Random SAQ Learning Flashcards
TIPS Procedure indications?
Secondary prevention of ascites and varicose
Contraindications of TIPS
TR, pHTN, heart failure
Sepsis, severe encephalopathy, HCC, coagulopathy, hepatorenal syndrome, hepatopulmonary syndrome, porto-pulmonary HTN, hydrothorax
Optimisation prior to TIPS
Drain large volume ascites
Work up for liver transplant - in case of liver failure post op.
Complications of Eisenmenger
RV hypertrophy
polycythemia
risk of paradoxical embolism
Ventilation strategies for Eisenmenger
Low adequate PEEP
Low plateau pressure to reduce PVR
Risk of radiation exposure
Follow ALARA principle - lowest dose, largest distance possible with protection
Cancer
Deterministic dose - hair loss, cataract, fertility
What’s a safe distance for radiation in fluoroscopy unit?
> 1.5m, exposure negligible
Measures to maximise flap perfusion
Flow, dictated by Ohm’s law and Hagen-Pouiselle’s Law
Q = Pressure / resistance
R = 8 x length x viscosity / (r^4 x π)
So Q = (pressure x r^4 x π) / 8xLxV
To increase flow
- maximise radius -> minimise use of vasopressor
- Maintain MAP, minimise CVP
- Minimise viscosity by keeping HCT 30-35
- Avoid hypothermia, acidosis
Budapest criteria for CRPS
At least one feature (sign+sx) from each category of
- Vasomotor: discolouration, temp diff
- Sensory: hyperalgesia, allodynia
- pseudomotor: oedema, sweating
- Motor: nail bed changes, weakness
Pathophysiologist of CRPS?
cytokine induced inflammation
SNS hyperactivity
Central sensitisation
Grades of gastric ultrasound findings
0-3
0 - empty
1 - <1.5ml/kg content
2 - >1.5ml/kg content
3 - solids
What’s special about type 2B vWF deficiency?
DDAVP contraindicated
Can cause thrombocytopenia
Aim of vWF level prior to neuraxial?
> 50% vWF and >50% factor 8
What is anaerobic threshold on CPET
point at which tissue oxygen demand exceeds oxygen delivery. Anaerobic metabolism occurs and lactate produced.
marked by disproportionate increase in CO2 production
AT of >10ml O2/kg/min = suitable
What is VO2 max
Peak O2 consumption during exercise.
Process of performing any regional block
Monitor, IV access, time out, mark site, assistant, consent
Post - monitor complication, test block
what size bronchoscope, ETT to LMA tube exchange with Aintree?
Bronchoscope size 4
ETT 6-7
Measures to improve ischaemic tolerance?
Regional or systemic hypothermia
avoid hyperglycaemia
Steroids
2 forms of coagulopathy in trauma?
Acute trauma coagulopathy
- Massive tissue injury, haemorrhage, shock state, tissue hypo perfusion.
- Consumptive coagulopathy, hypofibrinogen
Dilutional coagulopathy
When to consider damage control surgery>
Acidosis pH <7.3
Hypothermia <35
Coagulopathy
Significant bleeding -> MTP
Risks of damage control surgery?
While it improves mortality, there is association with increased rates of intra-abdominal infection, enterocutaneous fistula and ventral hernia formation
MTP targets / resus goals?
Hb > 70
Plt >50, or >100 in TBI
INR/APTT < 1.5x normal
Ionised calcium > 1.1
Fibrinogen >1.5g/L
K < 5
Temp > 36
Ph> 7.2
IV and PO doses of labetalol
PO 200mg TDS, up to 800mg TDS
IV 20-40mg Q15min, or infusion 0.5-2mg/min
Priorities of any neurosurgery
Maintain constant cerebral perfusion pressure of 50-60mmHg
Maintain cerebral oxygenation - Avoid seizure, maintain low CMRO2, avoid hyperthermia
Avoid increase in ICP
How to risk stratify anterior mediastinal masses?
Safe - asymptomatic, CT tracheal/bronchial diameter > 50% of normal
Unsafe - severely symptomatic, children with CT tracheal diameter <50% normal, regardless of symptoms
Rescue airway plans for large anterior mediastinal mass
Position of comfort
Rigid bronchoscopy - oxygenation and railroad ETT
Emergency sternotomy
ECMO
Properties of laser flex tube
specific tube for airway laser surgeries - reinforced, flexible, stainless steel, double cuffs
Airway surgery options
Closed techniques - MLT, laser flex tubes
Open - jet ventilation, intermittent apnoea technique
What to do during airway fire
Stop laser, saline to douse the fire
Take tube out
Manage airway post putting out a fire
Reinsert tube
Subacute - assess extent of tube, bronc
Post-op to ICU for dex, humidified air.
Reporting - risk man, indemnity, M&M
Intraop haemodynamic goals for carotid endarterectomy
Control within 20% of baseline
On X-clamp - maintain at, or above baseline.
Post-op, aim SBP 100-160mmHg
Layers of the pericardium
Fibrous pericardium
Serous pericardium - parietal and visceral layers, fluid in-between, 20ml
