Emergency Medicine and Intensive Care/Perioperative and Anaesthesia Flashcards
ASA classification
1 - health non drinker
2 - smoker, social drinker, pregnant, BMI >30, well controlled disease
3 - Poorly controlled disease, BMI >40, end stage renal, stroke or MI >3m
4 - stroke or MI < 3m, sepsis, DIC
5 - expected to die without operation eg rupture aneurysm, massive trauma
6 - braindead
Mechanism propofol and properties
GABA agonist
Rapid onset, antiemnetic
Choice for rapid onset induction
Sodium thiopentane
Mechanism ketamine and properties
NMDA receptor antagonist
Strong analgesia
Choice for induction in trauma
Ketamine
Choice for induction in haemodynamic instability
Etomidate
Blood matching units
Unlikely - group and save
Likely - 2 units
Definite - 4 to 6 units
Inhaled general anesthetics
Volatile liquids (ends in -flurone) - induction and maintanence Nitrous oxide - induction and maintanence
Avoid in pneumothorax
Nitrous oxide
IV general anaesthetics
Propofol
Thiopentane
Etomidate
Ketamine
Mechanism thiopentane
GABA agonist
Mechanism etomidate
GABA agonist
Lidocaine mechanism
Na channel antagnoist
Lidocaine toxicity treatment
IV 20% lipid emulsion
Recognise malignant hyperthermia
Inherited dominant fashion, related halothene and suxamethasone
Raised CK, temp, muscle rigidity
Treatment malignant hyperthermia
Dentrolene
Choice muscle relaxants
Suxamethasone
Atracurium
Vecuronium
Pancuronium
Only depolarising muscle relaxant
Suxamethasone
Fastest onset muscle relaxant
Suxamethasone
Reverse non depolarising muscle relaxants
Neostigmine, polarising cannot be reversed
Nasopharngeal airway contraindicated
Base skull fractures
Mechanism suxamethonium
Blocks acetylcholine receptors
Causes post op pyrexia
0-5d after - cellulitis, UTI, physiological, atelectasis
>5d - VTE, pneumonia, wound leak, anastomotic leak
Fasting before surgery
Clear 2h before
Food 6h before
Metformin for surgery
Day before normal
On day omit lunch dose if take 3x
Sulphonylureas for surgery
Day before normal
On day omit if 1x, omit morning dose if 2x
DPP inhibitors (-gliptins) for surgery
Take as normal
GLP1 analogues (-tides) for surgery
Take as normal
SGLT2 inhibitors before surgery
Day before normal
Omit on day
VTE prophylaxis for surgery
1) Stockings if low risk
2) LMWH if higher risk, unfractionate heparin in CKD
Diagnose anastomotic leak
CT scan
Prep for colonscopy
Laxatives day before
Poor post op pain management leads to
Pneumonia
Lots of saline can cause
Hypercholoraemic acidosis
Common cause confusion after op
Hyponatraemia
