Clinical questions (Medical Expert) Flashcards
You are at Anaesthetic Clinic and your 60y/o patient is coming in for a Lap Chole you note incidentally she has a systolic murmur, what do you do?
- Go through the basic Hx, Ex, Ix
- Focused Hx, Ex, Ix looking at signs of HF
Hx - SOB, exertional dyspnoea, orthopnoea
Ex - HR/BP, murmur, radiation, signs of HF including enlarged liver, pleural effusion, leg swelling
Ix- ECG, CXR, Previous cardiac investigations
What is the significance of sever AS in Anaesthesia.
Severe AS can lead to signifcant drop in CO, reduce coronary perfusion, higher risk of AMI, stroke.
Can be managed with strict blood pressure control and inotropes.
How do you manage Malignant Hyperthermia in OT
Call for help Call for MH trolley Stop volatile and washout with 100% oxygen high flow Add charcoal to circuit Give IV Dantrolene every 10 minutes IAL + IDC + Temp probe
Anaphylaxis
Main priority: Cease trigger Call for help Get anaphylaxis box Remove agents Minimize volatile maintain anaesthesia Large bore canulas Treat based on grade (1-4) Adrenaline 10mcg, 100mcg, 1mg Elevate legs Refractory treatment - salbutamol12 puffs, adrenaline infusion IAL - ABG, Bloods Tryptase @ 1,4,24 hours
N/V postoperative patient in recovery
Immediate:
Review patient, ABCD
A:
B: RATES,
C: HR/BP, Fluids 20mL/kg
D: drugs: review drugs, manage anxiety/pain
E: Abdomen: surgical causes? - Dex, Droperidol, Prochloperazine, Cyclizine
Subsequent
Admit to ward for IV rehydration, regular anti-emetics
Consider NGT
Non-opioid for pain management
What are the principles of CRISIS resource management?
Environment - know your environment Anticipate - Anticipate and plan Help - Call for help Leadership - Take leadership role Ensure role clarity and good teamwork Communicate - Communicate effectively Attention - Allocate attention wisely Workload - Distribute workload
Know your environment Anticipate, share and review the plan Provide effective leadership Ensure role clarity and good teamwork Communicate effectively Call for help early Allocate attention wisely – avoid fixation Distribute the workload – monitor and support team members
You are the most senior doctor at a resus. Patient is brought in unconscious by ambulance. Family members are hysterical and interfering with the resus. What is your management?
Managing the relatives (e.g. get someone to take them to a quiet room and take a history,, tell them you will speak with them ASAP but need to look after their relative etc.)
THEN, you needed to discuss how you would run the resus (team leader, role allocation, DRABC etc.)
ALS principles
What if the consultant refuses to come in during After Hours shifts?
Tell them that I feel that, given where I am in my training, that I would like them to be present before I proceed.
If still no success, I would call my SoT or another consultant and ask them to come in. I would then consult with my SoT or department director to explain that I had requested for the consultant to come in and they hadn’t
What would you do if there was a fire?
3 main fire hazards
Fuel (alcohol based solutions), combustion agent (oxygen) and energy (scalpel/laser)
Immediate action RACE
Remove/rescue anyone in the immediate area of the fire
Announce the alarm – CODE Red
Contain fire – close doors, remove potential sources of fire
Evacuate – as per fire warden, prepare equipment for evacuation
Anaesthetic equipment, pack cover patient wound
What are some other occupational hazards?
Patient factors: Needle stick injury – exposure to blood borne diseases
Exposure to respiratory diseases – TB
Anaesthetic factors: MSK morbidity – exposure to glass, BMV, latex injury. Osteoarthritis
Waste gases, Latex allergy
Personal: substance abuse, personal stress, fatigue
Surgical factors: X-ray/MRI radiation, diathermy, laser smoke inhalation
What is the difference between protocol and guideline?
A protocol is a step-by-step outline for undertaking a specific task. They normally have to be followed exactly, whereas with a guideline the recommendations need to be considered in the light of the particular patient and settings as well as the strength of the evidence base.
A guideline is ‘a systematically developed statement to assist decisions about appropriate healthcare for specific circumstances.’ Clinical guidelines are based on the best available evidence and provide recommendations for practice about specific clinical interventions for specific patient populations.
