Osce

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Question 2

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Confirmation that the airway is patent and present within the trachea

Measuring cardiac output

Question 3

Answer 3

1. Risk of Aspiration: Patients who have a full stomach, such as those who have recently eaten, or those with conditions predisposing to gastroesophageal reflux or vomiting. This includes trauma patients, pregnant patients (especially those in active labor), and patients who have not been appropriately fasted.
   
   2. Obesity: In morbidly obese patients or those with obstructive sleep apnea, there may be increased risk of airway complications.
   3. Poor Lung Compliance: Patients with poor lung compliance may require higher ventilation pressures, which might exceed the seal pressure of the LMA.
   4. Procedures involving the Airway: Surgeries or procedures that involve the airway (e.g., tonsillectomies) are not compatible with LMA use.
   5. Lack of Training: In settings where the medical personnel are not trained in LMA placement and management.
   6. Head and Neck Pathologies: Conditions like tumors, abscesses, or other masses in the neck or pharynx might make LMA placement difficult or risky.
   7. Non-cooperative or Agitated Patients: Since placement requires a degree of cooperation or at least a lack of resistance, it may be unsuitable for non-anesthetized patients who are agitated.
   8. Prolonged Surgery: Some suggest avoiding the LMA in surgeries that are very long due to the risk of sore throat and other complications.
   9. High Risk of Gastric Insufflation: Situations where high ventilation pressures are anticipated or where positive pressure ventilation is required might increase the risk of insufflating the stomach.
   10. Airway Obstruction: Conditions like epiglottitis, which cause severe upper airway obstruction, might not be suitable for LMA.

Question 4

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Question 6

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Propofol

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Question 8

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Question 9

Answer 9

1. Class of Drug:
   Sevoflurane is an inhalational anesthetic agent. It belongs to the class of drugs known as volatile halogenated ethers.
   
   2. Uses of Sevoflurane:
      • Induction and Maintenance of General Anesthesia: Sevoflurane can be used to induce anesthesia (put patients to sleep) as well as to maintain anesthesia during surgical procedures.
      • Use in Pediatric Patients: Due to its relatively pleasant smell compared to other inhalational anesthetics, sevoflurane is often preferred for mask inductions in children.
      • Short Procedures: Sevoflurane has a low blood-gas partition coefficient, which means it’s taken up and released by the body quickly. This makes it suitable for shorter procedures or day surgeries where rapid awakening is desirable.
      • Ventilation Management: In some cases, especially in intensive care units, sevoflurane can be used for sedation during mechanical ventilation, though this is less common than its use in the operating room.

Question 10

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Question 11

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Question 12

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Question 13

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Question 14

Answer 14

1. Cardiovascular System:
   • Tachycardia and Hypertension: The most common response to laryngoscopy is an increase in heart rate and blood pressure due to sympathetic nervous system stimulation.
   • Dysrhythmias: Arrhythmias, including bradycardia (especially in infants) or even asystole, can occasionally occur.
   
   2. Intracranial Pressure (ICP): The sympathetic response can lead to an increase in ICP, which can be detrimental in patients with head injuries or intracranial pathology.
   3. Ocular Pressure: An increase in intraocular pressure can occur, which is a concern in patients with eye injuries or certain ophthalmologic conditions.
   4. Airway Pressure: Laryngoscopy can lead to an increase in airway pressures, especially if there is resistance encountered during intubation.
   5. Bronchospasm: Manipulation of the airway can lead to bronchospasm, especially in asthmatics or patients with reactive airway disease.
   6. Gag Reflex and Coughing: Stimulation can provoke coughing or gagging, which can increase intra-abdominal and intrathoracic pressures.
   7. Release of Stress Hormones: Laryngoscopy stimulates the release of catecholamines (epinephrine and norepinephrine) and other stress hormones.
   8. Transient Decrease in Oxygen Saturation: Especially if the intubation attempt is prolonged, it may lead to a transient drop in oxygen levels.

Question 15

Answer 15

1. Surgery at a high risk for aspiration, such as bowl obstruction or pregnancy.
2. Surgeries where controlled ventilation is necessary such as general anesthetic where muscle relaxants are used.

Question 16

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Question 17

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Question 18

Answer 18

1. Emergency Ventilation: In situations where a patient stops breathing or is not breathing adequately, an Ambu bag and mask can be used to provide positive pressure ventilation until more definitive airway management can be established or the patient starts breathing adequately on their own.
   
   2. During Intubation: Before intubation or between intubation attempts, the Ambu bag and mask can be used to ventilate the patient and provide oxygen.
   3. In Hospital Settings: In many clinical situations, such as during the transportation of intubated patients or when a ventilator machine is temporarily not available.
   4. Pre-oxygenation: Before certain procedures like intubation, to increase the patient’s oxygen reserves.
   5. Anesthesia: An Ambu bag and mask can be used to assist ventilation during the induction and emergence from anesthesia, especially in cases where intubation isn’t required.

Question 19

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Question 20

Answer 20