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56 Cards in this Set
- Front
- Back
Hypertension Causes |
1. Inaccurate Measurement
2. Patient factors
3. Anaesthetic Factors
4. Surgical Factors
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Hypotension Causes (Fall > 20% Baseline, Systolic < 90, MAP <60) |
1. Reduced Pre-load
2. Reduced Contractility
3. Reduced SVR
4. Equipment error
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Intraoperative Hypoxia Causes (Fall in SpO2 > 5%, SpO2 <90%, or paO2<60mmHg) |
1. Reduced O2 Delivery
2. Reduced blood flow to the lungs
3. Impaired gas exchange / VQ mismatch
4. Artifact
5. Anaemia 6. Increased Oxygen Demand
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Postoperative Hypoxia causes |
1. Hypoventilation / Inadequate MV
2. Airway obstruction
3. V/Q Mismatch
4. Shunt 5. Decreased cardiac output following primary cardiac event 6. Others
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ST Changes |
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Reduced EtCO2 |
1. Reduced production
2. Increased elimination
3. Equipment error
4. Reduced CO2 excretion
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Increased CO2 |
1. Increased endogenous production
2. Increased Exogenous Source
3. Reduced Elimination
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Raised Airway Pressure |
1. Circuit
2. ETT
3. Reduced Pulmonary Compliance
4. Drugs
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Pulmonary Oedema |
1. Increased pulmonary hydrostatic pressure
2. Increased capillary permeability
3. Low pulmonary oncotic pressure
4. Inadequate lymphatic clearance 5. Reduced pulmonary alveolar pressure (negative pressure pulmonary oedema) 6. Neurogenic |
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Intra-operative Cardiac Arrest |
1. Pre-existing disease states
2. Surgical manoeuvres
3. Error in anaesthetic technique
4. Drug issues
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Bradycardia |
1. Cardiac Causes
2. Secondary causes
3. Anaesthetic causes
4. Anxiety |
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Tachycardia |
1. Cardiopulmonary causes
2. Secondary Causes
3. Anaesthetic Causes
4. Anxiety |
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Maternal Collapse |
1. General causes of collapse
2. Anaesthetic
3. Obstetric
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Failure to Wake |
1. Pharmacological
2. Metabolic
3. Respiratory failure
4. Neurological
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Regional Anaesthesia Checklist |
Consent / Contraindications IV Access Monitoring, assistance, equipment Positioning Landmarks / US anatomy Endpoints - nerve stimulation or testing block |
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Preparation for any anaesthetic |
MAADE Monitoring Access Assistance Drugs Equipment |
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General crisis management |
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Management of Errors |
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Lees Revised Cardiac Risk Index Outcomes |
0 RF - 0.4 % risk of major CV event 1 RF - 0.9% 2 RF - 6.6 % > 3RF - >11% |
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Lees RCRI measures |
High Risk Surgery (Intraperitoneal, IntraThoracic, Supringuinal Vascular) Creatinine > 176.8mcgmol/L Insulin dependant diabetic Prior TIA or Stroke IHD CCF |
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Child Pugh's Score |
Predictor of mortality in Liver Disease. Initially during hepatobiliary surgery but now more widely used Score 5-6 = Class A = 100% one year, 85% 2 year survival Score 7-9 = Class B = 81% 1 year, 57% 2 year survival Score 10-15 = Class C = 45% 1 year survival, 35% 2 year survival |
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Meld Score |
Initially used to predict mortality post TIPS, now used to prioritise for Liver Transplant Bilirubin, INR, Serum Creatinine combined in a formula to get a score indicating 3 month mortality
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Aortic Stenosis Grading |
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Indications for AVR |
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Haemodynamic goals in Aortic Stenosis |
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Causes of Aortic Stenosis |
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Prognosis of Aortic Stenosis after Symptoms |
Congestive Cardiac Failure: 2 years Syncope : 3 years Angina: 5 years |
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Mitral Stenosis Causes |
Rheumatic Disease |
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Mitral stenosis grading |
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Haemodynamic goals for mitral stenosis |
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Aortic Regurgitation Causes |
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Echo findings in Chronic AR |
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Echo findings in Severe Acute AR |
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Mitral Regurgitation Causes |
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Echo grading of MR |
Based on regurgitant fraction Severe: RF > 50% Moderate: RF 30-50% Mild : RF < 30% |
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Haemodynamic goals in MR |
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Pulmonary Hypertension Grading |
Mean Pulmonary Artery Pressure Mild: 25-50mmHg Mod: 40-55mmHg Severe: >55 mmHg |
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Pulmonary Hypertension Classification |
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Anaesthetic aims in pulmonary hypertension |
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PPM Codes |
NASPE Coding I -> Paced (O,A,V,D) II -> Sensed (O,A,V,D) III -> Response (I, T, D, O) IV -> rate modulation V -> antitachy functions |
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AICD coding |
I -> Shock chamber II -> paced chamber III -> detection (E, H) IV -> PPM function as per ppm codes |
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Indications for PPM |
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Indication for AICD |
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Peripheral Vascular Disease ABI vs Symptoms |
ABI 0.6 - 0.9 : Claudication ABI 0.3 - 0.6 : Rest Pain ABI <0.3 : Ulcers and gangrene |
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Issues in heart transplant patient |
Denervation: - increased resting HR - resistant to anticholinergics - poor response to hypovolaemia; stress; valsalva Complications: - immune mediated coronary disease - rejection - PPM dependance Immunosuppression: - Infection, malignancy - Drug SES (renal & Liver) - need to continue in periop period |
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Issues in Lung transplant |
Denervation: - decreased mucosal sensitivity - decreased cough - decreased mucociliary function - decreased lymphatic drainage - prone to sputum and oedema Immunosuppressents: - infection, malignancy - steroid dependance - drug SES (liver, renal) Intubation/Ventilation - Protective lung strategies - ETT just past vocal cords and carefully inflated to minimise damage to tracheal/bronchial anastamosis |
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Marfan's Disease |
Autosomal dominant connective tissue disorder, FBN1 (fibrillin-1) Manifestations:
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CHADSVASC Score |
Score out of 90 - no therapy1 - aspirin2 - warfarin / dabigatran / rivaroxaban |
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Cervical Spine X-ray in RA |
AADI: the distance from the posterior border of the anterior tubercle of the atlas to the dens should be <3mm PADI: the distance from the posterior border of the dens to the anterior aspect of the posterior arch of C-1. Should be > 14mm |
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Extraarticular Features of RA |
Skin: nodules, vasculitdes Eyes: scleritis, sjogrens Heart: IHF, pericarditis, valvulitis Lungs: Effusions, Fibrosis Kidney: Renal amyloidosis Haematological: anaemia Neuro: neuropathies |
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Dystrophia myotonica: perioperative management |
Pre-op:
Peri-op
Post-op
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Predictors of post-op ventilation in Myasthenia Gravis |
Leventhal criteria
Remeber: Myasthenia Patients Deserve Respiratory Ventilation |
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Safe Antiemetics in Parkinsons |
Avoid Phentiazines / Butyrophenones / Metoclopramide |
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Guillain-Barre : Conduct of anaesthesia |
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CREST |
Localised Scleroderma |
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Scleroderma Anaesthetic issues |
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