What is a Mental Health

Mental health is more than the mere lack of mental disorders. The positive dimension of mental health is stressed in WHO’s definition of health as contained in its constitution: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. ”Concepts of mental health include subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence and recognition of the ability to realize one’s intellectual and emotional potential. It has also been defined as a state of well-being whereby individuals recognize their abilities, are able to cope with the normal stresses of life, work productively and fruitfully, and make a contribution to their communities. Mental health is about enhancing competencies of individuals...

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The Failed Airway !! (EAM part 5)

Although none of us wants to be in a “failed” airway situation, it will happen eventually to all of us. There are basically 2 scenarios, 1) can’t intubate but can ventilate with a BVM or 2) can’t intubate and can’t ventilate. In the first situation, one is at least able to maintain reasonable ventilation and oxygenation. However, the risk of aspiration increases as bagging continues. Even with adequate Sellick’s maneuver, some air will leak into the stomach causing gastric distension and eventually vomiting. The second situation is more desperate and if a decision is not made in seconds, the patient will die. Usually this involves one of two possibilities depending on time. The first is the creation of an immediate surgical airway either by cricothyrotomy, or percutaneous transtracheal jet...

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The Difficult Airway (EAM part 3)

Although the vast majority of emergency airways will go smoothly using the above technique of rapid sequence intubation, everyone, regardless of experience, is bound to have problems sometime. It is important to recognize which airways may give you problems before you begin down the road to a possibly failed airway attempt. It is important to choose the most appropriate technique for each particular airway situation before disaster occurs. I suggest that several simple questions be asked in every airway situation: If my intubation attempt does not succeed, will I be able to ventilate the patient with a bag-valve-mask? If I can not ventilate the patient with a BVM, what should be done next and what is my back up plan? Am I prepared to provide a surgical airway?Some estimation of the degree...

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Rapid Sequence Intubation (EAM part 2)

Rapid sequence intubation (RSI) consists of a series of discrete steps that are best followed to insure the greatest success. The patient should first be evaluated for the presence of a difficult airway and the ability to ventilate with a bag-valve-mask should intubation not be successful. It is obvious that the intubation should take place in a room that is prepared in advance with all equipment needed for resuscitation should that be necessary. It is the physician’s responsibility to make sure that all equipment is present and in working order before proceeding! Although nurses may assure you that everything is in working order, the physician is ultimately responsible and will be the one to have to handle the problem if some critical equipment is not functioning or a critical drug is not...

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Indications for Intubation (Emergency AirWay Management (EAM) part 1)

Airway skills are perhaps the most important skills that an emergency physician possesses. If the airway is lost in a critically ill patient for any reason, any of the other interventions you might make, or any great diagnoses are superfluous. It is good to remember that in the ABC’s of resuscitation, airway is first and foremost. With the exception of defibrillation in a cardiac arrest situation and possibly a needle decompression in the patient with a tension pneumothorax, airway control always assumes first priority. Since the need to protect the airway most often occurs in a crisis situation in the ED, the emergency physician can not rely on others, like anesthesia, to assist. Even moments of delay can spell disaster for the patient. Since every airway emergency presents in a different...

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What is a Primary Survey

The Primary Survey is the initial patient assessment, intended to rapidly and systematically identify and treat any immediately life-threatening problems. It follows the ABC format familiar from other courses, but extends this into more detail. Assessment and treatment proceed simultaneously – as a problem is identified, appropriate action should be taken before moving on. After any intervention, or if there is any sign of a change in condition, repeat the primary survey. The primary survey relates to patient assessment and treatment, and should only be started after ensuring safety of self and scene Primary Survey Airway with control of c-spine Breathing Circulation Disability Expose and evaluate Full assessment Following a look, feel, listen approach, things to look for are: Airway Look...

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