In this ultrasound still image, I have a phase array probe positioned on the left side of the body around the 8th rib. A left-sided pleural effusion is noted. It’s important to appreciate this view to look for free fluid in the subphrenic and splenorenal spaces. The green arrow denotes…
Understanding neuraxial anatomy is an essential part to successfully perform epidural and spinal (intrathecal) anesthetics. Here’s a schematic outlining the layers we encounter when performing these procedures:
With the growing usage of β-blocker therapy to control everything from atrial fibrillation and congestive heart failure to migraine prophylaxis and essential tremor, we need to be more aware of potential pitfalls due to drug interactions. A classic example is the need for epinephrine in a patient on a non-selective…
Do you know the acronym “SCALP” for the five layers of the scalp?
Anatomically, the trachea extends from the cricoid cartilage (level of C6/C7) to the carina (T4/T5) and is reinforced anteriorly by approximately 20 semicircular, cartilaginous rings. The trachea divides into the right and left mainstem bronchi which further divide into secondary bronchi (RUL, RML, RLL, LUL, and LLL). Of note, the…
Occlusive cuffs on endotracheal tubes (ETTs) allow us to “protect the airway.” Air/fluid is added and removed from this cuff through a pilot balloon (blue in the image below) which is connected to the cuff on the distal segment of an ETT via a thin, plastic tube. Several times during fellowship,…
Normally, the intrapleural pressure (Pip), or the pressure in the space between the lung’s visceral and parietal pleural layers, is slightly negative relative to the atmosphere (Patm). This is due to the chest wall and lungs recoiling away from each other. During a forced expiration, expiratory muscles can increase the…
I figure as an anesthesiologist and intensivist, I should have a post on the basic mechanism of breathing. Here’s my attempt to simplify this complex process while maintaining some of the important details! 🙂
For the last several months, multiple manufacturing delays have led to a nationwide shortage of injectable, intravenous (IV) opioid medications like morphine, hydromorphone, and fentanyl. These medications are routinely utilized in the perioperative and intensive care settings for analgesia and sedation, so the shortage has forced us to incorporate other…
“Starling forces” describe the movement across capillaries as a balance between hydrostatic and oncotic pressure gradients within the capillary and surrounding interstitium. Filtration across the capillary membrane occurs along its entire length and is based on a net driving pressure gradient.