITE.DATA [22] s3532)
7-vriga halsinfektioner
Det finns ett par vriga infektisa tillstnd som kan hota den vre luftvgen:
1-Peritonsillr abscess
2-Parotit
3-Infektioner i den submandibulra rymden (Ludwigs angina)
4-Infektioner i den parafaryngeala rymden
5-Infektioner i den retrofaryngeala rymden (t ex HYPERLINK "http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3153517/"Lin 2011 ADDIN EN.CITE ADDIN EN.CITE.DATA [23])
a) Nmn olika symtom / kliniska fynd som kan frekomma vid dessa tillstnd ( HYPERLINK "http://emedicine.medscape.com/article/837048-overview" \l "a10" Medscape Deep Neck Space Infections)
b) Vilka av dessa symptom/kliniska fynd var nrvarande vid anmlningsrendet dr lkaren missade en retrofaryngeal abscess? (HYPERLINK "http://www.lakartidningen.se/Functions/OldArticleView.aspx?articleId=12892"Soc 41-8206/09)
c) Vilka r tv komplikationer av parafaryngeala infektioner (HYPERLINK "http://www.nejm.org/doi/full/10.1056/NEJMicm065036"Heavey 2008 ADDIN EN.CITE Heavey20081842[24]1842184217Heavey, J.Gupta, N.University of Virginia, Charlottesville, VA 22903, USA. heavey@alum.dartmouth.orgImages in clinical medicine. Ludwig's anginaN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicine1501359142008/10/04HumansLudwig's Angina/*diagnosis/etiologyMaleMiddle AgedPeriapical Abscess/complicationsToothache/complications2008Oct 020028-47931883224810.1056/NEJMicm065036NLMeng[24], HYPERLINK "http://www.nejm.org/doi/full/10.1056/NEJMcps032253"Bliss 2004 ADDIN EN.CITE ADDIN EN.CITE.DATA [25])
8-Bakre nsbldning
a) Hur skyddar man luftvgen frn en bakre nsbldning med hjlp av en Foleykateter? ( HYPERLINK "http://www.lakartidningen.se/Klinik-och-vetenskap/Medicinens-ABC/2016/02/Praktisk-handlaggning-av-nasblodning/" Svensson 2016 ADDIN EN.CITE Svensson20162539[26]2539253917Svensson, U. K.Hellgren, J.ONH-kliniken - Sahlgrenska Goteborg, Sweden - Goteborg, Sweden.
ONH-kliniken - Sahlgrenska Goteborg, Sweden Institutionen for Kliniska Vetenskaper - Avdelningen for ONH Goteborg, Sweden.[Not Available]LakartidningenLakartidningenLakartidningenLakartidningenLakartidningenLakartidningen1132016/03/02Ambulatory CareCritical PathwaysEpistaxis/etiology/*therapyHumansNose/blood supplyPractice Guidelines as TopicSweden2016Feb 23ABC om - Praktisk handlaggning av nasblodning.0023-720526928680NLMswe[26] s3-5)
DEL III: PROCEDURSEDERING
1-Procedursedering genomfrt av akutlkare
a) Vad har Holland fr erfarenhet gllande PSA genomfrt av akutlkare? ( HYPERLINK "https://www.ncbi.nlm.nih.gov/pubmed/?term=27797871" 2016 Smits ADDIN EN.CITE ADDIN EN.CITE.DATA [27] abstract)
2-American Society of Anaesthetics (ASA) Physical Status Classification
Infr procedursedering genomfrs en risk-nytta bedmning av lmpligheten av procedursedering fr patienten. ASA score ger ett stt att klassificera patientens risk fr morbiditet och mortalitet i samband med generell anestesi. Fyll i fljande tabell ( HYPERLINK "http://swesem.org/category/Utbildning/SWESEMs-utbildningsmaterial" SWESEMS UTBILDNINGSMATERIAL Procedursedering s7; ven Roberts 6th Chapter 33 s588)
ASA 1ASA 2
ASA 3
ASA 4
ASA 5
3-LEMON Law
a) Vad str LEMON fr? (Rosen's 9th ed Chapter 01 s4 eller HYPERLINK "http://swesem.org/category/Utbildning/SWESEMs-utbildningsmaterial" SWESEMS UTBILDNINGSMATERIAL Endotracheal intubation Anteckning 26)
b) Vad menas med "the 3-3-2" rule? (Rosen's 9th ed Chapter 01 s5 eller HYPERLINK "http://swesem.org/category/Utbildning/SWESEMs-utbildningsmaterial" SWESEMS UTBILDNINGSMATERIAL Endotracheal intubation Anteckning 26)
c) Hur ser en Mallampati Class III ut? (Rosen's 9th ed Chapter 01 s5 eller HYPERLINK "http://swesem.org/category/Utbildning/SWESEMs-utbildningsmaterial" SWESEMS UTBILDNINGSMATERIAL Endotracheal intubation Anteckning 26)
d) Hur knsliga r bedside underskningar fr att frutse svrigheter vid laryngoskopi, intubation, ventilation? ( HYPERLINK "https://www.ncbi.nlm.nih.gov/pubmed/?term=29761867%5Buid%5D" Roth 2018 ADDIN EN.CITE Roth20182427[28]2427242717Roth, D.Pace, N. L.Lee, A.Hovhannisyan, K.Warenits, A. M.Arrich, J.Herkner, H.Department of Emergency Medicine, Medical University of Vienna, Wahringer Gurtel 18-20, Vienna, Austria, A-1090.Airway physical examination tests for detection of difficult airway management in apparently normal adult patientsCochrane Database Syst RevThe Cochrane database of systematic reviewsCochrane Database Syst RevThe Cochrane database of systematic reviewsCochrane Database Syst RevThe Cochrane database of systematic reviewsCd00887452018/05/162018May 151361-61372976186710.1002/14651858.CD008874.pub2NLMeng[28] abstract)
4-Utrustning & Personal
a) Vilken utrustning br vara tillgnglig vid procedursedering? ( HYPERLINK "http://swesem.org/category/Utbildning/SWESEMs-utbildningsmaterial" SWESEMS UTBILDNINGSMATERIAL Procedursedering s10 + s14; det rcker att bara lsa listan)
b) Vilka personal rekommenderas nrvara vid procedursedering med Propofol, Ketalar, IV Midazolam, Fentanyl enligt SWESEM? ( HYPERLINK "http://swesem.org/category/Utbildning/SWESEMs-utbildningsmaterial" SWESEMS UTBILDNINGSMATERIAL Procedursedering s11)
5-Monitorering
a) Vad r fallgroppen med att SpO2% monitorering? (Roberts 6th Chapter 33 s591)
6-Midazolam
a) Sedering eller smrtstillning? (Roberts 6th Chapter 33 s597)
b) Doser och tider: fyll i fljande tabell (Roberts 6th Chapter 33 s598)
IVIMPODos vuxen?Dos barn?Inslagstid?Duration?
c) Hur reverserar man Midazolam? (Roberts 6th Chapter 33 s610)
7-Propofol
a) Sedering eller smrtstillning? (Roberts 6th Chapter 33 s604-605)
b) Nr r propofol kontraindicerad? (Roberts 6th Chapter 33 s604-605)
c) Doser och tider: fyll i fljande tabell (Roberts 6th ed Chapter 33 s599)
IVDos vuxen?Dos barn?Inslagstid?Duration?
8-Fentanyl
a) Sedering eller smrtstillning? (Roberts 6th Chapter 33 s605-606)
b) Doser och tider: fyll i fljande tabell (Roberts 6th Chapter 33 s599)
IVDos vuxen?Dos barn?Inslagstid?Duration?
c) Hur behandlar man "rigid chest syndrome"? (Roberts 6th Chapter 33 s606)
d) Hur reverserar man Fentanyl? (Roberts 6th Chapter 33 s600)
9-Alfentanil (Rapifen)
a) Doser och tider: fyll i fljande tabell (Rosen's 9th Chapter 4 Tables 4.3 and 4.4)
IVDos vuxen?Inslagstid?Duration?
10-Ketalar
a) Sedering eller smrtstillning? (Roberts 6th Chapter 33 s606-607)
b) Biverkningar / kontraindikationer? (Roberts 6th Chapter 33 s603)
c) Doser och tider: fyll i fljande tabell (Roberts 6th Chapter 33 s599) (notera att vi har Esketamin (Ketanest), vilket r ca dubbelt s potent som Ketalar)
IVIMDos vuxen?Dos barn?Inslagstid?Duration?
Vid intresse finns mer om Ketamin i fljande artikel: HYPERLINK "https://www.ncbi.nlm.nih.gov/pubmed/?term=21256625" Green 2011 ADDIN EN.CITE Green20111847[29]1847184717Green, S. M.Roback, M. G.Kennedy, R. M.Krauss, B.Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, CA 92354, USA.Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 updateAnn Emerg MedAnnals of emergency medicineAnn Emerg MedAnnals of emergency medicineAnn Emerg MedAnnals of emergency medicine449-615752011/01/25*Anesthetics, Dissociative/administration & dosage/adverse effectsConscious Sedation/methods/*standardsEmergency Service, Hospital/*standardsHumans*Ketamine/administration & dosage/adverse effects*Practice Guidelines as Topic2011May0196-06442125662510.1016/j.annemergmed.2010.11.030NLMeng[29].
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Eric Dryver, SUS Lund
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