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VAGAL MANOEUVRES

These are actions to increase the activity of the vagus nerves to treat tachycardia. The increased vagal activity has a negative chronotropic action on the SA node and slows conduction through the AV node. These manoeuvres include:

  1. Carotid sinus massage—only perform this on one side of the neck at a time.

  2. The Valsalva manoeuvre (attempted forced exhalation against a closed glottis).

  3. Putting an ice-cold wet towel or bag of ice on the face, or immersing the face in icy water.

  4. Coughing.

  5. Squatting.

VALDECOXIB

Long-acting oral COX-2 selective NSAID. Also available as a parenteral pro-drug, parecoxib. See Parecoxib.

VAPING

Vaping is the inhalation of aerosols for pleasure or as an aid to reducing/ceasing cigarette smoking. Substances inhaled can be nicotine, vitamin E acetate, propylene glycol, glycerol, cannabinoids, heavy metals and potentially hundreds of other substances. It is felt that vaping has up to 5% of the health risk associated with smoking.1

EVALI

EVALI is an acronym for e-cigarette, or vaping product, use-associated lung injury. Vitamin E acetate is particularly harmful. This is a diagnosis of exclusion in patients that vape. It is characterised by:

  1. pulmonary infiltrates

  2. injury to alveolar epithelial cells and vascular endothelial cells

  3. severe acute respiratory distress

  4. dyspnoea, chest pain, cough

  5. fever

  6. nausea and vomiting

  7. diarrhoea.

Burns injuries

As the vapour is heated with power from a battery, a malfunction can result in burns to the user or injuries from the device igniting or exploding. Chemical burns may also occur.

Anaesthetic implications

At this stage there is little information in the literature about this issue. Patients who vape may have an increased risk of airway irritability and complications such as bronchospasm. However, the risk is probably less than in patients who smoke cigarettes.

VASA PRAEVIA

Description

In this condition, some fetal umbilical cord blood vessels run across or very close to the internal uterine os. These vessels are at risk of rupturing if their surrounding membranes break, as can occur with labour. This can result in fetal haemorrhage and death.

Causes

The cause is unknown but it may be associated with:

  1. placenta praevia

  2. in vitro fertilisation technology

  3. multiple pregnancy.

Diagnosis

  1. Routine obstetric ultrasound may identify placenta praevia.

  2. Transvaginal ultrasound is the best test.

  3. PV blood loss with severe fetal compromise.

  4. Undiagnosed vasa praevia results in a fetal mortality > 50%.

Management

  1. Elective CS at 35–37 weeks.

  2. Emergency CS for fetal distress.

VASOPRESSIN ...

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