جابريون⁸ (جراحة عملي )

🧠Treatment of epistaxis : 1️⃣reauscitation : ♦️airway : sever bleeding may be cause obstruction the air way ♦️circulation : sever bleeding may be cause hemodynamically un stable Circulation 1-two I.V lines canula 2-Blood transfusion for oxygenation 3- IV fluid to replacement hypivolemic . 4-Control of hypertension. 5-Correction of coagulopathies. 2️⃣packing of the nose ♦️Anterior packing 🚑Ribbon guaze with (antibiotic or normal saline ) 🔥The gauze should be 2.5 cm in adult and 12mm in horizontal and vertical packing 🔥can be remove every 24 hours foe 2-3 day ♦️posterior packing : Can be use the : 🚑gauze 🚑foley cathetraziation : 12fr with 15 cc of normal saline te prevent the foley to displacement 🚑nasal baloon: Can be used in anterior and poaterior packing 3️⃣Angiography and embolization Can be emblization the effected artey through femoral artery المريض الي عنده CABG ميصير ننطيه G/A 4️⃣systemic druge therapy

1️⃣Epistaxis : It is a bleeding of the nose most common occur from klesselback plexus bleed or it most serious occur due to shenioplatine artery bleeding

1️⃣nasopharyngeal airway ♦️o bypass obstruction at the pharynx area Like: ♦️• Ludwig’s angina ♦️• angioedema not use in skull base fracture ♦️• trauma with facial Fractures. ♦️-in conscious patient ♦️not use in skull base fracture

1️⃣oropharyngeal airway ♦️To bypass obstruction at oropharyngeal area ♦️ - in unconscious patient ♦️to bypass obstruction at the pharynx area Like: ♦️not definitive method unless: ♦️-vital and clinical signs return to normal (if not retun should turn another method)

3️⃣GCS > 8 : A- Oropharyngeal airway B-Nasopharyngeal airways 4️⃣ GCS < 8 Assisted ventilation by : A-Endotracheal intubation B-Laryngeal mask supraglotic device

اذا مصار زين نفحص GCS

1️⃣chin thurst and chin left maneuver 🧠chin thurst : dont use this maneuver if the pateint have neck injury(to avoid the spinal cord injery) 🧠chin left maneuver : Cane be pressur on the end of manduble if the patuent have neck injery In case of mandibular displacement, •a midline traction suture on the tongue • or jaw thrust ( neck injury ) or •chin lift maneuver •(unconscious no neck injury ) may •quickly maintain a patent airway •over com pharyngeal collapse .

2️⃣اذاجان أكو displacement mandibular :1-traction suture on the tongue 2-jaw thrust (neck injury) 3-chin lift ( no neck injury )

1️⃣أول ميجي مصاب أتأكد من ♦️ cervical injury (حته اسوي chin left لو chin thrust ) ♦️انظف الحلك اذا ب اي foregin body

يعني اذا أجانه حادث واحد وجهة متفلش هذا نسميه facial truma لازم نسوي أربع شغلات

هسه خلصنه من الحوادث

🧠Care of patient with tracheostomy tube 🚑1-Watch for : -bleeding,displacement,blocking of T. tube. 🚑2-Position of patient: flat or semi Fowler -to ease coughing and deep breathing -facilitate suctioning -minimize discomfo 🚑3-beside the patient -Tracheal dilator & another Tracheostomy tube -bell and pen with paper 🚑4-Put wet light gauze on Tracheostomy tube ( humidification ). 🚑5-Crusting: drops of normal saline or Ringer’s lactate instilled into the tracheostomy tube every 2–3 hours to loosen crusts. 🚑6. cleaning T.T by small NG tube -not pass more than 10 cm (granulation). 🚑7-Sterilization 🚑8-Periodical deflation of cuffed tube -to prevents pressure necrosis of trachea wall and dilatation of trachea.

🧠Type of tracheostomy tube ♦️A-Metal tracheostomy tube 🚑Advantage: 1-have inner & outer part : to remove the inner part for cleaning . 2-less irritant 🚑Disadvantage : 1-sharp , traumatic 2-not use in radiotherapy or in CT scan ♦️B-Portex tracheostomy tube 🚑type: Cuffed tracheostomy Non-Cuffed tracheostomy 🚑Used: 1-intra operatively ( to prevent aspiration of blood to the lung and prevent oxygen to pass out again ) 2-patient in the RCU 🚑Disadvantage : : 1-no inner tube 2-more irritant . Advantage : can use in radiotherapy , CT scan

🧠Intermediate (in the ward ) 1-tracheo- oesophageal fistula 2-trachea arterial fistula 3-tube obstruction by secretions 4-pneumothorax 5-displacement of the tube 6-surgical emphysema 7-dysphagia 8-infection 9-tracheal necrosis

🧠Immediate complication (in operative) 1-cardiac arrest : Dur to vagal inh8bition 2-Apnea Dur to the brain used to low O² and high Co² لعذا من يتغير هذا النظام يقوم حميع الفعليات حته يفتهم شصار 3-local damage to : ♦️-thyroid cartilage ♦️-cri'coid cartilage ♦️-laryngeal nerve 4-haemorrhage ♦️-thyroid veins ♦️-jugular veins ♦️-arteries. 5-air embolism 6-anaesthetic complications