Tim's key mnemonics Flashcards
Explain the NASPE/BPEG Generic (NBG) pacemaker classification system.
1) Paced Chamber
2) Sensed Chamber
3) Response to sensed events (sensing)
4) Programmability
Aka. Rate modulation/ responsiveness (rate modulation in response to MV or movement; i.e. exercise)
5) Anti-tachycardia functions or Multisite pacing (I.e. pacing in multiple places in the same chamber)
First 3 = anti-bradycardia functions (always stated)
What are the BP targets in the following conditions?
1) TBI (incl. Traumatic SAH)
2) ICH/haemorrhagic stroke
3) Acute ischaemic stroke
4) Spontaneous (aneurysmal) SAH
Emergency reversal of warfarin?
4F PCC 25-50 units/kg IV over 10 mins w/ vit K 10mg IV over 10 mins
https://docs.google.com/document/d/12Nq1CqXbnCBxiwQWVshMIh6SDiDx-3HsznZyGazRnEU/edit?usp=sharing Warfarin reversal
What is the optimal one lung ventilation strategy?
https://docs.google.com/document/d/1AUhzNz12J0huO0IBrftgqlYIlcNUQIsbJhC7NVjFpyA/edit?usp=sharing
Lung-protective ventilatory strategy, suggested targets
Tidal volume: 5-6 mg/kg IBW
Peak airway pressure <35cm H2O
Plateau airway pressure <25cm H2O
PaCO2: Normal
PEEP: 5cm H2O
FiO2: SpO2 94-98%
Can be either PCV or VCV
Risks of Laser?
https://docs.google.com/document/d/1hMPYtmYU2s7hCpj8vf0yicgbh04X9jjw4kQTG9Lo8Sk/edit?usp=sharing
LASER
Lung injury - from smoke
Aerosolization of carcinogens
Skin - burns
Electrocution
Eye injury - Cornea, lens. Painless retinal burns (can leave permanent blind spot in visual field)
Radiate - fires: airway (ETT), drapes
Laser safety principles?
https://docs.google.com/document/d/1hMPYtmYU2s7hCpj8vf0yicgbh04X9jjw4kQTG9Lo8Sk/edit?usp=sharing
LASER
Laser safety officer/signs
Airway/gases
- ETT: e.g. laser flex = dual cuff (designed for saline inflation if upper cuff struck by laser beam)
- silicone tube has less flammability & toxic debris vs rubber/PVC
- ETT cuff: fill w/ saline, twin cuffed if possible
- Gases: minimal required FiO2, no N2O
- Ventilation: apnoeic ventilation
Surgical - Drapes - non-combustible
- Matt surface instruments
Eyewear: For pt and OT staff - must be appropriate for wavelength of laser in use E.g. CO2 - clear plastic or glass
Room
- Window blinds
- Water on standby
RF for difficult bag-mask ventilation
https://docs.google.com/document/d/1xRHm6dujdOgqM7R_qbMLmImtCKOx3SLwieVFUNa9USU/edit?usp=sharing
MOANS
Mask seal:
-> Facial features: beards, saliva/blood
-> Anatomy: facial fractures, retrognathia
- Mothers
- Males, Mallampati 3 or 4
Obesity (BMI >26)
Age >55
No teeth (edentulous)
-> Neck radiation changes
-> Neck thickness
Snoring (OSA)/Stiff (bronchospasm)
RF for difficult intubation
https://docs.google.com/document/d/1xRHm6dujdOgqM7R_qbMLmImtCKOx3SLwieVFUNa9USU/edit?usp=sharing
LEMON
Look externally (large teeth/teeth limited MO, C-spine immobilisation)
Evaluate: TMD <6cm
Mallampati/Mouth opening <5cm
Obstruction (e.g. tumour) or OSA (STOPBANG)
Neck thickness/mobility -> need to neck flex and head extend - ‘sniffing morning air’
Difficult FONA RFs
https://docs.google.com/document/d/1xRHm6dujdOgqM7R_qbMLmImtCKOx3SLwieVFUNa9USU/edit?usp=sharing
SMART
Surgery on neck
Mass: Haematoma, infection, tumour
Access/anatomy (Obesity)
Radiation
Trauma
RFs for difficult SGA insertion
RODS
Reduced mouth opening
Obstruction: at or below level of glottis won’t be relieved
Distorted airway: anatomy
Stiff neck: limited movement
Stiff lungs: e.g. asthma decreases lung compliance
Which nerves are blocked in a scalp block?
https://docs.google.com/document/d/1_sE816UTEOV40Rfsq4raWc1T1eWmTy4lttK4iyAqp4E/edit?tab=t.0
Remember GLASSZ for nerves blocked
Greater occipital /greater auricular
Lesser occipital
Auriculotemporal
Supratrochlear
Supraorbital
Zygomaticotemporal (this is optional)
Compare/contrast 1st and 2nd gen SGAs
https://docs.google.com/document/d/1UfdSOWzdW9mHnt1b-e9xcVFf6bj8U8DW_mvruGpqCv8/edit?tab=t.0
2nd gen better
Gastric drainage tunnel
Higher seal pressures
Wider airway channels
Fixed curvature
Bite blocks
Enhanced intubation capacity
1st gen better
Lower profiles -> occasionally ease of insertion
Can have higher success rates of insertion
Key steps in pelvic trauma?
1a) Stablisation of bony pelvis (pelvic binder)
1b) Haemostatic resuscitation (blood products, permissive hypotension, 1:1:1, ROTEM/TEG)
2) Identification of assoc/ haemorrhagic injuries - eFAST/CT
- OT for laparotomy key
3) Control of pelvic arterial, venous and soft tissue bleeding (angioembolisation, preperitoneal packing, REBOA)
Components of damage control resuscitation?
Permissive hypotension,
Limited crystalloid administration, early transfusion
Avoid hypothermia/acidosis
Haemostatic resuscitation (TEG/ROTEM)
Correction of hyperfibrinolysis (TXA)
Damage control surgery (i.e. laparotomy)
Targets in Haemorrhage (haematologically)
Hb:70-90g/L (transfuse if below)
Fibrinogen: >1.5g/L
- >2g/L in obstetrics
PLT: >50 during active bleeding
- >100 in TBI or ICH
RBC:FFP ratio: 2:1 until coag tests available
- 1:1 in trauma
FFP: Maintain prothrombin ratio <1.5 times normal
Haemostatic tests: q30-60mins
TXA also!
What are the key conditions in chest trauma on a primary survey?
What are the potentially life-threatening injuries?
https://docs.google.com/document/d/1Wg228CwPZsk9y-SeuKEvFCiJp-QdDw1CgL-LMjpg0_E/edit?tab=t.0
1) key conditions
- Airway obstruction or disruption
- Tension pneumothorax
- Open pneumothorax
- Massive haemothorax
- Flail chest
- Cardiac tamponade
2) Potentially life threatening
- Aortic injury
- Thorax injuries (non-massive hemothorax, simple pneumothorax)
- Oesphageal perforation
- Muscular diaphragmatic injury (a stretch this one, I know)
- Fistula (bronchopleural) and other tracheobronchial injury
- Contusion to the heart or lungs
