martes, 7 de marzo de 2017

US de vía aérea / Airway ultrasound

Marzo 7, 2017. No. 2621



  



Ultrasonido laringotraqueal para confirmar la colocación correcta del tubo endotraqueal y ML
Laryngo-tracheal ultrasonography to confirm correct endotracheal tube and laryngeal mask airway placement.
J Ultrason. 2014 Dec;14(59):362-6. doi: 10.15557/JoU.2014.0037. Epub 2014 Dec 30.
Abstract
Waveform capnography was recommended as the most reliable method to confirm correct endotracheal tube or laryngeal mask airway placements. However, capnography may be unreliable during cardiopulmonary resuscitation and during low flow states. It may lead to an unnecessary removal of a well-placed endotracheal tube, re-intubation and interruption of chest compressions. Real-time upper airway (laryngo-tracheal) ultrasonography to confirm correct endotracheal tube placement was shown to be very useful in cadaveric models and during emergency intubation. Tracheal ultrasonography does not interrupt chest compressions and is not affected by low pulmonary flow or airway obstruction, but is limited by ultrasonography scattering and acoustic artifacts generated in air - mucosa interfaces. Sonographic upper airway assessment emerges as a rapid and easily available method to predict difficult intubation, to assess the laryngeal and hypopharyngeal size and visualize the position of the laryngeal mask airway in situ. This study demonstrates that the replacement of air with saline in endotracheal tube or laryngeal mask airway cuffs and the use of the contrast agents enables detection of cuffs in the airway. It also allows visualization of the surrounding structures or tissues as the ultrasound beam can be transmitted through the fluid - filled cuffs without being reflected from air - mucosal interfaces.
KEYWORDS: endotracheal intubation; laryngeal mask airway; upper airway sonography
PDF 

Ultrasonido: Una herramienta prometedora para el manejo contemporáneo de las vías respiratorias.
Ultrasound: A promising tool for contemporary airway management.
World J Clin Cases. 2015 Nov 16;3(11):926-9. doi: 10.12998/wjcc.v3.i11.926.
Abstract
Airway evaluation and its management remains an ever emerging clinical science. Present airway management tools are static and do not provide dynamic airway management option. Visualized procedures like ultrasound (US) provide point of care real time dynamic views of the airway in perioperative, emergency and critical care settings. US can provide dynamic anatomical assessment which is not possible by clinical examination alone. US aids in detecting gastric contents and the nature of gastric contents (clear fluid, thick turbid or solid) as well. US can help in predicting endotracheal tube size by measuring subglottic diameter and diameter of left main stem bronchus. US was found to be a sensitive in detecting rotational malposition of LMA in children. Also, US is the fastest and highly sensitive tool to rule out a suspected intraoperative pneumothorax. In intensive care units, US helps torule out causes of inadequate ventilation, determine the tracheal width and distance from the skin to predict tracheotomy tube size and shape and assist with percutaneous dilatational tracheostomy. US can help in confirming the correct tracheal tube placement by dynamic visualisation of the endotracheal tube insertion, widening of vocal cords (children), and bilateral lung-sliding and diaphragmatic movement. Thus, ultrasonography has brought a paradigm shift in the practise of airway management. With increasing awareness, portability, accessibility and further sophistication in technology, it is likely to find a place in routine airway management. We are not far from the time when all of us will be carrying a pocket US machine like stethoscopes to corroborate our clinical findings at point of care.
KEYWORDS: Airway; Difficult; Evaluation; Management; Ultrasound
PDF 
5to curso internacional Anestesiologia cardiotoracica_ vascular_ ecocardiografia y circulaci_n extracorporea.


Curso sobre Anestesia en Trasplantes, Cirugía abdominal, Plástica, Oftalmología y Otorrinolaringología.
Committee for European Education in Anaesthesiology (CEEA) 
y el Colegio de Anestesiólogos de León A.C.
Abril 7-9, 2017, León Guanajuato, México

Informes  (477) 716 06 16, kikinhedz@gmail.com
4° Congreso Internacional de Control Total de la Vía Aérea
Asociación Mexicana de Vía  Aérea Difícil, AC
Ciudad de México 21, 22 y 23 de Abril 2017
Informes: 
amvadmexico@gmail.com
Regional Anesthesiology and Acute Pain Medicine Meeting
April 6-8, 2017, San Francisco, California, USA
ASRA American Society of Regional Anesthesia and Pain Medicine
Like us on Facebook   Follow us on Twitter   Find us on Google+   View our videos on YouTube 
Anestesiología y Medicina del Dolor

52 664 6848905

Copyright © 2015

lunes, 6 de marzo de 2017

XVI Curso Internacional de Cirugía de la Mano / Homenaje al Dr. Luis Scheker / CDMX 2017


XVI Curso Internacional de Cirugía de la Mano / Homenaje al Dr. Luis Scheker / CDMX 2017




Los costos financieros y humanos asociados con fracturas osteoporóticas aumentarán exponencialmente si no se adoptan medidas preventivas

Ultrasonido pulmonar en pediatría / Lung ultrasound in pediatric

Marzo 6, 2017. No. 2620



  



Uso rutinario del ultrasonido pulmonar en neonatos en terapia intensiva
Routine application of lung ultrasonography in the neonatal intensive care unit.
Medicine (Baltimore). 2017 Jan;96(2):e5826. doi: 10.1097/MD.0000000000005826.
Abstract
The aim of this study was to study the features of lung ultrasonography (LUS) in lung disease and to evaluate the usefulness of LUS in the neonatal intensive care unit (NICU).All of 3405 neonates included in this study underwent an LUS examination. Diagnoses were based on medical history, clinical manifestation, laboratory examination, and signs on chest radiography (CR) and/or computed tomography (CT). A single expert physician performed all LUS examinations.There were 2658 cases (78.9%) with lung disease and 747 cases (21.9%) without lung disease. The main signs of neonates with lung disease on LUS were as follows: absence of A-lines, pleural-line abnormalities, interstitial syndrome, lung consolidation, air bronchograms, pulmonary edema, and lung pulse. These abnormal signs were reduced or eliminated on LUS as patient conditions improved. There were 81 cases that could not be diagnosed as lung disease by CR but were discovered as pneumonia, respiratory distress syndrome (RDS), or transient tachypnea of newborn (TTN) on LUS. Likewise, 23 cases misdiagnosed as RDS by CR were diagnosed as TTN on LUS. Among 212 cases of long-term oxygen dependence (LTOD) that failed to yield signs of pulmonary edema and lung consolidation on CR, 103 cases showed abnormal signs on LUS. Among 747 cases without lung disease, B-lines of 713 neonates (95.4%) could be found within 3 days after birth, and 256 neonates (34.3%) could be observed from 3 days to 1 week after birth. B-lines of 19 cases could be detected from 1 to 2 weeks after birth. The longest time at which B-lines could still be observed was 19 days after birth.LUS has clinical value for the diagnosis of lung disease and the discrimination of causes of LTOP in premature infants, particularly for the diagnosis and identification of RDS and TTN. Moreover, LUS has additional advantages, including its lack of radiation exposure and its ability to noninvasively monitor treatment progress. Therefore, LUS should be routinely used in the NICU.

Ultrasonido pulmonar. Una herramienta útil en el diagnóstico y tratamiento de la bronquiolitis
Lung ultrasound: a useful tool in diagnosis and management of bronchiolitis.
BMC Pediatr. 2015 May 21;15:63. doi: 10.1186/s12887-015-0380-1.
Abstract
BACKGROUND: Clinical assessment is the gold standard for diagnosis of bronchiolitis. To date, only one study found LUS (Lung Ultrasound) to be a valuable tool in the diagnosis of bronchiolitis. Aim of this study is to evaluate the accuracy of lung ultrasonography in the diagnosis and management of bronchiolitis in infants. METHODS: This was an observational cohort study of infants admitted to our Pediatric Unit with suspected bronchiolitis. A physical examination and lung ultrasound scans were performed on each patient. Diagnosis and grading of bronchiolitis was assessed according to a clinical and a ultrasound score. An exploratory analysis was used to assess correspondence between the lung ultrasound findings and the clinical evaluation and to evaluate the inter-observer concordance between the two different sonographs. RESULTS: One hundred six infants were studied (average age 71 days). According to our clinical score, 74 infants had mild bronchiolitis, 30 had moderate bronchiolitis and two had severe bronchiolitis. 25 infants composed the control group. Agreement between the clinical and sonographic diagnosis was good (90.6%) with a statistically significant inter-observer ultrasound diagnosis concordance (89.6%). Lung ultrasound permits the identification of infants who are in need of supplementary oxygen with a specificity of 98.7%, a sensitivity of 96.6%, a positive predictive value of 96.6% and a negative predictive value of 98.7%. An aberrant ultrasound lung pattern in posterior chest area was collected in 86% of infants with bronchiolitis. In all patients clinical improvement at discharge was associated with disappearance of the previous LUS findings. Subpleural lung consolidation of 1 cm or more in the posterior area scan and a quantitative classification of interstitial syndrome based on intercostal spaces involved bilaterally, good correlate with bronchiolitis severity and oxygen use. CONCLUSIONS: The lung ultrasound findings strictly correlate with the clinical evaluations in infants with bronchiolitis and permit the identification of infants who are in need of supplementary oxygen with high specificity. Scans of the posterior area are more indicative in ascertaining the severity of bronchiolitis.
5to curso internacional Anestesiologia cardiotoracica_ vascular_ ecocardiografia y circulaci_n extracorporea.


Curso sobre Anestesia en Trasplantes, Cirugía abdominal, Plástica, Oftalmología y Otorrinolaringología.
Committee for European Education in Anaesthesiology (CEEA) 
y el Colegio de Anestesiólogos de León A.C.
Abril 7-9, 2017, León Guanajuato, México

Informes  (477) 716 06 16, kikinhedz@gmail.com
4° Congreso Internacional de Control Total de la Vía Aérea
Asociación Mexicana de Vía  Aérea Difícil, AC
Ciudad de México 21, 22 y 23 de Abril 2017
Informes: 
amvadmexico@gmail.com
Regional Anesthesiology and Acute Pain Medicine Meeting
April 6-8, 2017, San Francisco, California, USA
ASRA American Society of Regional Anesthesia and Pain Medicine
Like us on Facebook   Follow us on Twitter   Find us on Google+   View our videos on YouTube 
Anestesiología y Medicina del Dolor

52 664 6848905

Copyright © 2015

miércoles, 1 de marzo de 2017

Fracturas proximales del húmero: Cirugía versus tratamiento conservador- PROFER Trial


Proximal Humerus fractures: Surgery Vs Conservative- PROFHER TrialDeciding on surgery vs no surgery for proximal humerus

Fuente
Este artículo es originalmente publicado en:
De y todos los derechos reservados para:
Courtesy: Saqib Rehman MD
Director of Orthopaedic Trauma
Temple University
Philadelphia
Pennsylvania
USA
Katharine Criner Woozley, MD. Hand and upper extremity surgeon, Albert Einstein Medical Center, Philadelphia, PA
From the 8th Annual Philadelphia Orthopaedic Trauma Symposium, June 11, 2016 at Lewis Katz School of Medicine at Temple University
  • Categoría
  • Licencia
  • Licencia de YouTube estándar