basic CT brain

Very nice video
https://youtu.be/RB7tfXFMwrc

Capnograph Interpretation

Normal Graph

Phase I: At the start of exhalation, anatomical and physiological dead space is
expired, so no CO2Phase II: Exhalation continues, so CO2 rises
Phase III: CO2 plateau
Phase IV: Inspiration








Capnograph in obstructive airway

• Fin-shaped appearance
• Slanting and prolongation of expiratory phase 
• eg. COLD, kinked ETT 

Rebreathing

• Elevated baseline from Zero
• eg. low gas flow

Hyperventilation

• High Resp Rate
• Low EtCO2 

Hypoventilation

• Low Resp Rate
• High EtCO2 

Sudden Fall EtCO2

• Asystole, 
• Hypotension
• Massive Pulmonary Embolism  

Sudden Fall an Rise

Small Air Emboli

Cardiac impulse on EtCO2 

Slanting Capnograph

• Contamination of the expired sample by fresh gas flows 
• Sampling site too near to fresh gas  

Spontaneous Resp Activity

Curare Cleft

• Inadequate muscle relaxation 

Return Of spontaneous resp.

• After Anesthesia

critical care guidelines

Infection:
Surviving Sepsis Guidelines
IDSA HAP Guidelines 2016
IDSA CAP Guidelines 2007
IDSA Guidelines for intra abdominal infection 2010
IDSA Guidlines for CAUTI 2010
IDSA Guidelines for management of Clostridium difficile Infection 2010
IDSA Guidelines for the Management of Bacterial Meningitis 2004
IDSA Guidelines for Management of Encephalitis 2008
IDSA Guidelines for Endocarditis Management 2015


Nurvous System:
Guidelines for the management of Acute stroke
Guidelines for the management of hemorrhagic stroke 2015
Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage 2012
Guidelines for the Management of Severe Traumatic Brain Injury
Guideline: for Treatment of Convulsive Status Epilepticus 2016

Respiratory System:

IABP Graph Analysis

For analysis of graph first put patienton 2:1 Augmentaion

Normal Graph

DIA: Unassisted End Diastolic Pressure
SYS: Unassisted Peak Systolic Pressure
AUG: Diastolic Augmentation/Peak Diastolic Pressure
ADIA: Assisted End Diastolic Pressure
ASYS: Assisted Peak Systolic Pressure (Systole after IAB deflation)
DN: Dicrotic Notch




Early Inflation

Inflation of Valve before dicrotic notch

Can be identified by drawing a line from dicrotic notch of unassisted pulse

Forced closure of Aortic valve
Reduces Stroke volume

Increased LV End diastolic volume(LVED)

Increased work load

Late Inflation

Dicrotic notch is visible brfore augmented diastolic graph 

AUG less than optimum

Decreased perfusion pressure and volume to coronary arteries  



Early Deflation

Augmented Systolic =Non augmented systolic pressure

U shape  at Augmented end diastolic pressures

No afterload reduction


Late Deflation

 Augmented end diastolic pressure > Non Augmented end Diastolic pressure
Violates rule 2for deflation