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Management of Acute Airway Obstruction
An acute upper airway obstruction (UAO) is a blockage that occurs in your upper airway. The upper airway of your respiratory system consists of the trachea, larynx or voice box, and throat. A blockage in your airway could prevent your body from getting enough oxygen. A lack of oxygen can cause brain damage, and even a heart attack, in a matter of minutes. Any obstruction of the upper airway has the potential to be life-threatening. Seek emergency medical attention immediately if you suspect that you, or someone you know, has an obstructed upper airway.Acute airway obstruction (the foreign body either completely obstructs the pharynx or acts as a valve on the laryngeal inlet), no warning signs, most frequently in a child 6 months-5 years playing with a small object or eating. Conscience is initially maintained. Perform maneuvers to relieve obstruction only if the patient cannot speak or cough or emit any sound: Children over 1 year and adults: Heimlich manoeuvre: stand behind the patient. Place a closed fist in the pit of the stomach, above the navel and below the ribs. Place the other hand over fist and press hard into the abdomen with a quick, upward thrust. Perform one to five abdominal thrusts in order to compress the lungs from the below and dislodge the foreign body. Children under 1 year: Place the infant face down across the forearm (resting the forearm on the leg) and support the infant’s head with the hand. With the heel of the other hand, perform one to five slaps on the back, between shoulder plates. If unsuccessful, turn the infant on their back. Perform five forceful sternal compressions as in cardiopulmonary resuscitation: use 2 or 3 fingers in the center of the chest just below the nipples. Press down approximately one-third the depth of the chest (about 3 to 4 cm).
About the Speaker
Dr Pooja Wadwa
Additional Director, Critical Care Medicine, ECMO specialist,FMRI,Gurgoan
Case Discussion on Acute Coronary Syndrome
Acute Coronary Syndrome (ACS) is a term used to describe a group of potentially life-threatening conditions related to the heart and blood vessels. ACS encompasses a spectrum of cardiac emergencies, including unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). The hallmark of ACS is inadequate blood supply to the heart muscle due to partial or complete blockage of coronary arteries, often caused by atherosclerosis or blood clot formation. STEMI, the most severe form of ACS, is characterized by ST-segment elevation on an electrocardiogram and demands immediate reperfusion therapy, such as angioplasty or thrombolytic drugs, to restore blood flow to the affected area. NSTEMI and unstable angina are also serious conditions requiring medical attention. NSTEMI involves elevated cardiac biomarkers but no ST-segment elevation, while unstable angina presents with chest pain at rest or with minimal exertion and no biomarker elevation.
Management of Stroke in ICU
Rapid transfer of stroke patients to the ICU allows for immediate assessment and intervention.Continuous monitoring of vital signs, neurological status, and oxygen saturation is essential to detect changes promptly. Administration of clot-dissolving agents like tissue plasminogen activator (tPA) within the therapeutic window can restore blood flow in ischemic stroke patients. For large vessel occlusion, mechanical removal of the clot using catheter-based techniques can be performed in eligible patients. Maintain stable blood pressure and perfusion to the brain while avoiding extremes that might exacerbate cerebral edema or hemorrhage. Ensure proper airway management and oxygenation to prevent secondary brain injury. Frequent imaging (CT or MRI) monitors for changes in brain structure, blood flow, and response to treatment. Continuous ICP monitoring helps manage elevated pressure and prevent cerebral herniation.
Optimizing Antibiotic Therapy in the critically ill Patients
Optimizing antibiotic therapy in critically ill patients is a crucial aspect of modern healthcare. Critically ill patients often face severe infections, and appropriate antibiotic treatment can significantly impact their outcomes. However, due to various factors such as altered pharmacokinetics, drug interactions, and the emergence of antibiotic-resistant pathogens, selecting the right antibiotic regimen can be challenging. This short intro explores the importance of tailoring antibiotic therapy to individual patients, considering the severity of their condition, microbiological data, and the prudent use of antibiotics to achieve optimal outcomes in critically ill settings.
Management of Delirium in Critical Care
Delirium in critical care requires prompt recognition and management due to its association with poor patient outcomes. Multidisciplinary collaboration is essential for effective delirium management in the critical care setting. The use of validated delirium assessment tools, such as the Confusion Assessment Method for ICU (CAM-ICU), aids in early detection. Identifying and addressing underlying causes, such as infections, medication interactions, and metabolic imbalances, is crucial in managing delirium. Non-pharmacological interventions, including maintaining a consistent environment and promoting sleep, can help prevent and manage delirium. When pharmacological intervention is necessary, low-dose antipsychotics like haloperidol or quetiapine are commonly used. However, caution should be exercised with antipsychotic use, especially in elderly patients, due to the risk of adverse effects. Dexmedetomidine, an alpha-2 adrenergic agonist, has shown promise in managing delirium while promoting sedation and analgesia. Regularly reassessing the patient's cognitive status and delirium risk factors is essential to tailor management strategies.
Pulmonary Embolism in ICU
Pulmonary embolism is a critical condition that often requires immediate attention and intervention when it occurs in the ICU. It is commonly caused by deep vein thrombosis (DVT), where a blood clot from the legs or pelvis travels to the lungs. PE can lead to impaired blood flow to the lungs, resulting in decreased oxygenation and potential respiratory failure. Patients in the ICU may have multiple risk factors for developing pulmonary embolism, such as immobility, surgery, trauma, cancer, or previous history of DVT. Diagnosis is challenging in the ICU due to the presence of various other conditions with similar symptoms, such as sepsis or acute respiratory distress syndrome (ARDS). Common symptoms of PE in ICU patients include sudden onset of shortness of breath, chest pain, rapid heart rate, and low blood pressure. The use of imaging modalities like CT pulmonary angiography is crucial for a timely and accurate diagnosis of PE in the ICU. Anticoagulation therapy with medications like heparin is often initiated promptly to prevent further clot formation and reduce the risk of complications.