Perioperative medicine and anaesthesia

Question 1

ASA grade

Answer 1

normal healthy patients, who are non-smokers and with no/minimal alcohol intake.

Question 2

ASA grade I

Answer 2

• mild systemic disease
• well controlled diabetes or hypertension, current smoker, obesity (BMI 30-40), and mild lung disease.

Question 3

ASA grade III

Answer 3

Severe systemic disease
e.g. poorly controlled diabetes or hypertension, COPD, morbid obesity (BMI >40), history of ACS/stroke/TIA >3 months ago.

Question 4

ASA grade IV

Answer 4

*severe systemic disease
* constant threat to life
* MI/stroke/TIA within 3 months

Question 5

ASA grade V is

Answer 5

moribund patients not expected to survive

Question 6

ASA grade VI

Answer 6

• brain dead
• used for transplant

Question 7

Simple airway manouvers

Answer 7

• suction
• head tilt/ chin lift
• Jaw thrust

Question 8

Aiway adjuncts

Answer 8

• Oropharyngeal airway (OPA)
• Nasopharynx airways

Question 9

Nasopharyngeal airway

Answer 9

Useful in patients with a sensitive gag reflex when using OPA
Contraindicated in base of skull fracture

Question 10

Supraglottic airway

Answer 10

• Sits over the top of the larynx
• Can be used with ventilation machine

Question 11

Surigcal airway managment

Answer 11

• Tracheostomy
• Cricothyroidotomy

Question 12

Signs and symptoms of c-spine injurt

Answer 12

• Neck pain
• Decreased range of motion in the neck
• Focal neurological deficits, such as weakness or numbness in the arms or legs
• Signs of spinal shock, including flaccid paralysis and loss of bowel or bladder control

Question 13

Nexus criteria- what is it

Answer 13

• criteria which suggest c-spine injury is **not likely **
• All criteria has to be met in Nexus criteria

Question 14

Nexus criteria

Answer 14

• Normal level of alertness
• No evidence of intoxication
• No painful distracting injuries
• No focal neurological deficit
• Absence of midline cervical tenderness

Question 15

What to do if C-spine isnt cleared

Answer 15

CT C-spine

Question 16

Managment of C-spine fracture

Answer 16

• airway managment
• appropriately sized semi-rigid collar
• block and tape use
• full body stabilisation

Question 17

Signs of post-operative bleed

Answer 17

• mild pyrexia
• hypotension
• tachycardia

Question 18

Managment of hypovolemic shock

Answer 18

fluid bolus of a crystalloid

Question 19

Mild to moderate pain managment

Answer 19

• Paracetamol.
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen.
• Aspirin (a salicylate NSAID).
• Weak opioids, such as codeine, dihydrocodeine, and tramadol.

Question 20

cluster headaches

Answer 20

• Primarily unilateral and typically more severe around the eye region.
• occur in clusters,
• numerous attacks within small time frame (e.g weeks)

Question 21

epidemiology of cluster headaches

Answer 21

more prevalent among middle-aged men

Question 22

What precipitates cluster headaches

Answer 22

• alcohol consumption
• smoking

Question 23

cause of cluster headaches

Answer 23

activation of the trigeminal nerve

Question 24

Signs and symptoms of cluster headaches

Answer 24

• Unilateral, severe headache, often around the eye
• A bloodshot or teary eye on the affected side
• Vomiting

Question 25

Treatment of cluster headaches

Answer 25

100% oxygen and sumatriptan

Question 26

Prophylaxis of cluster headaches

Answer 26

verapamil and steroids

Question 27

compartmental syndrome

Answer 27

increase in pressure within the muscle compartments of a limb, typically following trauma.

Question 28

Signs and symptoms of compartmental syndrome

Answer 28

• Severe pain, particularly evident during passive flexion of the toes
• Pallor of affected limb
• Paralysis or weakness of the limb
• pulselessness
• Paraesthesia

Question 29

Managment of compartmental syndrome

Answer 29

• Keep the limb at a neutral level with the patient
• Oxygen
• Fluid administration
• Remove all dressings/splints/casts down to the skin
• Analgesia for pain management (usually opioids)
• Fasciotomy