Quick Memorisation Flashcards
Pulmonary HTN severity
mPAP
Mild 20-40
Mod 40-55
severe > 55
How to calculate mPAP from RVSP?
(0.6x RVSP) +2
so if RVSP =40, mPAP =25mmHg
Normal mitral valve area?
> 4 cm2
Grading of MS
by area and by gradient
Mild - 1.6-2cm2, <5mmHg
Mod - 1-1.6cm2, 6-10mmHg
Sev - <1cm2, >10mmhg
MR severity grading?
Regurgitant fraction (RF), regurgitant volume (RV), and orifice of regurgitation
Mild - RF <30%, volume <30ml, orifice <0.2cm2
Mod - RF 30-50%, volume 30-60ml, 0.2-0.4cm2
Sev - RF >50%, >60ml, >0.4cm2
AS Severity criteria
AV area
Mean gradient
Vmax
Indexed aortic valve area
Mild AS?
AVA > 1.5cm2
Mean gradient <20mmHg
Vmax 2.6-2.9ms-1
Mod AS
AVA 1-1.5cm2
MG 20-40mmHg
Vmax 3-4ms-1
Severe AS?
AVA <1cm2
MG > 40mmhg
Vmax >4ms-1
6 components of Lee’s Revised Cardiac Risk Index
Ischaemic heart disease
CCF
Cerebrovascular disease
Diabetes
CKD
Suprainguinal vascular / thoracic / intra-peritoneal surgery
Score of ≥3 = 11.1% of MACE
NSTEMI types
I = plaque rupture
II = supply-demand mismatch
III = sudden cardiac death
IV = post PCI
V = post CABG
Which drugs can go down ETT?
NAVAL
Naloxone, adrenaline, vasopressin, atropine, lignocaine
EZ-IO needle size?
How do the colours indicate size?
15G
Colour indicates length
Red - 15mm
Blue - 25mm
Yellow - 45mmw
Vasopressin infusion dose?
Adult
1-2units bolus
Infuse @1-2units/hr
Criteria to proceed with surgery for pheochromocytoma?
BP < 160/90
NP STE on ECG
Normal BGLs
Orthostatic hypotension
Normal HCT
Amount of blood to raise Hb by 10g/L in children
4ml/kg
Unit of platelet will increase plt by?
1 unit in adult increases by 20-40x10^9/L
In paed = 10ml/kg
Amount of cryo to increase Fib by 1g/L
1 unit per 10kg of body weight
Typical adult dose is 10units, each unit contains 10-20ml (200ml total)
Dose of FFP?e
15ml/kg
RBC, Plt, cryo, FFP
- How long do you have after removing from fridge?
- Under what time frame can you return to fridge?
RBC, cryo, FFP = same
- 4 hours post remove from fridge, can return if <30 mins
Plt
- use within 1 hour.
- can return up to 1 hour.
Warm ischaemic time for organs
heart, liver - 30 mins
Pancreas, kidneys 60 mins
Lungs - 90 mins
heart from time of SBP < 90
Cold ischaemic time for organs?
Heart, lung 4 hours
Liver 6-10 hours
Pancreas 12-18 hours
Kidney 24 hours
Criteria for brain death
Unresponsive coma (GCS 3 for 24 hours)
apnoea
absence of brainstem reflexes
Need to have
- Intracranial pathology
- No sedation
- Normothermia, normotension
- Intact neuromuscular junction
- No metabolic cause for coma
Criteria for cardiac death
Immobility, apnoea
No pulse for 2 mins
No skin perfusion
Cardiac death categories
1 - dead on arrival
2 - failed CPR
3 - withdrawal in ICU
4 - cardiac arrest post brain death
Severity of ARDS
Mild PFR 200-300
Mod 100-200
Sev < 100
qSOFA score
≥2 = increased mortality from sepsis
BP ≤100mmHg
RR ≥22
GCS < 15
RIFLE criteria
Severity of renal impairment based on Creatinine and urine output
Risk - Cr 1.5x, UO <0.5ml/kg for 6 hours
Injury - Cr 20, UO<0.5 for 12 hrs
Failure - Cr 3x, UO<0.3 for 24hrs or anuric for 12 hours
Loss - complete loss of renal function for >4 weeks
ESRD - end state
Grading systems for SAH
WFNS (GCS, motor deficit, IV = GCS 7-12) - clinical grading I - V
Fisher - radiological grading
- I - IV
Canadian CT head rule
if any of the following high risk factors, get CT head
- GCS < 15
- Depressed/open skull fracture
- Basilar skull fracture
- >1 vomit
- Age ≥65
if no high risk, get a CT head if
- >30 mins retrograde amnesia
- dangerous mechanism
NEXUS criteria for C spine
Neurology
Ethanol
Xtra distracting injuries
Untoward change in level of consciousness
Soreness in midline
STOPBANG score
Snoring
Tired / sleepy
Observed apnoea
Pressure (HTN)
BMI > 35
Age > 50
Neck circumference > 43 cm in M, 41 in F
Male
Risk is high if score 5-8
Which drugs use
- Lean body weight
- total body weight
- Idea body weight
Prop induction / remi - LBW
Sux and prop maintenance - TBW
NDMRs - IBW
Indicators for CTG
MONITOR
- Meconium
- Obs bleeding
- Neuraxial
- abnormal fetal heart rate
- Temperature (fever)
- Oxytocin
- Request by mother
C-section Caterogies
1-4
I - immediate within 30 mins
II - within 60-90 mins
III - early than planned
IV - at a planned time
Grades of bone cement implantation syndrome
Grade 1 sats <94%, SBP drop >20%
Grade 2 sats <88%, SBP drop >40%
Grade 3 CPR
Unacceptable reasons to delay hip surgery
No staff / facilities
Minor electrolyte abnormalities
Echocardiogram
APGAR score
Appearance
Pulse (100 is cut off)
Grimace
Activity (?flexion)
respiration (none/weak/strong)
Scores to measure paediatric emergence delirium
Cravero Scale - obtunded -> responsive -> crying -> needs restraints (grade 5)
WATCHA scale - asleep -> calm -> crying -> crying inconsolably -> thrashing
Paeds ETT size
Age/4 + 4 (uncuffed)
step down 0.5 for cuffed
ETT depth in children
Age/2 + 12 lip
Age/2 + 15 for nose
Paeds approximate weight
(age + 4) x2
When to refer to specialist paed hospital?
Neonate < 28 days
Ex-prem <37/40 with a post-conceptual age <52 weeks
History of apnoea
Complex children ASA > 3
Bromage scale
G1 - free to move legs, no block
G2 - free to move feet, just flexing knees, partial 33% block
G3 - unable to flex, 66% block
G4 - unable to move legs, 100%
Child Pugh score criteria
A, B, C periop mortality
Albumin, INR, ascites, encephalopathy, bilirubin
A, 5-6, 10%
B, 7-9. 30%
C ≥10, 80%
What does MELD score predict?
Use bilirubin, INR, creatinine to predict 30 day mortality
Predicted post-op FEV1
Lung has 42 segments
22 right, 20 left
Right upper (6), middle (4), lower (12)
Left upper (10), lower (10)
Preop FEV1 x ((42-#segments removed)/42)
So if 21 segments removed, half the FEV1
CURB 65 score for pneumonia
Confusion
Urea > 7 mmol/L
RR ≥30
sBP < 90 mmHg
Age > 65 years
Score 3-5 = inpatients +/- ICU
Bronchial blocker size
ETT size 6, use blocker 7 Fr
ETT size 7.5, use blocker 9 Fr
Components of damage control resus
Permissive hypotension
Damage control surgery
Prevention of hypothermia, acidosis, hypocalcaemia
Carbon monoxide poisoning, when to treat and how?
> 10 % = symptomatic, FiO2 0.21 conservative
> 20% = FiO2 1.0
> 50% = coma / death, 3ATM 1.0
