24.2 Flashcards
- During paediatric gas induction, the gas flow recommended by SPANZA for least
environmental impact is
● 1L/min
● 2L/min
● 3L/min
● 4L/min
● 5L/min”
3L/min
The Society of Paediatric Anesthesia recommends 0.15/min/kg as the minimum safe and effective FGF during induction i.e . 3L/min for a 20kg child. Many anaesthetists routinely run 6-10L/min regardless of the child’s weight.
https://journalwatch.org.au/reviews/reducing-the-environmental-impact-of-mask
- The Mapleson circuit to best achieve normocarbia with mechanical ventilation is:
“● Mapleson A
● Mapleson B
● Mapleson C
● Mapleson D
● Mapleson E”
Mapleson D
Journal article entitled Mapleson’s Breathing Systems 2013: “For adults, Mapleson A is the circuit of choice for spontaneous respiration where as Mapleson D and its Bains modifications are best available circuits for controlled ventilation. For neonates and paediatric patients Mapleson E and F (Jackson Rees modification) are the best circuits.”
- SQUIRE guidelines
“From the SQUIRE website: SQUIRE stands for Standards for QUality Improvement Reporting Excellence. The SQUIRE guidelines provide a framework for reporting new knowledge about how to improve healthcare. They are intended for reports that describe system level work to improve the quality, safety, and value of healthcare.
PRISMA: Systematic review”
- Box and whisker plot - What does the box mean
Box = interquartile range
The five number summary is the:
minimum,
first quartile,
median,
third quartile and
maximum
- What does a green line on the rigid laryngoscope blade mean
(a) Reusable
(b) Recyclable
(c) Single use - disposable
(d) Immersible
? - single use?
Arndt blocker attachment point for the breathing circuit (just a schematic drawing provided in
the exam)
C
perpendicular port for ventilation, pop top for bronch, oblique port for suction
Vivasight components (arrow to the red bit in the exam)
Red port - flush port for the lens
Airway ports - blue = bronchial lumen, white = tracheal lumen
Monitor connector
Red port - flush for lens
Cuffs - tracheal clear, bronchial blue
What is the half life of semaglutide
3 days
7 days
14 days
7 days
https://pubmed.ncbi.nlm.nih.gov/29915923/
PREVENTT trial showed that in major abdominal surgery, iron infusions:
A Reduced allogenic red cell transfusion
B Reduced mortality
C Reduced readmission rates within 30 days
D Reduced infection rates
C - Reduced readmission rates within 30 days
Compared to UFH, enoxaparin
More selective for factor Xa compared to UFH which binds both Xa and thrombin via ATIII
- Child on 15mcg/kg steroids, duration of treatment to give hydrocortisone peri-operatively
A > 2 weeks
B 1 month
C 2 months
B - 1 month
AOA guidelines
DCD which is the organ which can have the longest ischaemic time
A Lungs
B Kidneys
C Liver
D Pancreas
E Heart
A - Lungs (90mins)
Warm ischaemia time:
Liver and pancreas 30mins
Heart 30mins (from sBP <90mmHg to cold perfusion)
Kidneys 60mins (from sBP <50mmHg)
Lungs 90mins (from sBP <50mmHg)
DCD criteria does not include:
A Immobility
B apnoea
C absent skin perfusion
D absence of circulation (no arterial pulsatility for 2 min)
C - absent skin perfusion
DCD. -absence of circulation 5 mins for withdrawal of cardio resp support
- if ECG present need to observe asystole for 5mins
Unresponsive, apnoea, no pulse/heart sounds
Post herpetic neuralgia, feels like insects crawling across head, what is it?
- Allodynia
- Dysaesthesia
- Formication
- Pruritis
Formication
- although technically dysaesthesia
Congenital long QT, drug should avoid:
A propofol
B thiopentone
C ketamine
Ketamine
Triggers:
- beta-agonists, ketamine
- SNS stimulation
- Other QT prolonging medications: antiemetics, antipsychotics, amiodarone, methadone
- bradycardia, tachycardia, hypertension, hypoxaemia, hypercapnia
- electrolyte disturbance. - low K, Mg, Ca
Treatment for recurrent torsades de pointes?
A - Flecainide
B- Lignocaine
C -Procainamide
D - Amiodarone
E - Sotalol
Lignocaine
TdP is polymorphic VT with long QT
First line treatment is Magnesium then treat the long QT
Amiodarone and procainamide will lengthen QT
https://www.emdocs.net/ecg-pointers-recurrent-and-refractory-torsades-de-pointes/
What level tryptase acceptable to diagnose anaphylaxis?
A- (1.2 of normal) + 2 /ml
B- (1.8 of normal) + 2
C- Normal + 2
D- 10/ml
E- 15/ml
A - 1.2 x normal + 2
UTD: The minimal elevation of the acute total tryptase level that is considered to be clinically significant was suggested to be ≥(2 + 1.2 x baseline tryptase levels) in units of ng/mL or mcg/liter
Treatment for refractory anaphylaxis?
A Glucagon IV 10 min
B Glucagon IV 5
C Glucagon IM 5 min
D Glucagon IM 10 min
Glucagon IV q 5mins (1-2mg)
other refractory treatment:
Norad infusion 3-40mcg/min
vasopressin bolus 1-2 units then 2U/hr
+/- metaraminol or phenylephrine
bronchospasm
salbutamol MDI 12 puffs (1200mcg) - IV bolus 100-200mcg +/- infusion 5-25mcg/min
Mg 2g over 20mins
+/ volatiles or ketamine
- Fem-fem VA ECMO, where is BG best representative of coronary PaO2?
- right radial
- Either radial
- Left radial
- Pre oxygenator
- Post oxygenator
Right radial
https://pmc.ncbi.nlm.nih.gov/articles/PMC8292640/
- Post op cognitive decline has an onset within:
- immediate post
- Within one day, lasting one week
- From ?3wk
- ?10 days post op for a year
- From 1 month to 1 year
From 7 days post op til 1 year post
Blue Book article 2019
Pre-eclamspia at 30 weeks with IUGR
A- low CO, low SVR
B- Low CO, high svr
C- High CO, low svr
D- High CO, high svr
B - Low CO, high SVR
https://www.ahajournals.org/doi/epub/10.1161/HYPERTENSIONAHA.118.11092
Women who subsequently developed preeclampsia/fetal growth restriction had lower preconception cardiac output (4.9 versus 5.8 L/min; P=0.002) and cardiac index (2.9 versus 3.3 L/min per meter2; P=0.031) while mean arterial pressure (87.1 versus 82.3 mm Hg; P=0.05) and total peripheral resistance (1396.4 versus 1156.1 dynes sec cm−5; P<0.001) were higher.
https://www.ajog.org/article/S0002-9378(20)31283-7/fulltext
Burns - expected physiological change in first 24 hours
A- High cardiac index
B- Increased PVR
C- Decreased SVR
D- High stroke volume
Increased PVR
- initially loss of intravascular volume + low CO and catecholamine surge -> vasoconstriction
https://journals.sagepub.com/doi/10.1177/0310057X20914908?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
Which increases the risk of blood product related graft vs host disease
- genetic variability between donor and recipient
- irradiated
- leukodepleted
- Immunodeficiency
- transfusion of non-cellular product
Immunodeficiency
The three primary risk factors for developing TA-GVHD are:
https://www.lifeblood.com.au/health-professionals/clinical-practice/adverse-events/TA-GVHD
Factors increasing risk:
- degree of immunodeficiency of the recipient.
- number of viable T lymphocytes transfused (affected by the age of the blood transfused, degree of leucodepletion and irradiation status), and
- genetic diversity between donor and recipient. Greatest risks are donations from blood relatives and with HLA-matched blood products (because in GVHD, the body cannot recognise the foreign T cells and allows them to engraft)
When reconstituted, fibrinogen concentrate should be transfused within:
- 30min
- 4h
- 6h
- 8h
6 hours
“RIASTAP product info:
If it is not administered immediately, it must be stored below 25oC and used within 6 hours of
reconstitution. The reconstituted solution should not be stored in the refrigerator”
- A man has this device put in because he isn’t suitable for anticoagulation with AF. What is a
WATCHMAN device/ where is it?
- left atrial appendage
- SVC
- IVC
- Right atrium
- Ascending aorta
LA appendage
A aortic mechanical On-X valve - has an inguinal hernia repair in 48 hours and his INR is 1.5, what should you do?
- bridge with enoxaparin
- bridge with heparin
- just withhold the warfarin
Withhold warfarin
On-X is approved for use with INR use 1.5-2.0
https://academic.oup.com/ejcts/article/65/5/ezae117/7646070
APRV ventilation
Spontaneously breathing patient
Longer inspiratory times (prolonged high pressure maximises recruitment) = better oxygenation
brief releases at lower pressure facilitate CO2 clearance
Similar to constant recruitment method
Best TOE view for detecting myocardial ischaemia
- Mid-Oesophageal 4 chamber
- Long axis
- 2 chamber
- Transgastric 2 chamber papillary
Transgastric mid papillary
“TOE was found to be good at detecting new left ventricular RWMAs, associated with ischaemia. In particular the transgastric short axis mid view of the left ventricle demonstrates areas of myocardium subtended by each of the three coronary arteries. It is therefore the most frequently used view for intraoperative monitoring of left ventricular ischaemia.” https://www.sciencedirect.com/science/article/pii/S0007091217351863#:~:text=In%20particular%20the%20transgastric%20short,monitoring%20of%20left%20ventricular%20ischaemia.
The pregnant MS lady, cat 1 section within 30min, what method
- spinal
- CSE
- Epidural
- GA
- Methylpred then GA
Spinal
Classic LMA cuff recommended pressure max (CmH2O)
30
40
50
60
60cmH2O intracuff pressure
Narrow complex tachycardia ECG in young person post op in PACU with SBP 90. What treatment
A. Modified valsalva
B. Adenosine
C. DCCV
valsalva
Child with status epilepticus, weight 20kg, which is NOT a recommended treatment with midazolam:
- IM 3mg
- intranasal 6mg
- intraosseous 3mg
- buccal 6mg
- IV 1.5mg
IV and IM doses too low
Buccal/ intranasal 0.3mg/kg x20 = 6mg
IV/ IO 0.15mg/kg x20= 3mg
IM 0.2mg/kg x20= 4mg
https://www.childrens.health.qld.gov.au/__data/assets/pdf_file/0021/174180/status-epilepticus-flowchart-and-medications.pdf
Highest rate of mortality is in BMI category of
- <18.5
- 18.5-24.9 - 25-29.9
- 30-34.9
- 35-39.9
BMI <18.5
Major burns patient, pharmacologic effects in relation to non-depolarising neuromuscular blockers
- Dose expected higher because of up-regulation of acetylcholine receptors
- Class 2 obesity has an ASA score of:
1
2
3
4
2
What are the features of Brugada syndrome on ECG?
Brugada sign - Coved ST segment elevation >2mm in one of V1-V3 followed by negative T wave
- Magnesium 20mmol given intra-op is NOT associated with
A - reduced pain scores in PACU
B - reduced PONV
C - Reduced MAC requirements
D - Prolonged NMB
E - Resp depression post op
Reduced MAC requirements
Does result in post-op resp depression
and decreased opioid consumption
Child 4mo with uncorrected TOF, having a tet spell, what will not work? or maybe “what would you avoid giving”?
- prostaglandin
- sedation
- fluid bolus
- vasopressor
- beta blocker
Prostaglandin
- Someone is on long acting MAOi, what drug is most likely to cause serotonin syndrome?
- pethidine
- tapentadol
- Methadone
- sux
- fent
pethidine
- Parkinson patient on an apomorphine infusion, what drug to give for nausea
- cyclizine
- ondansetron
- droperidol
- metoclopramide
Cyclizine
ondansetron interacts with apomorphine
Refractory epilepsy and vagal stimulator, what is most likely to cause it to inadvertently fire?
- hypertension
- tachycardia
- bradycardia
- Hypotension - Hyperthermia
Tachycardia
What is the most consistent factor to increase PONV rate in children?
- female sex
- age 3 years or older
- Use of short acting opioids
> 3 years old
Pre-op risk factors:
>= 3yo, Hx of POV/PONV/motion sickness
Fhx of POV/PONV
Post-pubertal female
What is not a good indicator of a neonate being ready for extubation?
- Grimace
- RR>16
- conjugate gaze
RR >16
Eight features have been found to be associated with successful awake extubation in children: eye opening, facial grimace, movement of the patient other than coughing, conjugate gaze, purposeful movement, low end-tidal anaesthetic concentration (<0.2% for sevoflurane, <0.15% for isoflurane and <1% for desflurane), Spo2 > 97%, tidal volume 5 ml kg−1 and a positive laryngeal stimulation test.
What nerve is not related to the trigeminal?
- auriculotemporal
- supratrochlear
- infratrochloear
- great auricular
Great auricular nerve - branch of C2/3
Right homonomous hemianopia and right hemisensory loss - affected region
- left posterior cerebral
- Left anterior cerebral
- Superior cerebellar
- Left anterior inferior cerebellar
left posterior cerebral a.
What is NOT a feature of TURP?
- hyperglycinaemia
- hyponatraemia
- hypervolaemia
- hypokalaemia
hypokalemia
Oxygen pulse in CPET is surrogate for:
- stroke volume
- anaerobic threshold
Stroke volume
(&peripheral O2 extraction)
Novel techniques for quantifying oxygen pulse curve characteristics during cardiopulmonary exercise testing in tetralogy of fallot 2024 - “Oxygen pulse (O2P) is the CPET surrogate for stroke volume and peripheral oxygen extraction.”
What increases DLCO?
Pulmonary haemorrhage
“UTD:
The diffusing capacity of the lungs for carbon monoxide (DLCO) is designed to reflect properties of the alveolar-capillary membrane, specifically the ease with which oxygen moves from inhaled air to the red blood cells in the pulmonary capillaries.
Increased DLCO — Disorders to consider when the DLCO is near or above the upper limit of the normal range include the following [17,72,73]:
●Obesity
●Asthma
●High altitude
●Polycythemia
●Pulmonary hemorrhage
●Left-to-right intracardiac shunting
●Mild left heart failure (due to increased pulmonary capillary blood volume)
●Exercise just prior to the test session (due to increased cardiac output)
●Supine position; Mueller maneuver”
What acceptable reason to defer NOF?
- K+2.7
- HR 110, AF
- Hb86
- Na126
AAGBI 7 acceptable reasons for delaying NOF
1. Hb <80
2. Acute CCF
3. Uncontrolled DM
4. Correctable cardiac arrhythmia with vent rate >120bpm
5. Na <120 or >150, K <2.8 or >6
6. Reversible coagulopathy
7. Chest infection with sepsis
- What is the most sensitive predictor of 30 day mortality and MACE? .
- DASI score 55
- AT<11
- proBNP >300
- 6MWT<…
- VO2 <11
High proBNP
DASI score improved RCRI prediction of 30d mortality/MI and 1yr mortality
METS study
VO2 max and DASI questionnaire relationship - score of 48 on DASI something equals
VO2 peak of?
A - 20ml/kg/min
B - 30
C - 40
D - 50
30ml/kg/min
DASI conversion formula - 𝑉o2 peak (ml kg−1 min−1) = (0.43×DASI)+9.6.
Sepsis guidelines, what measure is NOT recommended to assess fluid status/ dynamic?
- urine output
- passive leg raise
- PPV”
urine output
surviving sepsis - “For adults iwth sepsis or septic shock, we suggest using dynamic measures to guide fluid resuscitation over physical examination or static parameters alone. Weak recommendation, v low quality evidence.
Dynamic parameters = passive leg raise, fluid bolus, SV, SVV, PPV, echo”
Newborn at 1min, sats 75%, grimacing, pulse 120, RR 40. What do you do?
a Observe
b CPAP
c Intubate
d CPR
Observe
ANZCOR guidelines - at 1min, sats expected 60-70%. HR >100
Diagnosis for TRALI NOT based on
A- hypoxaemia
B- Onset within 6 hours of transfusion
C- PCWP high
D- Bilateral infiltrate on CXR
C - High PCWP
“UTD:
TRALI is a clinical diagnosis made using the criteria outlined by the NHLBI’s working group on TRALI or the Canadian Consensus Conference (CCC) on TRALI
The diagnostic criteria for TRALI and possible TRALI share the following features:
acute onset of hypoxemia
bilateral infiltrates on frontal chest radiograph, and absence of circulatory overload as the primary etiology of respiratory insufficiency. For a diagnosis of TRALI to be made, all of these features must be present. In addition, there should be no pre-existing ALI/ARDS risk factors at the time of transfusion”
Diagnosis HITS based on 4Ts Score, which are:
UTD:
Thrombocytopenia
*Platelet count fall >50 percent and nadir ≥20,000/microL – 2 points
*Platelet count fall 30 to 50 percent or nadir 10 to 19,000/microL – 1 point
*Platelet count fall <30 percent or nadir <10,000/microL – 0 points
●Timing of platelet count fall
*Clear onset between days 5 and 10 or platelet count fall at ≤1 day if prior heparin exposure within the last 30 days – 2 points
*Consistent with fall at 5 to 10 days but unclear (eg, missing platelet counts), onset after day 10, or fall ≤1 day with prior heparin exposure within 30 to 100 days – 1 point
*Platelet count fall at <4 days without recent exposure – 0 points
●Thrombosis or other sequelae
*Confirmed new thrombosis, skin necrosis, or acute systemic reaction after intravenous unfractionated heparin bolus – 2 points
*Progressive or recurrent thrombosis, non-necrotizing (erythematous) skin lesions, or suspected thrombosis that has not been proven – 1 point
*None – 0 points
●Other causes for thrombocytopenia
*None apparent – 2 points
*Possible – 1 point
*Definite – 0 points
To confirm ETT, need ETCO2 more than how much from baseline?
7.5mmHg
https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15817
Patient presents for a trans-urethral resection of the prostate (TURP). He had a single
drug-eluting coronary stent for angina pectoris inserted six months ago and is taking clopidogrel and aspirin. The most appropriate preoperative management of his medications is to
A - Cease clopidogrel for 5 days
B - Cease clopidogrel for 10 days
C - Continue both
D - Cease clopidogrel for 7 days and aspirin for 20 days
A - cease clopidogrel 5 days
Woman complaining of persistent shortness of breath 3 days post prolonged knee operation. v/q scan showing patchy, non segmental areas of equal non ventilation and perfusion. Cause
- PE
- Pulm infarct
- COPD
- Atelectasis
COPD
Airway abnormality eg mucous plugging causes matched defect secondary to HPV
vs
Flow abnormality eg PE/infarct causes a mismitch V/Q because you can stop blood flow but lung will remain ventilated
What is the half life of a 100u/kg heparin dose?
- 30mins
- 1hour
- 2 hours
- 3 hours
- 4 hours”
60 mins
“Blue Book 2023
Heparin 25iU/kg –> t1/2 30min
100IU/kg –> 60min
400IU/kg –> 150min”
What nerve is not potentially damaged by insertion of supraglottic airway?
- Facial
- Trigeminal
- Glossopharyngeal - Vagus
- Lingual
Facial nerve
- Somatic innervation in the second stage of labour includes the following nerves EXCEPT
- Genitofemoral nerve
- Posterior cutaneous nerve of the thigh
- Inferior gluteal nerve
- Pudendal nerve
Inferior gluteal nerve - motor to thigh
Cryoprecipitate does NOT contain
- Factor IX
- Factor XIII
- Fibronectin
- Von Willebrand Factor
Factor IX
Cryo contains: vwF, fibronectin, fibrinogen (I), VIII, XIII
Use of methylene blue rather than patent blue
- Reduced rate of anaphylaxis
- More expensive
- Easier to see sentinel nodes
- Reduced O2 saturations
Reduced rate of anaphylaxis
https://www.nationalauditprojects.org.uk/downloads/NAP6%20Chapter%2018%20-%20Patent%20Blue%20dye.pdf
Which additive prolongs block longest?
A - Clonidine
B - Dexamethasone
C - Bicarbonate
D- Adrenaline
Dexamethasone
Clonidine +2hrs
Bicarbonate - increased speed of onset
Adrenaline +1hr
The recommended skin preparation for a neuraxial?
0.5% chlorhex/ 70% alcohol.
The accompanying image is obtained while doing an ultrasound guided erector spinae plane block at the level of the transverse process of the fourth thoracic vertebra. The muscle marked by the arrow is the
(what is the sequence of muscles?)
Trapezius
Rhomboids
Erector Spinae
NAP7 - most common cause perioperative arrest?
- Major haemorrhage
- Anaphylaxis
- Airway issues
Major Haemorrhage
NAP 7 2023: The most common causes of perioperative cardiac arrest were major haemorrhage (17%), bradyarrhythmia (9.4%) and cardiac ischaemia (7.3%) but varied by surgical specialty
DDAVP NOT used for:
- nocturnal enuresis
- Haemophillia B
- Von Willebrand disease 2A
- Uraemic bleeding
- Central diabetes insipidus
Haemophilia B
Noradrenaline has tissued into skin from peripheral cannula, most appropriate first step is:
- remove cannula
- Flush with saline
- Hyalase
- Cold compress
- phentolamine
Phentolamine
Avoid cold compress, don’t flush
Hyalase can be used for large volume extravasation
Keep cannula in situ
What is not associated with POTS?
- COVID-19
- Hypermobility disorder
- Normal resting LV function
- ECG changes
ECG changes
- Need a normal ECG for PoTS
- IS assoc w/ long covid, EDS, and need normal LV function
- https://www.acc.org/Latest-in-Cardiology/Articles/2016/01/25/14/01/Postural-Tachycardia-Syndrome-POTS-Diagnosis-and-Treatment-Basics-and-New-Developments#:~:text=Left%20ventricular%20function%20must%20be,could%20mimic%20a%20POTS%20presentation.”
PFT in patient, detect nitric oxide >70ppm number ppb. SIgnificance?
- Smoker
- COPD
- Exacerbation of asthma
Exacerbation of asthma
Compared to a continuous infusion, PCEA does NOT reduce
- Incidence of instrumental delivery
- Incidence of C-section rates
- Clinical workload
- Motor weakness
Incidence of CS
* PIB superior analgesia to Infusion ○ Better spread (bolus under pressure) ○ Less breakthrough pain (better analgesia) ○ Longer time to PCEA use ○ Less overall LA required ○ No difference in instrumental delivery and CS rate Less motor block (2.7 vs 37% and 1% vs 21.8%)
A 70-year-old man undergoes a stress echocardiogram as part of his preoperative preparation before a total hip replacement. If he has clinically significant coronary artery disease, the earliest indicator during his test is most likely to be:
A - ECG changes
B - RWMA
C - diastolic dysfunction
D - Angina
E - Hypotension
?Diastolic dysfunction
What is the purpose of the Modified Borg scale for CPET?
Subjective grade of dyspnoea as rating of percieved exertion
- ANZCOR recommendations on minimum time from cardiac arrest to post arrest prognostication?
A - 24hrs
B - 48hrs
C - 72hrs
72hrs - testing done at this time
brain death certification with ANZICs - >24hrs post arrest
“ANZCOR. CTB 48h
72 hours: pupillary light reflex, pupillometry, corneal reflex, eeg, NSE, MRI 72h-7d
4 days GCS >3
7 days (status) myoclonus “
Spinal, 3ml, patient supine and horizontal, hyperbaric qualities vs normal bupivacaine
A Lesser block height, shorter DoA
B Lesser block height, Longer DoA
C Greater block height + shorter DoA
D Greater block height+ Longer DoA
E No difference in block height, longer DoA
Greater block height, shorter DOA
Which anaesthetic has least effect on ECOG - electrocorticography for epilepsy surgery?
A ketamine
B propofol
C remifentanil
Remifentanil
Dexmed also good
conflicting - sevo/propofol
avoid - ketamine, midaz
https://pubmed.ncbi.nlm.nih.gov/33819715/
Best post-op analgesia after wisdom tooth removal
A Ibuprofen
B Celecoxib
C Tramadol
D paracetamol
Celecoxib
https://www.thejcdp.com/doi/pdf/10.5005/jp-journals-10024-2428
Which drug NOT to give with cocaine toxicity?
A - phentolamine
B - Metoprolol
C - GTN
D - Propofol bolus
B- metoprolol ->unopposed alpha stimulation
SGLT-2i use for diabetes, what do they NOT cause?
A Glycosuria
B Reduced eGFR
C Euglycaemic ketosis
D Hypoglycaemia
Hypoglycaemia.- low risk
reduced GFR - GFR dip on initiation of SGLT2i
Buprenorphine patch stopped, when will plasma levels drop by 50%
A - 12hrs
B - 24hrs
C - 48hrs
D - 72hrs
A - 12 hrs
5 kPa is approximately equivalent to:
A - 37 mmHg
B - 45 mmHg
37mmHg
1kPA = 7.5mmHg
Risk of AFE is highest in:
A - Caesarean Section
B - induction of labour
C - Labour augmented by oxytocin
Induction of labour
- increased again if oxytocin used
You have induced a patient (I forget this part) and ten minutes later - reduced air entry left side, sats 85%, hypotensive. Lung USS on the left side shows no sliding and a lung point sign.
- Left needle decompression 2nd IC space
- Left chest drain insertion
- Left finger thoracostomy
- Pull the ETT back 2cm
- Get a chest XR
Needle decompression, 2nd IC space
Compared with open mechanical aortic valve repair, TAVI has:
- Reduced mean gradient
- Reduced vascular injury
- Reduced arrhythmia
- Reduced paravalvular leaks
Reduced arrhythmia - less likely to need a pacemaker
TAVR has -> only significant results
RR all cause death 0.67
RR disabling stroke 0.35
RR AKI 0.21
RR rehospitalisation 0.63
RR AF 0.25
RR risk of bleeding 0.37
RR vascular complications 1.92
RR pacemaker 2.9
RR mild paravalvular leak 6.6, moderate 4.67
RR reintervention 3.7 in high risk cases
similar valve gradients
The number of segments in the left lower lobe of the lung is:
A 2
B 3
C 4
Four - Superior, Anteromedial, Lateral, Posterior
