Random Crap I Should Know Flashcards
Child-Pugh score
Each 1-3 points.
Used to predict surgical mortality
A - 5/6;
B 7-9 points
c - >10; >50% mortality; 1 year survival 45%, 2yr 33%
Bilirubin 50
Albumin (g/l) >35, 30-35, 2.3
Encephalopathy none, grade 1-2, grade 3-4
Ascites none, moderate, marked
Sarcoidosis is;
A multi system granulomatous disease that causes non caseating granulomas in involved organs
Lung disease in 50 %; restrictive or obstructive picture, skin issues, laryngeal sarcoid, may have mediastinal mass
SLE is;
A chronic autoimmune inflammatory condition
Pericarditis, libman-Sachs endocarditis, accelerated CAD
Pulm HTN, interstitial lung disease, risk of PE
Small vessel vasculitus
Renal involvement
Joint issues in 90%
High risk thromboembolic events
May be on steroids
Signs of an innocent murmur in a child
Clinically well, growing normally, feeding normally Pulses are normal No history of recurrent chest infection Murmur is; Soft EarlySystolic or continuous Often varies with posture No thrill Quality - blowing, musical
Nerves to block for scalp block
7 paired nerves; Supraorbital - V1 Supratroachlear - V1 Zygomaticotemporal - V2 Auriculotemporal - V3 Lesser occipital - cn2/3 Greater occipital - cn2 Greater auricular - cn2/3
Non technical skills
Situational awareness
Team working
Task management
Decision making
Effects of quitting smoking
1 day - HbCO levels and nicotine levels lower; better oxygen delivery
3 weeks - improved wound healing
6-8 weeks - sputum volume not > than non smokers, improved pulmonary function
>6/12 - improved immune function
Ask, advise, refer
Classification of equipment;
Critical - will penetrate skin, mucous membranes, enter vascular system. Must be sterilised.
Semi-critical - will be in contact with intact mucous membranes or be contaminated with readily transmissible organisms. Need high level disinfection or sterilisation.
Non-critical - intact skin, or no direct patient contact. Low level disinfection or cleaning.
Hand hygiene solution contains;
2-4% chlorhex and 60-95% alcohol
Classification of equipment re cleaning;
C = critical SC = semi critical NC = non critical
Face mask - SC
Laryngoscope - c
Bougie - c
Breathing systems - used for more than one patient if bacterial filter used
Sampling line - need viral filter
Surfaces/monitor - cleaned between each patient with detergent and water
Flexible bronch - C
Ultrasound - will depend on what used for; NC use, just clean; SC use - use a cover; critical use will need high level disinfectiono
Definitions asepsis, disinfection, sterilisation
Asepsis - prevention of microbial contamination of living tissues or sterile materials
Disinfection - inactivation of non-sporting organisms using thermal or chemical means
Sterilisation - compete destruction of all microorganisms including spores
Systemic sclerosis;
Immune activation, vascular damage and deposition of collagen
Classified as;
limited cutaneous - hands/face and CREST
Diffuse cutaneous - risk of renal, lung, CVS disease
Develop - Myocarditis and conduction abnormalities Pulmonary fibrosis and HTN Chronic renal failure Oesophageal hypomotility Thick skin - difficult iv access Limited mouth opening
ETT size for children;
Depth;
Size of LMA
Age/4 +4
Age/2 + 12
LMA - on packaging 1, 5kg 1.5 5-10kg 2 10-20kg 2.5 20-30 3 >30kg
Assessment before any procedure;
Simple!
Consent Iv access Monitoring Position Local anaesthetic Evaluate
Active cardiac conditions
Unstable coronary syndromes (Mi last 30 days, CCS 3 or 4)
Dulecompensated failure
Severe valve disease
Significant arrhythmias
Drugs that raise PVR
Nitrous
Ketamine
Protamine
WHO pulm HTN classification.
- Arterial - portal HTN, shunts
- Venous - MR
- Due to respiratory disease or hypoxia
- Due to thrombus
- Due to direct vasculature changes
Monitoring during anaesthesia;
Required
Available
Should be available
Must; O2 analyser Sats ETCO3 ETAA Disconnection alarm
Clinical monitoring must occur; circulation, ventilation, oxygenation
Should; ECG NIBP Temp NMT
Available; IBP CVP 5lead BID TOE CO monitor Resp mechanics
Preventive vs pre-emptive analgesia
Pre emptive - given before incision to try and reduce pain
Preventive - an intervention that has benefit that lasts longer than 5xt 1/2
CRPS diagnosis
Vasomotor/colour
Sudomotor
Sensory
Motor
2 signs, 3 symptoms
And pain disproportionate to inciting event
Indications for CEA;
Symptomatic >70% stenosis NNT 6 to reduce risk of stroke
50-69% stenosis NNT 22
Asymptomatic - absolute risk reduction 1%/year CEA vs medical management
Bridging therapy for anticoagulation for AF;
CCF HTN Age >75 Diabetes CVA/TiA/thromboembolism - 2 Vascular disease Age 65-75 Sex female
Score >/= 2 - anticoag indicated
- 2% stroke risk
Score 1- discussion
Score >/=6 - bridging recommended
Filter modes for ECG
Diagnostic - minimal filtering
- good representation but lots of interference
Monitor - maximal filtering
- good rhythm monitor but poor assessment of ST segments
ST segment
5 lead, V5 and 2 = highest detection of changes
Stages of diastole;
Isovolumetric relaxation
Early rapid filling (E wave)
Diastasis
Late rapid filling (A wave)
Usually E:A > 1 (a only provides 30%)
Mild - reversal
Progresses with E:A >1.5 ( with pseudo normalisation in between)
Quality assurance
An organised process that assesses and evaluates health services to improve practice or quality of care
Planning
Implementation
Review
Setting standards
Classification acute renal dysfunction;
RIfLE
Risk creat x 1.5, u/o low 6 hours Injury creat x 2, u/o low 12 hours Failure creat x3, Anuria 12 hrs Loss - complete loss for > 4 weeks End stage - complete loss >3/12
CTG recording;
Early decels
Late decels
Variable decels
Early - head compression
Late - uteroplacental insufficiency
Variable - umbilical cord compression
Requirements for pneumonectomy/lobectomy;
Lobectomy;
FEV1 >1.5L or >80% predicted
Need to be able to climb 3 flights stairs
Pneumonectomy; FEV1 >2L Ppo-FEV1 0.7-0.8l Need to be able to climb 5 flights stairs - approx equal to VO2 max >20ml/kg/min If VO2 max
Power supply in theatres
Mains power plus two levels of redundancy (white sockets = only connected to mains);
1. SPS (secondary power supply), Onsite generator (secondary power supply) - red sockets = connects to sps
This does take 15seconds or 2 mins to connect
2. Uninterrupted power - back up battery bank = dark blue power circuit
Adverse effects of transfusion;
Immediate; Febrile reaction Allergic urticarial reaction Severe allergic reaction Acute haemolytic reaction Bacterial contamination TRALI Volume overload Hypothermia Citrate toxicity Potassium effects
Delayed; Delayed haemolysis Alloimmunisation Transfusion associated graft vs host Immunomondulatory effects Iron accumulation Infectious disease transmission
Block for lower leg surgery;
Sciatic nerve;
Find popliteal artery with probe under leg.
Tibial nerve lateral to it.
Common peroneal is superficial to the tibial.
They join together usually 5-10cm from knee crease.
Saphenous nerve; branch of femoral.
Supplies medial aspect
Lies medial to femoral artery, below sartorius muscle
How does aortic Doppler estimate cardiac output;
CO = VTI x CSA x HR
VTI - velocity-time index
- calculated using descending aortic flow -> velocity time curve -> AUC
CSA - cross sectional area, use USS or algorhythm
Grades of murmur
1 listen carefully
2 soft but heard readily
3 easily heard immediately
4 thrill and loud
5 thrill heard with just rim touching chest
6 thrill audible with stethoscope off chest wall
Values of ejection fraction
Normal >55%
Mildly impaired 45-54%
Moderate 30-44%
Severely impaired
Nerves of lumbar plexus
Iliohypogastric Ilioingiinal Genitofemoral Lateral femoral cutaneous Femoral Obituarator
T12-L4
Pre-thoracotomy assessment
Respiratory mechanics; ppoFEV1 >40% low risk
Calculated; preop FEV1 x (1- functional tissue removed/100)
Gas exchange;
DLCO ; predixted 20ml/kg/min good = 5 flights stairs
If ppoVO2 max
Post op delirium vs POCD
POD- a change in mental state characterised by a reduced awareness of the environment and a disturbance in attention. Between 1-3 days post op. May be associated with hallucinations, disorientation. Increased mortality. Ketamine appears to reduce incidence.
POCD- a deterioration in cognition temporally related to surgery. Need preop neuropsychological testing to confirm. 25%. >60s at 1 week, 1% unresolved at 2 years. ? Due to micro emboli or inflammatory response.
Pre eclamptic BP 170/110, headache proteinuria. Which not used to control hypertension;
Magnesium
Commonest organism causing meningitis post spinal;
Strep salivarius
Bias
Systematic deviation from the truth
Selection - use random allocation, clear inclusion/exclusion criteria
Performance - ensure blinding
Measurement - standard measure
Attrition - due to withdrawal - assess using intention to treat
Reporting - all results reported
Publication - negative studies published
Systematic review
Formal process
Involves identification, appraisal and evaluation
Used to draw conclusions about a specific issue
Includes;
Literature review using clearly defined and reproducible search criteria
Faster and cheaper than reexamination
Can include large and small studies
Meta analysis (statistical analysis) can then provide level one evidence
How to determine sample size
Alpha error - probability of committing type 1 error
Beta - probability of committing type 2 error
Effect size - small differences harder to detect
Variance - increased variance needs bigger numbers
Test statistic - how sensitive is the test
Trauma induced coagulopathy
Due to; depletion, dysfunction and dilution
Exacerbated by; hypothermia, acidosis, fluid resus
Characterised by; Factor five inhibition Low fibrinogen Systemic anticoagulation Impaired platelet function
Management; Early detection MBT protocol Prevent hypothermia and treat acidosis Use TXA and calcium Consider factor 7
