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Chemistry Anesthesia Presentation

Transcript: Kaitlyn Almquist Anesthesia General Anesthesia https://www.medicalnewstoday.com/articles/265592.php https://www.qmul.ac.uk/media/news/2017/smd/major-grant-awarded-to-resolve-debate-on-treatment-after-major-surgery.html C12H18O Propofol https://en.m.wikipedia.org/wiki/Propofol John B. Glen Origin http://www.laskerfoundation.org/awards/show/discovery-and-development-propofol-widely-used-anesthetic/ https://www.dentistrytoday.com/news/industrynews/item/1589-patients-prefer-propofol-for-sedation Uses https://spectrum.ieee.org/the-human-os/biomedical/diagnostics/in-hospital-intensive-care-units-ai-could-predict-which-patients-are-likely-to-die https://blog.radiology.virginia.edu/mri-definition-kids-imaging/ https://www.vetpet.com/veterinary-services/veterinary-surgery.html Physical and Chemical Properties https:/www.pfizerinjectables.com/products/Propofol http://www.healthyblackwoman.com/nurses-doctors-abusing-the-drug-that-ended-michael-jacksons-life/ Reaction https://webbook.nist.gov/cgi/cbook.cgi?ID=C2934078&Mask=8 Phenol, 2,4,6-tris(1-methylethyl)- Phenol, 2-(1-methylethyl)- Propofol Phenol, 2,4-bis(1-methylethyl)- Interesting Facts https://www.tmz.com/2012/05/24/propofol-conrad-murray-missouri-michael-jackson/ https://www.theodysseyonline.com/dorys-short-term-memory-loss https://www.asahq.org/whensecondscount/anesthesia-101/types-of-anesthesia/general-anesthesia/ https://en.m.wikipedia.org/wiki/Propofol https://pubchem.ncbi.nlm.nih.gov/compound/propofol#section=Boiling-Point https://webbook.nist.gov/cgi/cbook.cgi?ID=C2934078&Mask=8 Sources

Background presentation

Transcript: Go on Exchange present your country abroad Work with different mentalities Diversity Explore different cultures Be a Member Develop your skills Have an impact Enrich your knowledge AIESEC Be a Leader Lead your team Achieve your vision Coach others Be a mentor EXPERIENCE YOUR AIESEC JOURNEY Gives you a great experience

Epidural Anesthesia Presentation

Transcript: Epidural anesthesia decreases pulmonary function during labor. Lung function is decreased during the procedure due to the motor blockade. Women that have severe asthma or chronic pulmonary disease need to put this information into consideration. An epidural anesthesia is the best method of anesthesia for postoperative outcome and has the lowest chance of postoperative pulmonary complications (Groeben 290). The purpose of this analysis is to provide an overview for anesthesiologists, obstetrics professionals, and women considering an epidural anesthesia (Merrill 1). Anesthesia and analgesia are interchangeable terms, analgesia is just one general aspect of anesthesia. Works Cited Thesis Statement Epidural Anesthesia and Health Risks Neurological Deficits Following Epidural or Spinal Anesthesia (Halpern et al.) Effects of Epidural vs Paternal Opioid Analgesia on the Progression of Labor Epidural anesthesia provides numerous benefits for women in labor. It prevents both, the adverse biochemical changes and stress during labor. The procedure also prepares women for the possibility of forceps, cesarean section, or the delivery of a second twin without the need for general anesthesia. This method is also beneficial for women with pre-eclampsia; this method suppresses noradrenaline contractions, instead producing beneficial haemodynamic changes ( Reynolds 751). Epidural Analgesia in Obstetrics Paralysis can occur after an epidural anesthesia procedure. The paralysis occurs in three out of fifty thousand women that have an epidural anesthesia during labor. The paralysis has lasted from seventy two hours up to four months after the procedure (Kane 150).The paralysis could have been caused by being administered a toxic chemical or by a chemical contamination of the anesthesia (Kane 159). " Epidural anesthesia for women in labor may be beneficial at the time of labor, but it is not always beneficial for women in the long run" (Merrill 1). Epidural Anesthesia and Pulmonary Function Women that experience labor at night have to deal with the increased risk of an unintentional dural puncture in the lower back. The unintentional dural puncture is caused from the anesthesiologist being fatigued, motor skills not as sharp, and less focused. A dural puncture can occur at any time of day this causes backaches and headaches for an unspecified duration after the epidural anesthesia procedure (Aya 666). Increased Risk of Unintentional Dural Puncture in Night-time Obstetric Epidural Anesthesia Epidural Analgesia Compared With Combined Spinal-Epidural Analgesia During Labor in Nulliparous Women Epidural anesthesia prevents walking during labor, for the procedure causes a motor blockade. A combined spinal-epidural anesthesia injection is a one time injection that allows for movement. This procedure is a one time injection, unlike an epidural anesthesia which remains in during labor. Since this method does not cause a motor blockade their is no chance of paralysis (Nageotte et al.). Images found on google images

Background Presentation

Transcript: 14th Week Consulting interns can be expensive Time and Money Personal Experience Preliminary Design Stage NFPA 101 and NFPA 13 New and Existing Education, Business, and Mercantile Definition of Project This app would be used to provide interns and recent graduates with an outline of guidelines for how to design and review designs of specific occupancies. With the given time frame, I will be writing the information that will go into the app Begin parametric study: Speak with my mentor and Jason to understand more about what critical variables I could concentrate on for this app. Choose those parameters and begin my study Gather information from NFPA 101 and NFPA 13 for new and existing education, business, and mercantile occupancies. By: Breanne Thompson Next Steps (Continued) Finish preparing for Draft of Analysis Pull together and discuss results of project Draw my conclusions and state future work needed Turn in Final Paper! 10th and 11th Week Turn in my parametric study Begin draft of analysis Map out the process of the app for the key elements 15th Week References Next Steps 7th Week Prepare for Final Presentation Summarize my draft of analysis into presentation Work on how to incorporate a live demonstration for my presentation App Development Background Information 8th-9th Week Continuous Process Objective-C for Apple products Java for Android products 6 months of studying Places to Learn: Codecademy, iOS Dev Center, Android Developers Training Hire App Developer will cost thousands Prepare Final Paper Dive into Shark Tank! 1. http://lifehacker.com/5401954/programmer-101-teach-yourself-how-to-code 2. http://www.bluecloudsolutions.com/blog/cost-develop-app/ 6th Week Background Presentation 12th-13th Week

Background Presentation

Transcript: Real action and accountability Amnesty International Non-state actors/ Rebel Groups?? ...and what about men?? ignoring male rape victims? would rape exist without a man? Weapons of War: Rape UN as an Arena - NGO's - Discussion and dialogue Arena Instrument Actor Critical Thinking Weapons of War: Rape UN as an instrument UNSC Resolution 1820 (2008) UN as an Actor - UN Action Against Sexual Violence in Conflict Weapons of War: Rape Problems with 1820 "Roles and Functions of International Organizations" "Sexual violence, when used as a tactic of war in order to deliberately target civilians or as a part of a widespread or systematic attack against civilian populations, can significantly exacerbate situations of armed conflict and may impede the restoration of international peace and security… effective steps to prevent and respond to such acts of sexual violence can significantly contribute to the maintenance of international peace and security" (UNSC Resolution 1820, p. 2)" http://www.stoprapenow.org/uploads/advocacyresources/1282164625.pdf Background Presentation- Kristin Mann Weapons of War: Rape Brief Insight - used to manipulate social control - destabilize communities - weaken ethnic groups and identities Examples: - Sudanese Militia - Rwanda Genocide - DRC Critical Thinking http://www.womenundersiegeproject.org/blog/entry/the-need-for-numbers-on-rape-in-warand-why-theyre-nearly-impossible-to-get Critical Thinking Increased Data Collection by international organizations - determine humanitarian responses - ensures justice and reparation - provides recognition and dignity

Anesthesia Presentation

Transcript: Anesthesia Day Patient History • NPO 34 y.o. F NKA 5'7'' 190 lb.s • Pre-op Meds: • Ranitidine 150 mg • Ancef 2g • Pre-op Labs: • Type & Screen #1 2018 36.9°C 36.8°C 18.0°C

Anesthesia Case Presentation

Transcript: REVIEW OF SYSTEMS Standard PACU monitoring (EKG, sO2, NIBP, temp) Pain can be treated with Hydromorphone in 0.2mg doses PONV can be treated with additional doses of Zofran 4mg q4h to maximum of 16mg Maintain normal hemodynamics (BP and HR within 20% of baseline) QUESTION 1 PATIENT AND PROCEDURE ANALYSIS: ASA 3 PLAN Induction & Airway ALL at age 6 treated with Anthracycline chemotherapy HTN (Controlled on metoprolol (baseline 142/75)) N/V and motion sickness (No treatment) Diagnosed OSA (patient snores loudly and wakes up at night) - does not tolerate his nasal CPAP BPH CVA (without deficit) preceding heart transplant Gout (Takes prenisone, recent flare up s/p prednisone dose increase) HLD Works out every other day (heavy weight lifting and cardio) Discussion with surgeon regarding positioning prone position may require ETT intubation, which will require relaxation and subsequent reversal. Research shows that ProSeal LMA can be inserted and used in the prone position, and provides a seal up to 30cm H2O, reducing induction-incision time and increasing intraoperative hemodynamic stability (Brimacombe, et al, 2007) (Wekseler, et al, 2007) ultimately decided on a lateral position with the ProSeal LMA H&P reviewed Review tests as indicated from H&P TTE, Dobutamine Stress Echo, EKG, Right Heart Catheterization, Cardiac Consult (heart transplant, HTN) BUN, SCr, Renal Consult (kidney transplant) CBC (rectal bleeding) Plan discussed with patient. Consent signed and confirmed. Renal Positioning: left lateral position with right arm free draped T&S verified at blood bank Standard ASA Monitors 16-20g x 1 IV required Fluids at 5-8mL/kg/hr Ancef 1g Disposition planning: to PACU, then home thorough report to PACU nurse, verifying understanding of patient considerations Emergence Anthracycline induced cardiomyopathy s/p Orthotopic Heart Transplant in 2000 GETA with no complications noted Echo showed moderate LVH, with normal LV function (EF 55-60%) Right Heart Cath showed RV systolic pressure of 24-38 mmHg, PAP of 24/11 mmHg and Cardiac Index of 2.4 L/min/m2 Dobutamine Stress Echo from 6/2014 showed no evidence of ischemia EKG was NSR at 90 BPM CXR showed no evidence of cardiomegaly Cardiac consult: stable cardiac function with normal LV function and no evidence of vasculopathy Maintenance Cardiac Transplanted Heart transplanted heart has no sympathetic, parasympathetic, or sensory innervation, and the loss of vagal tone results in a higher than normal resting heart rate no sympathetic response to surgical stimulation, intubation, or hypovolemia is "Preload Dependent" because the heart cannot increase its rate to increase cardiac output (severed connection to carotid baroreceptors) When hepatic and renal function are normal, there is no contraindication to the use of any anesthetic drug. (Akhtar, 2012) Case reports show refractory bradycardia leading to asystole after administration of anticholinesterase neostigmine (unresponsive to anticholinergic treatment because of denervation of the heart) Indirect acting sympathomimetics are ineffective at increasing heart rate - must use epinephrine or isoproterenol EF 55-60%, negative stress echo with excellent exercise tolerance, and the patient will continue his beta blocker perioperatively. With an understanding of transplanted cardiac physiology, there is no contraindication to the planned procedure. QUESTION 2 Other PAST MEDICAL HISTORY Cancer QUESTIONS At conclusion of surgery, LMA should be removed deep to prevent coughing/bucking and potential dehiscence at surgical site adequate Vt (at least 5mL/kg) and RR (10-20/min) should be used as guides RR can guide fentanyl during emergence Treat hypotension with phenylephrine, Hypertension with Labetalol or fentanyl If plan B must be used, treat refractory bradycardia during reversal with epinephrine Transfer patient to PACU with 3L O2 via NC, give detailed report to PACU nurse, including recommendations QUESTION 4 How is the innervation of the transplanted heart different from the native heart? Akhtar, S. (2012). Ischemic Heart Disease. In Hines, R. L. & Marschall, K.E. (Eds), Stoelting's anesthesia and co-existing disease (pp. 1-30). Philadelphia: Elsevier Saunders. Brimacombe J. R., Wenzel V., Keller C. (2007) The proseal laryngeal mask airway in prone patients: A retrospective audit of 245 patients. Anaesthesia Intensive Care, 35(2):222-5. Jaffe, R. A. (2014). Anesthesiologist's manual of surgical procedures. Philadelphia: Walters Kluwer Health. Morgan, G.E., Mikhail, M. S., Murray, M. J. (2006). Clinical anesthesiology. McGraw Hill. Weksler N., Klein M., Rozentsveig V., Weksler D., Sidelnik C., Lottan M., Gurman G.M. (2007). Laryngeal mask in prone position: Pure exhibitionism or a valid technique. Minerva Anestesiology 73(1-2):33-7. Which special considerations do we take for the kidney transplant recipient? Prednisone (recently increased to 40mg) (will take DOS) Lopressor 25mg (will take DOS) ASA 81mg (continued in

Background Presentation

Transcript: Death rate 2012: 12.84 deaths/1,000 population (World ranking: 22) Infant (Child Mortality) Total: 79.02 deaths/1,000 live births (world ranking: 10) HIV/AIDS (2) Appropriate Technology Landlocked country Great African Rift Valley system: East – Lake Malawi South – mountains, tropical palm-lined beaches Mainly a large plateau, with some hills Lake Malawi (Lake Nyasa) Almost 1 million people have AIDS 60% of these are female Declining in urban areas, Rising in rural areas Leading cause of death amongst adults Contributes to the low life expectancy: 54.2 years 209th ranking (One of the lowest) 500,000 children have been orphaned due to AIDs Micro-finance Policy Framework and Strategies (Health SWAp) increasing the availability and accessibility of antenatal services; utilization of skilled health personnel during pregnancy, childbirth and postnatal period at all levels of the health system; strengthening the capacity of individuals and institutions to improve maternal and neonatal health; increasing the number of skilled health personnel; constructing and upgrading health facilities to offer essential health services particularly focusing on rural and underserved areas; and provision of ARVs and micronutrients during pregnancy. Geography of Malawi CCST 9004 Appropriate Technology for the Developing World Indicator 3: Literacy Rate of 15 – 24 year-olds According to the World Bank, microfinance is defined as: Microfinance is the provision of financial services to the entrepreneurial poor.This definition has two important features:it emphasizes a range of financial services—not just credit— and it emphasizes the entrepreneurial poor. Goal 2: Achieve Universal Primary Education Appropriate Technology: SIRDAMAIZE 113 Population: 16,777,547 (estimated in July 2013) Population growth rate: 2.758% (2012 est.) (World ranking: 18) Age structure Children: 50% of total population HIV/AIDS Human Resources Education Poverty Food Insecurity Erratic Rainfall Patterns/Droughts Corruption Lack of Foreign Investment Languages Indicator 5: Proportion of seats held by women in National Parliaments Central Region: 1-9 (Yellow) *Capital: Lilongwe Northern Region: 10-15 (Red) Southern Region: 16-27 (Green) Lake Malawi (Blue) Land surface area 45,747 square miles Challenges: · shortage of qualified primary school teachers; · inadequate physical infrastructure; · poor retention of girls mainly from standard five to eight; · high disease burden due to HIV and AIDS consequently leadinto absenteeism, especially among girls who take care of the sick · Poverty levels are high in rural areas. Malawi – Climate/Agriculture Trading partners: South Africa, Zambia, China, US Challenges: · shortage of qualified primary school teachers; · inadequate physical infrastructure; · poor retention of girls mainly from standard five to eight; · high disease burden due to HIV and AIDS consequently leading to absenteeism especially among girls who take care of the sick; and · poor participation of school committees and their communities in school management. · Poverty levels are high in rural areas. 1 Doctor per 50,000 people Hinders the ability to deliver medical services to people in need Reason: Emigration Lack of access to education Aggravated by AIDS > 4 nurses are lost each month This also affects other sectors: Government Business Farmers Human Resources HIV/AIDS - Contemporary GDP: US $14.58 billion (2012 est.) (World ranking: 142) Labor force: agriculture: 90%; industry and services: 10% (2003 est.) Countries main income Agriculture Main crops: maize, tobacco, tea, sugar cane, groundnuts, cotton, wheat, coffee, and rice Industry: tobacco, tea, sugar, sawmill products, cement, consumer goods Challenges: limited capacity in terms of human and material resources to facilitate adult literacy and continuing education; early marriages perpetuated by socioeconomic factors; socio–cultural factors that make people believe that men should be leaders while women are followers; and, poor learning environment which affects girls in primary and secondary schools e.g. sanitary facilities, long distances to education facilities, extra burden from domestic chores especially for adolescent girls resulting into high dropout rate. 1964: Independent from Britain Indicator 1: Maternal Mortality Ratio Malawi Demographics Problems - Outline Indicator 4: Share of Women in Wage Employment in the Non- Agriculture Sector measure of employment opportunities ( i.e equal proportions of men and women in formal employment) Yet, more women participate in the agriculture sector than in the formal wage employment especially in jobs that require professional qualifications. Due to: literacy levels, gender disparity and cultural values. Facts About the Product: Drought tolerant maize variant Able to mature under limited rainfall Suitable for marginal rainfall areas 136 days to mature Normally: 150 – 180 days Able to mature under limited rainfall Suitable for marginal rainfall areas

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