Open Airways Consent: Fill & Download for Free

Read the attached links from St. John’s Ambulance. Neither CPR or the Heimlich are going to be your first choices, if they are choking or standing up. In summary for an adult:If at any point they become unresponsive, call for help/dial 911 (999 in the UK, 112 in Europe), open airways, check breathing and apply CPR if necessary.Ask if they are choking. If they can gasp a yes, then some air is getting through and they can probably cough out the obstruction - ask them to cough.If they couldn’t even gasp an answer, or coughing doesn’t work, ask if you can slap them on the back. If they nod yes then lean them forwards and use the heel of your hand to give up to five sharp back blows between their shoulder blades. Get them to check their mouth.If they still can’t breathe, call for help/dial 911/999/112. Ask their permission to apply up to five abdominal thrusts (the Heimlich Manoeuvre). See links for details.If that doesn’t work, then you have already called for help, haven’t you?For children, the same but don’t slap or abdominal thrust them harder than you have to, but remember that broken ribs get better, dead children don’t!For babies, lie them on your thigh for the back slaps, then turn them face up and check their mouth for obstructions. If necessary use two fingers to give up to five downward chest thrusts and then check their mouth again.Adult Choking - Symptoms & First Aid Advice - St John AmbulanceChoking Child - First Aid for Parents - St John AmbulanceBaby choking - First Aid for Parents - St John Ambulance

I hope this helps you if you haven’t had surgery before and you’re really nervous about it or just want to know what to expect. I wrote it really carefully and in such a way that answers the types of questions that I would have if I hadn’t experienced surgery both as a patient and as a caretaker of a patient. Good luck with your surgery and I hope that you have the outcome you are hoping for! Remember: aftercare is usually really important. Get help complying with it, as necessary.So. At the hospitals I’ve been to, which have all been in Massachusetts and New York, the process is very civilized for scheduled (not emergency) surgery. You’ll have a pre-op meeting before your surgery date where a nurse or a PA will test you (an EKG, for example, if you hadn’t had one in a while) to establish that your general health is good enough to green light you for surgery. They explain how you will prepare for your surgery at home, which usually involves fasting from the night before and not drinking anything the morning of unless it’s a sip of water to take your every day medications. They may give you “prep” that makes you poop non-stop the day before until you’re empty, and they may give you a bottle of liquid “soap” to shower with a few times so that your skin is basically stripped of any grubby little germs that could infect your site once they open you up.If you’re going to have surgery that will affect your gait, they’ll give you a little pamphlet that basically says “hey! pick all of the stuff up off the floor and put it on the counter now because you’re not going to be able to bend over or lift and if you trip and fall, you have to come back to the hospital”. You sign papers attesting that you understand their counsel and know what is expected, on your part, both before and after. At this time, if you don’t already have an end of life directive filed (like a “do not resuscitate” order) they’ll ask for you to make some decisions. You’ll assign a health care proxy—somebody to make medical decisions for you if need be while you are unable to give consent (once they’ve given you anesthesia, for example).On the morning of your surgery, you’ll usually be asked to wear embarrassingly comfortable clothing and arrive far before your procedure. You arrive with whoever is going to “be there for you” that day—a friend, family… hopefully not a guard from the prison. In most cases, this person is also your proxy. The pre-surgical waiting area will probably be packed with a full roster of people getting operated on that day and nurses will be calling names in groups to bring you into the secondary areas appropriate for your specific surgery. Your friend can come with you to this pre-op area. You get into the Johnnie. You get the robe. You get the slipper socks. Your stuff gets put into a plastic bag with your name on it. Somebody takes it away or plunks it under your gurney. Soon, you’re in bed in a big room with a lot of other people from the waiting room, except now you’re all dressed the same way. If you are lucky? You get an awesome heated cotton blanket. Or two.The surgeon comes to meet you. The anesthesiologist comes to meet you. Perhaps another doctor, nurse or physician’s assistant. Generally, they are polite and friendly to try and put you at ease so that you can focus on what they are telling you. They can describe what their plan is for once they get you under and open and will answer any questions you might have. You sign papers, papers and papers. Somebody, usually a nurse or anesthetist assistant but, sometimes, a dedicated cath nurse (the fastest and the best!) will fit you with an IV line in your arm or hand and tape it into place. You’ll get electrodes taped to you. You’ll get a pulse ox monitor clamped to your finger and taped on. These items get hooked into machines that go “beep beep: you’re alive” or “beeeeeeeeeeeeep: you’re dead” and also monitor things like your blood pressure. You get a silly paper shower cap thing to go over your hair. If it’s a long surgery, they will fit you with a catheter to collect your urine, but not until you are unconscious.Most people are nervous—that’s part of why you get to have your friend, family or prison guard there to keep you company. Another reason is to have somebody socially familiar with you at your baseline personality to be able to flag an issue for the surgical team which they otherwise mightn’t detect because they don’t know you. Like: if you’re not speaking at all? They want somebody there to say “Yeah, this is normal. He barely speaks to anybody” or “she’s deaf without her hearing aids in so you should yell, because she’s too polite to complain”.With somebody who knows you there, it’ll be easier for the doctor to communicate with you, efficiently, even if you aren’t a reliable self reporter…you’ll likely overhear examples of this with elderly patients being corrected by their grown children about which medicines they take and when, for example. Lastly, because general anesthesia works a bit differently on each individual, they want you to have a witness to the talk you have with your team, in case you can’t remember points in the discussion you’d want to immediately after you wake up…things about how you may feel, initially and what could constitute them deciding to keep an eye on you, overnight, in the recovery room or admitting you to a room on one of the floors instead of just going home. Either would be outside the norm; it’s insurance coverage, nowadays, that pre-determine how long you’ll stay in hospital (more on this later).Somebody (usually a nurse or an anesthetist) will give you ‘a little something’ through the IV to relax you but *not* to knock you out. You will still be conscious the whole time that you are in this first staging area. Eventually, you’ll bid goodbye to whoever came with you that morning, and an orderly will appear to wheel you, your bed and your drip line to the surgical suite. You may have to wait in a hallway for a bit but, by then you really might feel that first stage “cocktail” and not be extremely conscious of time, so it’s not nerve-wracking. They may or may not (depending on factors like the type of and projected length of your surgery as well as known intolerances to certain anesthesia protocols) give you a second “stage” of anesthesia at this time. If this happens, it still will not be the dose that knocks you out.Once you’re wheeled into the theater, itself, you’ll see your team again but, this time, they’ll also have silly hats and also paper masks on like they’re ready to rob a bank. They may check to ask if you’re “all set to go” because by then they’ll have placed a little oxygen mask made out of see-through plastic over your mouth and nose which will inhibit your verbal communication and you’re limited to nodding or shaking you head, thumbs up sign, etc. The mask smells like ozone and, by this time, you *are* relaxed.The anesthetist will address you: these are the doctors who are going to monitor your vital signs all throughout the surgery and make sure that you are in the appropriate level of sedation. They are going to adjust any medicine in your lines, as necessary. If you become distressed, they will be sure that you are intubated to secure an open airway. The anesthetist is your friend in that room, cari g for your whole body, while the surgeon is more like the mechanic, just compartmentalizing their focus on one discrete part of your body.If you didn’t get a second stage of anesthesia yet, they might do it here. Or: they may knock you out straight. They’ll let you know before they do anything. If they give you a second stage in the theater it will only take a minute or so before they give you the thing that will induce unconsciousness. When they push the meds to put you out through the IV, sometimes it stings a bit; in my experience, it’s almost always a sensation of cold—like ice water is entering the veins in your forearm. You are asked to count down backwards from one hundred. You probably won’t make it to 90, even if you try really hard. It’s awesome. I love that part. Especially if you’ve been in too much pain to sleep: it’s a relief.They like for whoever brought you in to stay in a family waiting area during your surgery. The surgeon will often go to them and report how the surgery went and, if you are family, they’ll discus any findings—like if they sent any samples to pathology, for example. Most importantly, they want somebody they can find fast should the surgeon, for some reason, need a proxy to make a medical decision for the patient mid-procedure. Somebody present that the can find fast to sign off on such a decision is easier for them than trying to reach the proxy by phone—-for example. When time is of the essence, the fewer layers of complexity, the better.*Here is an un-solicited piece of advice related to your role as somebody’s emergency contact: if your partner or parent feels very ill and they go in to see the doctor by themselves, just make sure your phone is charged. If you are down as their emergency contact, you may well become their proxy. So, if while they are gone, you happen to get a phone call from a number you don’t recognize? Pick it up. In the rare case your friend’s exam has findings that indicate an emergency surgical procedure, they may be unable to give consent. An example of this would be: if the physician has a sudden reason to use an endoscope, they will likely give a relaxing agent first. If they find something exploding in there, and your friend is semi-drugged, they want to obtain permission to operate from a sober person. If the permission involves a choice between clinical approaches with different degrees of risk, the decision can be an important one.Sometimes during regularly scheduled (not emergency) surgery there is a surprise when they open a patient up and they recognize something visual that’s different than what they expected to see based on previous imaging and they have to change horses mid-stream and perform a surgery other than what was planned or have an on-call surgeon with a different specialty “scrub in”. It’s uncommon. Still, without a proxy, in order to gain consent, your team will have to stop the operation and wait a long time for the anesthesia to wear off so that they can ask the patient, personally, what they want to do. I believe the exception to this case is an emergency intervention-you definitely sign an okay for emergency surgery if it’s required. So, if you start having a heart attack when you go in for a nose-job, they know how to prioritize. They won’t bother with finding your contact.Unless you have a poor reaction to the anesthesia, you will probably come into consciousness very slowly and not feel terribly bad at first. Some people experience side effects when coming out from under—-I know my sister (for one) felt really emotional and sad right after she had her wisdom teeth out. It was purely an effect of the drugs. I only had an with general anesthesia once—a terrible acidic burn in my throat from reflux. I have mentioned this every other time since and the anesthesiologist must understand what to do for that because it’s never happened again.For me, coming out from under anesthesia is a slow and gentle becoming aware of my surroundings—sounds first, before the ability to open my eyes. Then eyes need to close again…it’s like that. This is uncanny because we don’t usually wake up in hospital beds but, for me, by the time I can effectively move my body at all, I’ve had enough time to figure out where I am. So, it’s better than having jet lag from international travel, and waking up in a hotel room with no idea where TF you are for a full minute.The post op recovery area (PACU), where you’ll wake up, is another big room with all of your surgery friends whose names were being called that morning, before you went in. You’ll be awake but groggy before your proxy/friend/guard is called to visit you, bedside. Sometimes, the nursing staff will allow only a brief visit at first and then send your buddy out to wait again until you have more of your bearings back. Depending on what surgery you had, you will likely begin to feel some degree of pain while you are still in the post-op recovery room. The nurses there will help manage your pain as it develops, usually through your IV line. If you are scheduled for surgery with aftercare and a two night stay (for example) you’ll get wheeled to your room by an orderly when a bay becomes available.If your insurance code is for a 23 hour stay surgery, the idea is not to admit you to the hospital (a floor); you’ll stay overnight in a quieter corner of the recovery room and be discharged from there if everything goes fine. A complication will probably get you moved to a floor/admitted. If you’ve had day surgery, specifically, this is the graham cracker and apple juice room, baby. Here, the goal is to discharge you as soon as you can meet certain bench marks—usually you have to be able to talk, swallow—even if it’s just ice chips, walk without assistance unless you usually need assistance (like a cane, etc) and pee. These are all signals that you’re awake enough to understand and sign off on the post op directives they give you explaining which scrips you need to get filled and how to take care of the surgical site so that it doesn’t get infected and what symptoms to watch out for because it means you’re having a complication and need to come back into hospital.As mentioned before, different people come out from under anesthesia different ways; some people take longer. The person who has waited for you (and is responsible for getting you home and set up in your regular bed) will have been paged or otherwise fetched from the waiting room by this time and should be present to hear your post-op instructions about how to change the wound dressings, and get any phone numbers for emergency questions, visiting nurses, physical therapy, etc. It is really important that your friend listen closely, ask any questions and make any notes they need to at this time. It’s very possible that you won’t really remember it afterwards because of how anesthesia works on our memory.Usually, you’ll get dressed back into the comfy clothes you came in that morning. If the surgical site makes this impossible you may be the lucky winner of a free Johnnie and robe or paper trousers (like scrubs with a draw string). Your friend will drive you or accompany you on your way home with livery and will (hopefully) help set you up before leaving you alone. This means: picking up your prescriptions for you, feeding your hungry cat, minding your dressing/wound care, and making certain that you have what you need, within reach, at your bedside, such items as you may have brought home from the hospital like a walker, cane or crutches, bandages, your regular medicines, tv remote, etc.The exception to these options is more rare: if your surgery goes poorly or you were in critical care to begin with, you’ll be going to the ICU instead of a regular surgical floor. This is the area they try to keep super-sterile because there are a lot of really sick people inside. There are doctors around all the time. You will likely be poked and prodded more than really allowed to rest as they try different techniques to stabilize your condition.Another alternate outcome is a stint in rehab—either one that’s planned for before surgery or appears necessary after surgery. It’s a midway stop between the hospital where you had your surgery and wherever you call home. Rehab is still a hospital, but it’s not in the same building as where you had your surgery. It will have a less-critical level of care and usually the focus there is on therapies that will help you bridge the gap between your procedure and being able-bodied enough to be able to get up and use the toilet by yourself (for one example).A lot of the risk you undertake with surgery is not going to happen in the operating room, but from post-op complications. If you live alone and require more care than your proxy can offer (we all have jobs) then you MUST NOT leave that hospital without a plan in place for some level of in-home care. They *have to* hook you up with services. They cannot, in good faith, let you leave with no plan. No plan makes it reasonable to expect you will have to be readmitted after a few days of inadequate home care. Unless you fill and take your prescriptions appropriately and clean and monitor your wounds, can get around easily on your own, and have a relatively clean area with fresh laundry and linen…your chance of a fall is high, your chance of infection is high.A second hospital admission and possibly a second surgery is much more expensive than preventative care such as a visiting nurse who can help assess any reason to call the hospital : allergic reactions, infections, worsening of condition. You are entitled to care if you can not appropriately care for yourself after a surgery, have nobody who you can rely on to check in on you, and you are not yet ambulatory enough to visit a drop in clinic for services. Insist on securing aftercare before you go to surgery. What happens between your hospital discharge and your first scheduled post op visit with your doctor is a critical yet enormously under-rated part of the healing process—of which surgery is only the initial stage.

Thanks for A2A !!I remember quite a few serious ones, thanks to the unparalleled Emergency services department at Osmania General and Gandhi hospitals, where I worked in the last 5 years.Young guy with intestines in his hands !!A 25 or so old young guy got into a brawl with some of his mates and one of them was so drunk that he stabbed this poor guy with a broken beer bottle.Somehow, this patient of ours held on to his nerves and carefully held the intestines that came out from this open belly in his bare hands and made it in proper time to the emergency department at Osmania.I was shocked to see this dude walking into the emergency holding the bowels with his bare hands.Soon my team recovered from the shock, started resuscitation, covered the open intestines with a sterile gauge and took him up for surgery.Patient survived and was discharged a week later. I distinctly remember his little cousins giving us chocolates as a token of gratitude.Old man with a knife inserted into his upper chestThis happened a few months ago at Osmania quite co-incidentally on my birthday.An elderly man probably got tired of his life and decided to end it for good. Too sad!!He stabbed himself with a knife in the lower neck and waited for it to kill him.Quite fortunately he didn't die and his son got him to the hospital.After extensive imaging and taking him for surgery, we found that the knife has missed all the important blood vessels in the neck and chest. Speak of luck!!We removed the knife in time and the patient survived.A young male with a swollen, painful legI think this case haunts me for the rest of my life.This was a 25 year old male came to us with sudden swelling of leg in the calf area.Since it was 2 in the morning and most of his signs were consistent with compartment syndrome ( essentially rapid built up of pressure in leg muscles with high chances of losing the leg ), we decided to go ahead with the procedure to relieve the pressure.During the surgery, much to everyone’s horror after evacuating the blood clot in the leg, the bleeding just doesn't stop!!We soon recovered and apply good deal of pressure and dressed up the wound.Later, he was put on blood transfusions and further tests were done to see why he wasn't clotting his blood.Turned out, he was a patient with haemophilia A, which went undiagnosed for 25 years till he presented to us.We treated him with Factor 8 injections ( to replace the deficient protein the blood to make it better clot ) and he did well.We discharged the patient after a month.An elderly lady with fluid around her heart !!It was 4 in the morning when we received a elderly lady brought in by her son for having suffered blunt force trauma to her abdomen and diagnosed to have been bleeding inside.The problem for taking this patient up for surgery straight away was she had long standing collection of fluid around her heart (pericardial effusion) and now it became severe enough to compromise her functioning of heart leading to breathlessness.She would have collapsed on the operating table without optimising this condition.The situation was quite tense, that early in the morning we didn’t have access to radiology or cardiologist and patient was in no position to be shifted to an other area for consult.I decided to extract all the fluid around her heart with a syringe, however the problem was it had every chance of injury the heart and thereby at times stopping it all of a sudden when the needle touches the heart.I explained the situation to her and her son. Putting great faith in us, he consented for the procedure.We put in a needle carefully into the sac around her heart and sucked out 250 ml of fluid much to the rapid improvement in her breathing.We went on to do the surgery for her bleeding into the abdomen and he she did well post procedure, discharged her after a week in the hospital.A young boy presenting with severe head injuryThis guy has hit his head riding a motorcycle after getting drunk, he came in drowsy with no clue of what is happening around him added to which his organ systems are gradually fading away.We resuscitated him, secured his airway / circulation etc, called in the neurosurgeon after scanning his brain which showed a large blood clot pressing on his brain.We could get him to surgery in time and evacuated the clot, I was there throughout the ordeal and assisted the neuro-surgeon while evacuating the clot.After 15 days in the hospital, the patient recovered and was sent home. Although he does have some degree of deficits from the brain damage and is on physiotherapy.A patient with supervasmol poisoningSuper vasmol is a common hair dye, which when taken through mouth can be a deadly poison.The liquid while swallowing causing swelling of the upper parts of the wind pipe essentially cutting off air entry to the lungs and chokes the patient to death.Once we saw the patient, there was no time to be lost and was shifted straight to the operating room.We made a small opening in the neck to access the wind pipe and bypass the block caused by the poisoning.Patient did well over time and was sent home after counselling from a psychiatrist.A “rowdy” who received a sword wound to the neckAt midnight, we once had a patient who suffered deep cut to the neck after involving in a fight with a rival gang.The wound was deep enough to cause heavy bleeding from the blood vessels that carry to and from the brain and upper neck.The whole incident was scary, he had 40 followers with him added to which was 5–6 constables, a sub inspector, the whole deal!!We were shit scared at first, then asked the police guys to clear his followers from the emergency area while another member of the team put pressure on the wound to stop bleeding and rushed him to the OR with pressure on.Quite fortunately, we were able to isolate the bleeding vessel and tie it off to avoid further blood loss.Patient did fine after the procedure and was sent home 3 days later.An old man with a broken spineA few months ago while working in Gandhi as senior resident in emergency, I came across this old guy who suffered injury to the neck and was brought in to emergency as he was unable to move any of his legs or arms.After examining him, I found that he practically lacked any sensation below his collar bones / clavicles and couldn't move his body below the neck.We immediately immobilised his neck suspecting spinal cord damage.Later he was sent in for imaging the neck which revealed a fracture of the spine and severe injury to the spinal cord causing the lack of sensations and movement below his neck.Any further unnecessary movement of his neck would have resulted in death.The neurosurgeon was called in to fix the spine although quite sadly, the recovery of sensation and movement post procedure is quite slow as is the case with most neurological injuries.Although the patient survived, he is likely to be wheel chair bound for quite a while.A elderly lady with an infected armA 50 year old day developed rapidly spreading infection of her left arm reaching the elbow from the injured finger in a matter of 1–2 days.The only hope in this patient for survival was to remove the arm at the shoulder joint.However we were in a fix as this was never been attempted in an emergency before in our hospital.We took the help of Orthopaedics team and after a gruelling surgery, removed her arm till the shoulder (Disarticulation).Although she had some degree of heart failure in the post procedure period, she did well and was discharged a week later.A young lady with extreme breathlessness23 year old lady came in with sudden onset of severe inability to breathe and collapsing pulse.On examination she was found have air filling the cavity around the left lung causing compression / deviation of wind pipe.A needle was put in to let out the air and was later considered for a chest drain.Patient did well and was sent home a few days later. The cause was due to an air filled cavity on the lung that burst out.A young man with severe pain in belly and high feverThis was an unknown patient with no carers who was brought in with severe pain in the abdomen with spiking fever causing drenching of his body.After resuscitation, he was found to have an abscess (an infected fluid collection) of large size in the liver that has burst into rest of his belly and caused severe pain and rapid spread of infection.We considered the patient for surgery, underwent clean up of the whole infected material and was put in ICU post procedure.A week later he was eating well and readied for discharge.I came across him again in the clinic a month later and I couldn’t recognise him. He now had a job, was in much better health and hygiene than the one I saw a few weeks ago.A middle aged man with a dead internal organ !This guy had suffered a blunt injury to the abdomen which later lead to bleeding into the cavity and shock.After scanning him up, we took him up for surgery since he was not responding to medical treatment alone and the test results were inconclusive.Much to everyone’s horror, after removing the blood and clots, we found the “pancreas” (a glandular organ that sits across the upper abdomen) to be dying off in the central area.It couldn't just be left alone as there is high chance of this dead material getting infected and causing life threatening sepsis.But since it was all surrounded by important blood vessels in that area, we took time to remove the dead portion piece by piece.Much to the surprise of everyone, he got well in 10 days and was sent home later that weekNow, decide for yourself which injury / infection was the worst !!Quick response and good team support were critical in all cases. I decided not to put in any original pictures from the surgeries as patient identity needs to be protected and some images are really disturbing to publish online without a filter.Image sourcesAnatomy Large Intestines Silicone Mold for Fondant Chocolate Soap ClayMRCEM Part "B" Revision NotesBleeding Varicose Veins | Bleeding Spider Veins | Schulman Vein and Laser CenterPericardiocentesis - WikipediaEpidural hematomaSuper Vasmol 33 Kesh KalaExternal Carotid ArteryАндрей Королев 86 - Own work, CC BY-SA 3.0, File:Cervical Spine MRI (T2W).jpgOT-OrthoNursing/medicalLiver Abscess - Net Health Book“| Tidsskrift for Den Norske Legeforening.” Tidsskrift for Den Norske Legeforening, n.d., 12.