Emergency Neuroanesthesia

Neurosurgical patients who require emergency anesthetic intervention fall into two groups. There are those who present with, or who have suffered an acute deterioration of, a condition of the brain or spinal cord. These patients may have compromised ventilation or other system failure as a consequence of their primary disease. They have the potential for aspiration of stomach contents if they have lost protective airway reflexes or if they are anesthetized without specific measures to prevent regurgitation. They may be hemodynamically unstable because of dehydration, sepsis or interference with autonomic reflexes. They may have specific effects of a disease process that affects a number of organ systems (e.g. rheumatoid disease, metastatic carcinoma).

The other group of neurosurgical patients are victims of trauma in whom neurological damage may be only one of a number of life- or limb-threatening conditions. In these patients there may be several injuries that compete for intervention, but appropriate management of one may be detrimental to the management of others. A methodical and coordinated approach will minimize the risk of missing serious injuries and will treat life-threatening injuries in appropriate order of priority. Management of the multiply injured patient must initially focus upon the ABC (airway, breathing and circulation) of basic life support. Implicit in management of the airway is avoidance of unnecessary movement of a potentially unstable cervical spine. However, hypoxia and aspiration of gastric contents into the lungs are more certain killers than theoretical cervical instability. Aggressive management to maintain cerebral perfusion pressure in these patients appears to be associated with improved outcome [30]. Novel therapies that may decrease secondary injury may have a place in the future.

Cure Your Yeast Infection For Good

Cure Your Yeast Infection For Good

The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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