Best Practice & Research Clinical Anesthesiology Assignment

Case Study Analysis

1. What are the SIRS criteria entail and how is Sepsis identified and treated?

The Systemic inflammatory response syndrome (SIRS) is a defense response of the body towards certain stressors such as acute inflammation, trauma, reperfusion, ischemia, malignancy and surgery among others. There are various criteria that satisfy the presence of SIRS. The first criterion is a body temperature of either below 36degrees Celsius or above 38degrees Celsius. Secondly, a higher than 20breaths/minute of respiratory rate or a less than 32 mmHg of CO₂ partial pressure. Thirdly, having a greater than 90beats/minute of heart rate. Finally, having a leukocyte count of either greater than 12000/microliters or less than 4000/ microliters (Thompson et al., 2019). Whenever two of these criteria occur together, it is an indication of a possible SIRS. There are various diagnoses done to identify the presence of Sepsis. These include testing of a person’s temperature, breathing rate and heart rate, and testing of blood, to determine whether the above criteria are met. Furthermore, other tests essential for determining the areas affected include the use of imaging studies such as X-Rays and CT scan, wound culture test, blood pressure tests, urine or stool samples test and testing of respiratory secretions such as the saliva. The first line treatment of Sepsis is the use of antibiotics. The medications are administered intravenously where the medication should immediately begin after an hour of diagnosis (Thompson et al., 2019). However, after 2-4days of taking the medication intravenously, tablets antibiotics should replace the intravenous antibiotics. Best Practice & Research Clinical Anesthesiology Assignment

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2. When are colostomy reversals appropriate and what are some postoperative complications that can occur?

An operation that is usually done either permanently of temporarily at the end of the colon with an aim of diverting one end of the colon through an opening on the tummy is referred to as a colostomy (Park et al., 2018). The opening formed in the tummy is usually referred to as a stoma. It is through the stoma that a pouch-like bag can be placed for stool collection. To begin with colostomy reversals are appropriate when an individual’s colostomy is temporary. The reversals of a colostomy require another operation for them to be successfully reversed. However, they are only done when a person has fully recovered and is in a good health. A reversal usually takes a minimum of 3months after the initial colostomy operation. Colostomy reversals are also appropriate when a person has enough rectum left intact, when a person has a good control of the anal sphincter muscles and when one does not have any existing health complications in their rectum or bowel (Park et al., 2018). After colostomy reversals have been done in an individual’s body, there are common problems that occur to the bowel. These include incontinence, loose stool, pain and sudden bowel urges. There are other issues that include belly blockage and infection, and development of a scar tissue in the bowel. Best Practice & Research Clinical Anesthesiology Assignment

3. When should pain management be considered with patient who have abdominal surgery?

Pain management is one important factor that should be considered for patients who have abdominal surgery. To begin with, post-abdominal surgery pain control should be considered as it is essential towards speeding the recovery process, and minimizing the chances of further health complications such as blood clots and pneumonia from occurring (Joshi & Kehlet, 2019). Through pain control for patients with abdominal surgery, the responsible nurse or physician is able to effectively monitor the patient’s progress while at the same time planning for any health complication that might develop. Pain management requires the coordination of the patient and the healthcare provider for a quality treatment plan to be achieved. Furthermore, pain management should be considered for these patients as it facilitates the patient to complete vital tasks such as breathing exercises and walking (Joshi & Kehlet, 2019). These are some of the simple activities that bring comfort to the patient during the recovery period. The patient should however collaborate with the healthcare providers towards implementing pain control measures. For instance, the patient should not worry about being a bother to someone whenever in pain. Instead, they should inform the nurses and physicians of any slight pain to help them measure the pain and intervene appropriately. Best Practice & Research Clinical Anesthesiology Assignment

4. If a patient requires intubation after being on BIPAP, what would the initial ventilator settings be?

The AC is the most appropriate ventilator to use for intubation of patients who were on BIPAP. The AC is essential as it facilitate the control of the important physiologic parameters that provide a good comfort for the patient. The initial functionality of the AC is through setting a fixed tidal volume that facilitate the ventilator to deliver at intervals of a certain time when breath is initiated by the patient (Daniel et al., 2021). It is then followed by setting FiO2 of 100% and progressively titrating downwards with guidance from ABG or Oximetry. Regardless of the peak, plateau or compliance pressure in the lungs, the tidal volume delivered by the ventilator will always be the same. The decision to use an AC ventilation further results to modification of two more parameter settings which include the respiratory rate for delivering breaths per minute(bpm) and the Positive End Expiratory Pressure (PEEP). These settings assure quality ventilations especially in respiratory and acidosis patients. In other diseases such as the Acute respiratory distress syndrome, the use of Low tidal volume ventilation has been showed to be effective. Therefore, starting a patient on low tidal volume of between 6 to 8 mL/Kg of ideal body weight facilitates reduction of ventilator induced lung injuries. Best Practice & Research Clinical Anesthesiology Assignment

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References

Daniel, P., Mecklenburg, M., Massiah, C., Joseph, M. A., Wilson, C., Parmar, P., … & Zehtabchi, S. (2021). Non-invasive positive pressure ventilation versus endotracheal intubation in treatment of COVID-19 patients requiring ventilatory support. The American journal of emergency medicine, 43, 103-108. https://doi.org/10.1016/j.ajem.2021.01.068

Joshi, G. P., & Kehlet, H. (2019). Postoperative pain management in the era of ERAS: an overview. Best Practice & Research Clinical Anaesthesiology, 33(3), 259-267. https://doi.org/10.1016/j.bpa.2019.07.016

Park, W., Park, W. C., Kim, K. Y., & Lee, S. Y. (2018). Efficacy and safety of laparoscopic Hartmann colostomy reversal. Annals of Coloproctology, 34(6), 306. doi:10.3393/ac.2018.09.07

Thompson, K., Venkatesh, B., & Finfer, S. (2019). Sepsis and septic shock: current approaches to management. Internal Medicine Journal, 49(2), 160- Best Practice & Research Clinical Anesthesiology Assignment

1. What is the SIRS criteria entail and how is
Sepsis identified and treated?
2. When are colostomy reversals appropriate and what are some postoperative complications that can occur?
3. When should pain management be considered with patient who have abdominal surgery?
4. If a patient requires intubation after being on BIPAP, what would the initial ventilator settings be?

Each answer must be about/at least 200 words. Best Practice & Research Clinical Anesthesiology Assignment