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Quick Memorisation Flashcards

1
Q

Pulmonary HTN severity

A

mPAP
Mild 20-40
Mod 40-55
severe > 55

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2
Q

How to calculate mPAP from RVSP?

A

(0.6x RVSP) +2

so if RVSP =40, mPAP =25mmHg

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3
Q

Normal mitral valve area?

A

> 4 cm2

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4
Q

Grading of MS
by area and by gradient

A

Mild - 1.6-2cm2, <5mmHg
Mod - 1-1.6cm2, 6-10mmHg
Sev - <1cm2, >10mmhg

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5
Q

MR severity grading?

A

Regurgitant fraction (RF), regurgitant volume (RV), and orifice of regurgitation

Mild - RF <30%, volume <30ml, orifice <0.2cm2

Mod - RF 30-50%, volume 30-60ml, 0.2-0.4cm2

Sev - RF >50%, >60ml, >0.4cm2

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6
Q

AS Severity criteria

A

AV area
Mean gradient
Vmax
Indexed aortic valve area

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7
Q

Mild AS?

A

AVA > 1.5cm2
Mean gradient <20mmHg
Vmax 2.6-2.9ms-1

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8
Q

Mod AS

A

AVA 1-1.5cm2
MG 20-40mmHg
Vmax 3-4ms-1

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9
Q

Severe AS?

A

AVA <1cm2
MG > 40mmhg
Vmax >4ms-1

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10
Q

6 components of Lee’s Revised Cardiac Risk Index

A

Ischaemic heart disease
CCF
Cerebrovascular disease
Diabetes
CKD
Suprainguinal vascular / thoracic / intra-peritoneal surgery

Score of ≥3 = 11.1% of MACE

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11
Q

NSTEMI types

A

I = plaque rupture
II = supply-demand mismatch
III = sudden cardiac death
IV = post PCI
V = post CABG

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12
Q

Which drugs can go down ETT?

A

NAVAL
Naloxone, adrenaline, vasopressin, atropine, lignocaine

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13
Q

EZ-IO needle size?
How do the colours indicate size?

A

15G
Colour indicates length
Red - 15mm
Blue - 25mm
Yellow - 45mmw

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14
Q

Vasopressin infusion dose?

A

Adult
1-2units bolus
Infuse @1-2units/hr

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15
Q

Criteria to proceed with surgery for pheochromocytoma?

A

BP < 160/90
NP STE on ECG
Normal BGLs
Orthostatic hypotension
Normal HCT

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16
Q

Amount of blood to raise Hb by 10g/L in children

A

4ml/kg

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17
Q

Unit of platelet will increase plt by?

A

1 unit in adult increases by 20-40x10^9/L

In paed = 10ml/kg

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18
Q

Amount of cryo to increase Fib by 1g/L

A

1 unit per 10kg of body weight

Typical adult dose is 10units, each unit contains 10-20ml (200ml total)

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19
Q

Dose of FFP?e

A

15ml/kg

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20
Q

RBC, Plt, cryo, FFP
- How long do you have after removing from fridge?
- Under what time frame can you return to fridge?

A

RBC, cryo, FFP = same
- 4 hours post remove from fridge, can return if <30 mins

Plt
- use within 1 hour.
- can return up to 1 hour.

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21
Q

Warm ischaemic time for organs

A

heart, liver - 30 mins
Pancreas, kidneys 60 mins
Lungs - 90 mins

heart from time of SBP < 90

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22
Q

Cold ischaemic time for organs?

A

Heart, lung 4 hours
Liver 6-10 hours
Pancreas 12-18 hours
Kidney 24 hours

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23
Q

Criteria for brain death

A

Unresponsive coma (GCS 3 for 24 hours)
apnoea
absence of brainstem reflexes

Need to have
- Intracranial pathology
- No sedation
- Normothermia, normotension
- Intact neuromuscular junction
- No metabolic cause for coma

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24
Q

Criteria for cardiac death

A

Immobility, apnoea
No pulse for 2 mins
No skin perfusion

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25
Cardiac death categories
1 - dead on arrival 2 - failed CPR 3 - withdrawal in ICU 4 - cardiac arrest post brain death
26
Severity of ARDS
Mild PFR 200-300 Mod 100-200 Sev < 100
27
qSOFA score
≥2 = increased mortality from sepsis BP ≤100mmHg RR ≥22 GCS < 15
28
RIFLE criteria
Severity of renal impairment based on Creatinine and urine output Risk - Cr 1.5x, UO <0.5ml/kg for 6 hours Injury - Cr 20, UO<0.5 for 12 hrs Failure - Cr 3x, UO<0.3 for 24hrs or anuric for 12 hours Loss - complete loss of renal function for >4 weeks ESRD - end state
29
Grading systems for SAH
WFNS (GCS, motor deficit, IV = GCS 7-12) - clinical grading I - V Fisher - radiological grading - I - IV
30
Canadian CT head rule
if any of the following high risk factors, get CT head - GCS < 15 - Depressed/open skull fracture - Basilar skull fracture - >1 vomit - Age ≥65 if no high risk, get a CT head if - >30 mins retrograde amnesia - dangerous mechanism
31
NEXUS criteria for C spine
Neurology Ethanol Xtra distracting injuries Untoward change in level of consciousness Soreness in midline
32
STOPBANG score
Snoring Tired / sleepy Observed apnoea Pressure (HTN) BMI > 35 Age > 50 Neck circumference > 43 cm in M, 41 in F Male Risk is high if score 5-8
33
Which drugs use - Lean body weight - total body weight - Idea body weight
Prop induction / remi - LBW Sux and prop maintenance - TBW NDMRs - IBW
34
Indicators for CTG
MONITOR - Meconium - Obs bleeding - Neuraxial - abnormal fetal heart rate - Temperature (fever) - Oxytocin - Request by mother
35
C-section Caterogies 1-4
I - immediate within 30 mins II - within 60-90 mins III - early than planned IV - at a planned time
36
Grades of bone cement implantation syndrome
Grade 1 sats <94%, SBP drop >20% Grade 2 sats <88%, SBP drop >40% Grade 3 CPR
37
Unacceptable reasons to delay hip surgery
No staff / facilities Minor electrolyte abnormalities Echocardiogram
38
APGAR score
Appearance Pulse (100 is cut off) Grimace Activity (?flexion) respiration (none/weak/strong)
39
Scores to measure paediatric emergence delirium
Cravero Scale - obtunded -> responsive -> crying -> needs restraints (grade 5) WATCHA scale - asleep -> calm -> crying -> crying inconsolably -> thrashing
40
Paeds ETT size
Age/4 + 4 (uncuffed) step down 0.5 for cuffed
41
ETT depth in children
Age/2 + 12 lip Age/2 + 15 for nose
42
Paeds approximate weight
(age + 4) x2
43
When to refer to specialist paed hospital?
Neonate < 28 days Ex-prem <37/40 with a post-conceptual age <52 weeks History of apnoea Complex children ASA > 3
44
Bromage scale
G1 - free to move legs, no block G2 - free to move feet, just flexing knees, partial 33% block G3 - unable to flex, 66% block G4 - unable to move legs, 100%
45
Child Pugh score criteria A, B, C periop mortality
Albumin, INR, ascites, encephalopathy, bilirubin A, 5-6, 10% B, 7-9. 30% C ≥10, 80%
46
What does MELD score predict?
Use bilirubin, INR, creatinine to predict 30 day mortality
47
Predicted post-op FEV1
Lung has 42 segments 22 right, 20 left Right upper (6), middle (4), lower (12) Left upper (10), lower (10) Preop FEV1 x ((42-#segments removed)/42) So if 21 segments removed, half the FEV1
48
CURB 65 score for pneumonia
Confusion Urea > 7 mmol/L RR ≥30 sBP < 90 mmHg Age > 65 years Score 3-5 = inpatients +/- ICU
49
Bronchial blocker size
ETT size 6, use blocker 7 Fr ETT size 7.5, use blocker 9 Fr
50
Components of damage control resus
Permissive hypotension Damage control surgery Prevention of hypothermia, acidosis, hypocalcaemia
51
Carbon monoxide poisoning, when to treat and how?
>10 % = symptomatic, FiO2 0.21 conservative >20% = FiO2 1.0 >50% = coma / death, 3ATM 1.0
52
3 options of off the floor airway emergency
Crack on Stay and play Head for home
53
Lower lobe segments for left and right lung
Right - MALPA Medial, lateral, anterior, posterior, apical Left - ALPA Anterior, lateral, posterior, apical
54
Indications for R) DLT
Left main bronchus lesion (extra or intra-luminal) Left pneumonectomy
55
TAVI vs. surgical AVR outcomes
TAVI improves mortality in the short term, esp in high risk cases. - Fewer major bleeding, AKI, new AF. - Higher rates of needing PPM, vascular complications Long term - Higher likelihood of reintervention - SAVR better long term survival in low risk patients
56
Aim of airway management in bronchopleural fistula
Adequate lung isolation avoid soiling of good lung avoid enlarging the fistula avoid creating a tension pneumothorax
57
Risk factors for bleomycin induced pulmonary fibrosis
Age > 70 Large cumulative dose renal failure Concurrent radiotherapy Genetic Treatment <6 months
58
Causes for RV failure post coming off bypass
Poor RV protection Graft failure if RCA grafted Air embolism down RCA Protamine reaction Pre-existing RV dysfunction
59
Best TOE view for LV RWMA
Transgastric LV mid papillary short axis view
60
Best TOE view to assess the valvular structures and Atrial /ventricular sizes
Mid-oesophageal 4 camber view
61
Best views to assess RV
mid-oesophageal 4 chamber to assess the TV and PV, RV anterior wall, RA Transgastric views - RV inferior wall
62
3 legged stool to assess thoracic surgical patients
Lung parenchyma - DLCO - PPO DLCO > 40% Respiratory mechanics - PPO FEV 1 > 40%, or >0.8L Functional reserve - CPET testing, > 4MET, or VO2 max > 15ml/kg/min
63
6MWT values to predict worse outcome?
Distance < 340m =1,115 ft 5.827 in significant association to post-op pulmonary complications Distance <450m =1,476 ft 4.535 in increase post-op pneumonia
64
Indications for CPET
Uncertainty regarding suitability of surgery (borderline findings on other testing) Risk stratification intraop and assist in post-op destination determination For those who are unable to exercise on treadmill
65
Dose of vasopressin infusion
1-4 units / hr
66
Features to differentiate serotonin syndrome with NMS?
SS - due to serotonin activity NMS - dopamine antagonists NMS - hyporeflexia, rigidity SS - hyperreflexia, clonus
67
Treatment options for thyroid storm
Beta blocker - Esmolol 20-40mg Q10M - Propranolol 40mg PO or up to 1mg/min IV Stop T4 -> T3 PTU 200-400microg Q6H Hydrocortisone 100-200mg IV Q8H Stop synthesis of new hormone with potassium iodide

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