Exam 2021 Flashcards
Triad of serotonin syndrome?
Motor dysfunction
Altered mental status
Autonomic dysfunction
Criteria to stratify severity of serotonin syndrome
Hunter criteria
Treatments for serotonin syndrome?
Aggressive support care
- IV hydration to prevent rhabdo and AKI
Blood pressure management
- Hyper and hypo both possible
Hyperthermia
- Treat with anaesthetic agent, benzodiazepines
Seizure management
Specific treatment cypropheptadine
Damage control resuscitation components
Resuscitative transfusion
Limit crystalloid transfusion
Avoid triad of coagulopathy
Early damage control surgery
Control of haemorrhage
Permissive hypotension
Criteria for thoracotomy in trauma
Bleeding of >1500ML
or >200ml /hr for 2 hours
Targets to permissive hypotension in damage control resus
Penetrating injury - resus to radial pulse presence
Blunt cavity trauma - resus to radial pulse + blood transfusion to aim good UO
Head injury - aim MAP > 90, assuming ICP of 30 to maintain CPP of 60
Which nerve does a PVB not block in the context of breast surgery?
Branches of brachial plexus
- Supraclavicular
- Lateral and medial pectoral branches
Type of airway stents
Silicone - needs of rigid bronchoscopy
Metalic - can use flexible broncoscopy
Pros and cons of silicone stents in airway
Can reposition, can remove, less tumour invasive and granulation tissue formation
Needs rigid bronch, higher risk of migration, rate of infection
Pros and cons of metallic airway stent
Can use flexi bronch, larger internal diameter to external diameter ratio, self expanding device
Challenging to reposition and remove, increase risk of vascular perforation, higher rate of tumour invasion and granulation formation
Components of informed consent?
Informed
Competent
Voluntary
Allowed to ask question
Documentation
What is Addison’s Disease?
Primary or secondary adrenal failure
Intra-op considerations for Addison’s Disease
Stress dosing of steroids
- 100mg IV hydrocortisone on induction, then continuous infusion of 200mg over 24 hours.
- Fludrocortisone if required, discuss with endo input
- Stress dose to continue for 2-3 days
Haemodynamic instability
- Addisonian crisis -> life-threatening hypotension, unresponsive to adrenaline/norad
- Need steroid/vasopressin support
Avoid sux due to potential hyperK+
What is primary Addison’s disease
Autoimmune destruction, or adrenal destruction due to infection, surgery, haemorrhage
What is secondary Addison’s disease?
HPA axis suppression or disease
Glucocorticoid deficiency only.
Causes of Addisonian Crisis?
Stress, acute adrenal haemorrhage, pituitary apoplexy
Mode of anaesthesia for airway stenting?
Conscious sedation if metallic stent
GA, SV, arterial line with rescue rigid bronch for severe disease
Nerve supply to breast
T2-T6 thoracic nerve roots
Anterior cutaneous branches penetrate to reach muscle and skin
Supraclavicular nerve (C3-C4) - sensory to upper and outer regions of breast
medial and lateral pectoral nerves, branches of branchial plexus, between pec major and minor
Target nerves for PECS I block
Lateral and medial pectoral nerves
Targets of PECS II block?
lateral cutaneous spinal nerves
Long thoracic nerve
Intercostal nerves
DBS burst frequency and how it’s used?
2x bursts of three stimuli at 50Hz, 750ms apart
Improves sensitivity of manual assessment
No fade = at least 60% TOFR
Muscles involved in axillary brachial plexus block?
biceps
coraco-brachialis
conjoint tendon of lateral doors and teres major
Teres major deep
Which nerves not blocked in axillary brachial plexus block to cause tourniquet pain?
intercostobrachial + medial brachial cutaneous.
Dopamine replacement therapies for Parkinson?
Levodopa + carbedopa
Pramipexole
Selegiline
Anticholinergic
Bridging therapy for Parkinson if NBM?
Apomorphine subcutaneously
Rotigotine transdermal
Withdrawal syndromes names for PD?
Parkinson hyperpyraxia syndrome
Dopamine agonist withdrawal syndrome
