🫁 Tracheostomy 🔬 Definition ➡️ Tracheostomy is a surgical procedure where a permanent or temporary opening (called stoma) is created in the trachea (windpipe) through the neck. ➡️ A tracheostomy tube is inserted for breathing. Trachea = windpipe 🚇 → carries oxygen from nose/mouth to lungs. When this “road” is blocked 🚧, tracheostomy gives a new entry gate 🚪 directly into lungs. ⸻ 📍 Anatomy Involved • 👃 Nose → 🗣️ Pharynx → 🧵 Larynx (voice box) → 🛣️ Trachea → 🫁 Lungs • Tracheostomy tube is usually inserted below the cricoid cartilage (2nd–4th tracheal ring). 📌 Why here? ✔️ Safe zone (less vascular) ✔️ Away from vocal cords ✔️ Easy access ⸻ 🧑⚕️ Indications (When it’s Needed) 1. 🚫 Upper airway obstruction • Tumor, trauma, swelling, foreign body 2. ⏳ Prolonged ventilation (>7–10 days in ICU) 3. 💉 Major head/neck surgeries 4. 🤕 Neurological patients (stroke, spinal cord injury – poor airway protection) 5. 😷 Excess secretions → easier suctioning 6. 🫀 Post cardiac/thoracic surgeries with delayed extubation ⸻ ⚙️ Procedure – Step by Step 1. 💉 Local / general anesthesia given 2. ✂️ Horizontal / vertical incision on neck 3. 🧵 Soft tissue + strap muscles separated 4. ⛏️ Trachea identified → small window made 5. 🧪 Tube inserted + secured with tapes 6. 💨 Patient now breathes through tracheostomy ⸻ 🛠️ Types of Tracheostomy ⏳ By Duration • Temporary (ICU, post-op cases) • Permanent (laryngeal cancer, irreversible airway damage) 🧪 By Technique • Surgical tracheostomy (open, in OT) • Percutaneous tracheostomy (bedside in ICU using dilators) ⸻ 🌬️ Advantages • 🚪 Direct airway access • 💨 Easier ventilation for long term • 🧹 Suctioning secretions simple • 🔇 Can allow speech (with speaking valve) • 😌 More comfortable than prolonged ET tube ⸻ ⚠️ Complications 🩸 Early (hours–days) • Bleeding 🩸 • Pneumothorax 🫁💥 (air leak into chest) • Subcutaneous emphysema 💨 under skin • Tube displacement ❌ 🦠 Late (days–weeks) • Infection 🤒 • Tube blockage 🧱 by secretions • Tracheal stenosis (narrowing 🚧) • Tracheoesophageal fistula (abnormal opening 🔗) ⸻ 🏥 Nursing Care 1. 🧴 Suctioning secretions regularly 2. 💧 Humidified oxygen to prevent dryness 3. 🔄 Tube care & changing ties 4. 🧼 Stoma site cleaning (prevent infection) 5. 🛑 Emergency readiness → spare tube at bedside 6. 🗣️ Communication support → writing board, speaking valve ⸻ 📊 Comparison: Normal Breathing vs Tracheostomy 👃 Nose/Mouth → 🗣️ Larynx → 🛣️ Trachea → 🫁 Lungs ➡️ Normal route 🫁 Tracheostomy Neck stoma ➡️ Tube ➡️ Trachea ➡️ Lungs ➡️ Shortcut route 🚪

👉 “When the aortic endograft becomes the solution to prevent type II endoleak!” Context 60-year-old male with a large, painful aorto-iliac aneurysm extending to the right internal iliac artery. Prominent lumbar arteries and inferior mesenteric artery (IMA) → high risk of type II endoleak after standard EVAR. Open repair is a valid option, but we opted for endovascular exclusion. 🎯 Challenge Combine safety and durability in an urgent setting while neutralizing retrograde perfusion via the IMA and lumbar arteries—the usual culprits behind type II endoleaks. In a symptomatic, painful aneurysm, avoiding any endoleak altogether is preferable whenever possible. 🛠️ Strategy 1- Aortic cuff deployed across the ostia of the IMA and lumbar arteries → “one-shot” 💥 closure of these inflows (an “all-around embolization” effect without coils). 2- Bifurcated infrarenal endograft to exclude the aneurysm sac. Anesthesia: procedure performed under local anesthesia with light sedation. ✅ Outcomes Early and 1-year follow-up: no endoleak detected and no sac enlargement. Patient asymptomatic. ⚠️ Limitations / patient selection  Not a universal approach. Feasibility depends on: - Available aortic cuff diameters (oversizing, landing zone constraints). - Aneurysm sac configuration (geometry, alignment, ostial positions).   💡 Why it works - Eliminates the retrograde feeding route (IMA + lumbars) before exclusion. - Preserves EVAR advantages (lower peri-op morbidity/mortality, faster recovery) without paying the price of type II endoleaks. #EVAR #TypeIIEndoleak #Aneurysm #VascularSurgery #Endovascular #PatientSafety #Innovation Hugo Georgé W. L. Gore & Associates Louis Pasteur Santé

Day 118 🤩 🫁 Tracheostomy 🔬 Definition ➡️ Tracheostomy is a surgical procedure where a permanent or temporary opening (called stoma) is created in the trachea (windpipe) through the neck. ➡️ A tracheostomy tube is inserted for breathing. Trachea = windpipe 🚇 → carries oxygen from nose/mouth to lungs. When this “road” is blocked 🚧, tracheostomy gives a new entry gate 🚪 directly into lungs. ⸻ 📍 Anatomy Involved • 👃 Nose → 🗣️ Pharynx → 🧵 Larynx (voice box) → 🛣️ Trachea → 🫁 Lungs • Tracheostomy tube is usually inserted below the cricoid cartilage (2nd–4th tracheal ring). 📌 Why here? ✔️ Safe zone (less vascular) ✔️ Away from vocal cords ✔️ Easy access ⸻ 🧑⚕️ Indications (When it’s Needed) 1. 🚫 Upper airway obstruction • Tumor, trauma, swelling, foreign body 2. ⏳ Prolonged ventilation (>7–10 days in ICU) 3. 💉 Major head/neck surgeries 4. 🤕 Neurological patients (stroke, spinal cord injury – poor airway protection) 5. 😷 Excess secretions → easier suctioning 6. 🫀 Post cardiac/thoracic surgeries with delayed extubation ⸻ ⚙️ Procedure – Step by Step 1. 💉 Local / general anesthesia given 2. ✂️ Horizontal / vertical incision on neck 3. 🧵 Soft tissue + strap muscles separated 4. ⛏️ Trachea identified → small window made 5. 🧪 Tube inserted + secured with tapes 6. 💨 Patient now breathes through tracheostomy ⸻ 🛠️ Types of Tracheostomy ⏳ By Duration • Temporary (ICU, post-op cases) • Permanent (laryngeal cancer, irreversible airway damage) 🧪 By Technique • Surgical tracheostomy (open, in OT) • Percutaneous tracheostomy (bedside in ICU using dilators) ⸻ 🌬️ Advantages • 🚪 Direct airway access • 💨 Easier ventilation for long term • 🧹 Suctioning secretions simple • 🔇 Can allow speech (with speaking valve) • 😌 More comfortable than prolonged ET tube ⸻ ⚠️ Complications 🩸 Early (hours–days) • Bleeding 🩸 • Pneumothorax 🫁💥 (air leak into chest) • Subcutaneous emphysema 💨 under skin • Tube displacement ❌ 🦠 Late (days–weeks) • Infection 🤒 • Tube blockage 🧱 by secretions • Tracheal stenosis (narrowing 🚧) • Tracheoesophageal fistula (abnormal opening 🔗) ⸻ 🏥 Nursing Care 1. 🧴 Suctioning secretions regularly 2. 💧 Humidified oxygen to prevent dryness 3. 🔄 Tube care & changing ties 4. 🧼 Stoma site cleaning (prevent infection) 5. 🛑 Emergency readiness → spare tube at bedside 6. 🗣️ Communication support → writing board, speaking valve ⸻ 📊 Comparison: Normal Breathing vs Tracheostomy 👃 Nose/Mouth → 🗣️ Larynx → 🛣️ Trachea → 🫁 Lungs ➡️ Normal route 🫁 Tracheostomy Neck stoma ➡️ Tube ➡️ Trachea ➡️ Lungs ➡️ Shortcut route 🚪

🚨 AVF Creation Under the Block—Anticoagulation Uninterrupted Arteriovenous fistula (AVF) creation for hemodialysis is often performed under brachial plexus block. But what about patients who remain on anticoagulation perioperatively? 📚 This single-center retrospective study of 442 patients (101 on anticoagulation) compared interrupted vs. uninterrupted anticoagulation during AVF creation under ultrasound-guided regional anesthesia. ✅ Key findings: • No block site bleeding in either group at 30 days • Surgical site hematomas occurred in ~10% of patients, regardless of anticoagulation strategy • One reintervention required, otherwise events were nonoperative 💡 Takeaway: Uninterrupted anticoagulation during AVF creation with regional anesthesia was not associated with increased block- or surgical-site bleeding. These results support individualized, shared decision-making between surgeons, anesthesiologists, and patients. 📖 READ HERE -> https://lnkd.in/eAm6F9AV #RAPM #ASRA #RAPM #ASRA

✅ INCENTIVE SPIROMETRY ✅ What It Is: Incentive spirometry is a respiratory therapy technique that uses a handheld device to help patients breathe deeply. It is mainly used to prevent or treat lung complications, especially after surgery or during long bed rest. The goal is to: • Re-expand the lungs • Improve oxygenation • Prevent infections like pneumonia or atelectasis (collapsed lung) ✅ When It’s Used: Incentive spirometry is commonly recommended for patients who: • Have undergone abdominal or chest surgery • Are on prolonged bed rest • Have lung diseases (e.g., COPD, pneumonia) • Are recovering from rib fractures • Have weak respiratory muscles ✅ How to Use It (Step-by-Step): 1. Sit upright (in bed or a chair). 2. Hold the spirometer upright. 3. Exhale normally. 4. Place the mouthpiece in your mouth and seal your lips around it. 5. Inhale slowly and deeply through the mouthpiece. 6. Watch the indicator rise to the target level. 7. Hold your breath for about 3–5 seconds. 8. Remove the mouthpiece and exhale slowly. 9. Rest a few seconds. 10. Repeat 10 times every 1–2 hours, or as instructed. Many devices include: • A piston/chamber to show inhalation volume • An adjustable marker to set a target • A ball/indicator to show correct speed of inhalation ✅ Benefits: ✔ Prevents lung collapse (atelectasis) ✔ Improves lung expansion ✔ Reduces risk of pneumonia ✔ Clears secretions ✔ Improves breathing post-surgery ✔ Strengthens respiratory muscles ✅ Precautions: • Avoid rapid inhalation (can cause dizziness) • Clean the device daily • Stop if chest pain or severe discomfort occurs • Follow healthcare provider instructions ✅ Who Should Not Use It? Caution in patients with: • Severe respiratory distress • Uncontrolled pain • Facial or oral trauma • Very young children (unless assisted)

More Than Just a Cuff: The Anatomy Behind Accurate Blood Pressure Monitoring We all know the routine: the cuff tightens on your arm, and a few moments later, you get two numbers that define your "blood pressure." But have you ever stopped to think why we use the arm? The answer lies in understanding the vital arterial map, like the one in this image. While this diagram shows several key arteries, two are absolutely fundamental to cardiovascular assessment and blood pressure monitoring. 1. The Brachial Artery: The Gold Standard The artery labeled A in the upper arm is the Brachial Artery. This is the primary site for non-invasive blood pressure measurement. Here’s why: · Ideal Location: It's a major artery that is both close to the heart and easily accessible. Placing the cuff over the brachial artery allows us to accurately estimate the central aortic pressure. · The Sounds of Korotkoff: When a clinician uses a stethoscope to listen below the cuff, they are hearing the turbulent blood flow in the brachial artery. The point at which these sounds appear (systolic pressure) and disappear (diastolic pressure) gives us our critical readings. 2. The Radial Artery: The Pulse You Know The artery labeled B in the wrist is the Radial Artery. While we don't typically measure blood pressure here, its role is interconnected: · Pulse Checks: It’s the most common site for checking heart rate and rhythm. In critical care or during procedures, an arterial line can be placed here for continuous, direct blood pressure monitoring, providing a real-time waveform and precise values. What About the Leg Arteries? A Story of Comparison The arteries in the leg—like the Popliteal (C) and Dorsalis Pedis—are not used for routine blood pressure checks. However, they are critically important for one key reason: the Ankle-Brachial Index (ABI). The ABI is a simple, non-invasive test that compares the blood pressure in your ankle (using the posterior tibial or dorsalis pedis arteries) to the blood pressure in your brachial artery. A significant difference between the two is a primary screening tool for Peripheral Artery Disease (PAD). Key Takeaways for Professionals and Patients: · Precision Matters: Proper cuff placement directly over the brachial artery is essential for an accurate reading. An error here can lead to misdiagnosis and improper management. · It’s a Systemic Picture: Blood pressure isn't just about the arm. Comparing pressures in different parts of the body (like with the ABI) provides a powerful snapshot of overall vascular health. · Understanding Drives Compliance: When patients understand the "why" behind a simple test, it fosters better engagement and adherence to monitoring protocols. #medical #hospital #nurse #emergency #critical #cardiology #preoperative #postoperative

More Than Just a Cuff: The Anatomy Behind Accurate Blood Pressure Monitoring We all know the routine: the cuff tightens on your arm, and a few moments later, you get two numbers that define your "blood pressure." But have you ever stopped to think why we use the arm? The answer lies in understanding the vital arterial map, like the one in this image. While this diagram shows several key arteries, two are absolutely fundamental to cardiovascular assessment and blood pressure monitoring. 1. The Brachial Artery: The Gold Standard The artery labeled A in the upper arm is the Brachial Artery. This is the primary site for non-invasive blood pressure measurement. Here’s why: · Ideal Location: It's a major artery that is both close to the heart and easily accessible. Placing the cuff over the brachial artery allows us to accurately estimate the central aortic pressure. · The Sounds of Korotkoff: When a clinician uses a stethoscope to listen below the cuff, they are hearing the turbulent blood flow in the brachial artery. The point at which these sounds appear (systolic pressure) and disappear (diastolic pressure) gives us our critical readings. 2. The Radial Artery: The Pulse You Know The artery labeled B in the wrist is the Radial Artery. While we don't typically measure blood pressure here, its role is interconnected: · Pulse Checks: It’s the most common site for checking heart rate and rhythm. In critical care or during procedures, an arterial line can be placed here for continuous, direct blood pressure monitoring, providing a real-time waveform and precise values. What About the Leg Arteries? A Story of Comparison The arteries in the leg—like the Popliteal (C) and Dorsalis Pedis—are not used for routine blood pressure checks. However, they are critically important for one key reason: the Ankle-Brachial Index (ABI). The ABI is a simple, non-invasive test that compares the blood pressure in your ankle (using the posterior tibial or dorsalis pedis arteries) to the blood pressure in your brachial artery. A significant difference between the two is a primary screening tool for Peripheral Artery Disease (PAD). Key Takeaways for Professionals and Patients: · Precision Matters: Proper cuff placement directly over the brachial artery is essential for an accurate reading. An error here can lead to misdiagnosis and improper management. · It’s a Systemic Picture: Blood pressure isn't just about the arm. Comparing pressures in different parts of the body (like with the ABI) provides a powerful snapshot of overall vascular health. · Understanding Drives Compliance: When patients understand the "why" behind a simple test, it fosters better engagement and adherence to monitoring protocols. #medical #hospital #nurse #emergency #cardiology #preoperative #postoperative #MohamedReda #Linkedin

✨ “Limited manpower. Septic shock. Difficult airway. Urgent laparotomy. This was one of those nights that tested every skill of an anesthesiologist.” 🚨 Emergency Laparotomy in Sepsis: An Anesthesiologist’s Challenge It was 6:30 PM when we had to make a “now or never” decision. A 65-year-old gentleman with acute abdomen, initially managed conservatively, deteriorated rapidly. Total counts dropped from 15K to 2.1K, acidosis worsened, INR rose to 1.5. The diagnosis: perforation around the pylorus. The Anesthesia Journey 🩺 In the evening with limited manpower, we briefed the team and moved him to the OR. Arterial line and right IJV CVC were secured under superficial cervical plexus block. Low-dose noradrenaline was started. Induction was slow — Propofol, Fentanyl, RSI with Rocuronium. Initial laryngoscopy with Macintosh revealed a CL grade 3b, so intubation was achieved using a Macoy #4. BP fluctuations were managed with noradrenaline titration and fluids. A four-quadrant TAP block (0.2% Ropivacaine) pre-incision minimized opioid use. Intraoperative Hurdles ⚡ The surgeon found a pyloric perforation. At this point, we encountered another challenge — feeding access. The plan was to place a Freka tube into the jejunum, but despite Magill assistance, it wouldn’t pass. Instead, we advanced the already placed 16F Ryles tube into the jejunum, and a second 14F Ryles tube was placed in the stomach for decompression. Noradrenaline requirements gradually came down from 2 mcg/kg/min to 0.5 mcg/kg/min. ABG parameters are improving, urine output was reassuring, and CVP was maintained between 5–7. Postoperative Care 🌙 The patient was extubated inside the OT after reversal with Sugammadex. Thanks to the pre-incision 4QTAP block, his VAS score was <2 post-extubation, showing excellent pain control even without an epidural (which was avoided due to INR 1.5). He was then shifted to the PACU for further postoperative care, with clear instructions to continue noradrenaline infusion and taper only if SBP >150 mmHg. By postoperative day 3, he was improving well and shifted out of PACU. Reflections 💭 This case reinforced several lessons for me as an anesthesiologist: • Managing sepsis with impending shock demands vigilance and adaptability • Always anticipate the possibility of a difficult airway 😷 • Opioid-sparing strategies like pre-incision 4QTAP blocks are valuable in high-risk patients 💉 • Even seemingly simple steps like Ryles tube placement can become complex under pressure • Above all, staying calm and composed in odd-hour emergencies is the true art — the anesthesiologist sets the pace of the OT. #Anesthesiology #Anaesthesia #CriticalCare #EmergencySurgery #PerioperativeMedicine #RegionalAnesthesia #DifficultAirway #SepsisManagement #OpioidSparing #AcuteCare #PatientSafety #OperatingRoom #MedicalEducation #AnesthesiaJournals #AnesthesiologyCommunity

🫀 We don’t opt for #protectedVT ablation often, and our is experience that it isn’t needed in many patients. But in some select cases it can be the gamechanger. The PAINESD score is sensitive but not specific because in many patients with a high PAINESD #VTablation can be performed safely without mechanical support. (see 1)   In this ICM patient s/p three VT ablation procedures with an LVEF of 15% and extensive LV scar, recent VT episodes caused immediate hemodynamic collapse with prolonged CPR. We therefore decided that hemodynamic support was the prudent choice See video for procedural details. An #Impella CP was placed via the left femoral artery at the start of the procedure. (cheers Samuel Lee 🤝) We had #InHeart CT data available. (another rabbit hole, see 2.) Maps acquired with #HDgridX and created by master mapper Malte Wader aka Mapelangelo (another gamechanger this guy). All mapping and ablation via antegrade transseptal access. The #mitralclip wasn't an issue (it usually isn't, see 3.)   VT#1 probably relied on epicardial substrate but was successfully ablated from the endocardium. (see 4.) Patient was non-inducible at the end.  ✅ Impella removed on the table, Impella access closed with 2x Perclose and 1x Angioseal. Total duration 3:15h. All done under cardiologist led sedation, no anesthesiology, no pressors. (see 5.) Patient was discharged 2 days later. Patient selection for #protectedVT ablation deserves closer scrutiny — the variability between centers is remarkable, and patient characteristics alone don’t explain the differences in Impella utilization. In this case hemodynamic support surely made a difference. 1)       https://lnkd.in/eJQnFpfW 2)       https://lnkd.in/ey7Atrvk (Jan-Hendrik van den Bruck) 3)       https://lnkd.in/eR7Yt7Ha (Moneeb Khalaph) 4)       https://lnkd.in/eTZ_aSTD (Arian Sultan) 5)       https://lnkd.in/eavrEZ5E (PD Dr. med. Helge Servatius) Daniel Steven, Jana Ackmann, Jonas Wörmann, Sebastian Dittrich, Abdul Parwani, Immanuel Erdmann, Prashanthan Sanders, Christian Meyer

One of the most common questions I hear is: “What are my options if I have a thyroid nodule?” For decades, the answer was limited: ▪️“Watch and wait” ▪️Medications with side effects ▪️Radioactive iodine (not for everyone) ▪️Surgery: effective but invasive, often with lifelong hormone replacement But now, things have changed. Thyroid Radiofrequency Ablation (RFA) is transforming how we treat symptomatic benign thyroid nodules: 🔸 Minimally invasive, non-surgical 🔸Outpatient procedure under local anesthesia 🔸Preserves thyroid function 🔸Same-day return to normal activities 🔸Proven long-term nodule shrinkage and symptom relief Patients get results without scars, without hospital stays, and without the risks of thyroidectomy. For physicians, it’s an opportunity to deliver better care and expand treatment options in-office. If you’re a clinician treating thyroid disease, now is the time to consider adding RFA to your practice. At RGS HealthCare - Medical Equipment Specialists, we provide the technology, training, and support to help you succeed. #ThyroidRFA