100 secret /book

100 secret /book 作者：Hassan Alhjeeme

1. Ketamine best inducation agent for patients with :

1.1. elevated intracranial pressure [ICP]

1.2. hypovolemic trauma

1.3. acrive bronchospastic disease

2. Local anesthetic agents :

2.1. Esters

2.2. Amides

3. Adequate oxygenation

3.1. Controlled Postperative pain

3.2. Resolved postperative nausea and vomiting

3.3. Required for postanesthesia unit discharge

4. PONV: postperative nausea and vomiting

5. The shoulder primarily supplied by:

5.1. Superiorly : suprascapular nerve

5.2. Both can anesthetize by interscalene block and it's first complications is ipsilateral phrenic nerve block result in:

5.2.1. Hemidiaphragmatic paralysis

5.2.2. Horner syndrome

5.2.3. unilateral recurrent laryngeal nerve paralysis

5.2.4. Pneumothorax \ air in pleural cavity ,chest cavity

5.2.5. inadvertent neuraxial injection\الحقن العصبي غير المقصود

5.2.6. Accidental intravascular injection

5.3. Inferiorly : axillary nerve

6. Age-related physiological changes include:

6.1. Left ventricular hypertrophy

6.2. Increased reliance on preload for cardiac output

6.3. Decreased venous compliance

6.4. Increased closing capacity

6.5. Decreased glomerular filtration rate

6.6. Decreased hepatic function

6.7. Increased risk for postoperative delirium

7. Patients with reactive airway disease [ex: asthma] require through preoperative preparation incluiding:

7.1. Inhaled β-agonist therapy

7.2. Possibly steroids

8. Congestive failure:heart not able to pump blood around body proprley

9. Aspiration : to draw in or out using a sucking motion

10. Pneumothorax : when the lung collapsed due to air entering the pleural space

11. ROTEM: rotational thromboelastometry

12. The best practice to ensure termination of the relaxant effect from neuromuscular blocking agents are:

12.1. Dose them sparingly

12.2. Allow enough time for normal metabolism to occur

13. If for some reason a patient is not recovering from neuromuscular blockade , they should remain intubated on supported ventilation until they can demonstrate return of strength

14. Nonanion gap metabolic acidosis: hyperchloremia/ eleoctrolyte impalance occurs when there's to kuch blood chloride in the blood

15. Patients who receive high volumes fluid , especially normal saline , often develop hyperchloremia and a nonanion gap metabolic acidosis

16. Nitrous oxide should not be used in:

16.1. Setting of pneumothorax

16.2. Bowel obstruction

16.3. Pneumocephalus

16.4. During middle ear or opthalmological surgeryl / eye surgery

17. Hypoxemia / low oxygen level in blood/ causes :

17.1. Low inspired oxygen

17.2. Alveolar hypoventilation

17.3. V/Q mismatch

17.4. Right-left shunt

17.5. Impaired oxygen diffusion

18. The newborn heart less complaint cause it's less mature \ less responsive to inotropic support \ myocardial mature complete 6-12 months age

19. Propfol uses:

19.1. Adult patients with docomunted egg allergies

19.2. Should avoided in children with anaphylaxis to egg

20. Local anesthetic

20.1. Inuced

20.1.1. CNS toxicity

20.1.1.1. Manifests with excitation

20.1.1.2. Seizures

20.1.1.3. Loss of conscious

20.1.2. Cardiac toxicity

20.1.2.1. Happens after CNS toxicity

20.1.2.2. Hypotension

20.1.2.3. Conduction blockade

20.1.2.4. Dysrhythmias

20.1.2.5. Cardiac arrest

20.2. It's toxicity treated with lipid emulsion therapy /ex: intralipid 20%

21. Glocuse control before,,during and after surgery important for:

21.1. Reduce the risk of wound infection

21.2. Promote rapid wound healing

21.3. Avoid metabolic complications and shorten hospital stay

21.4. Insulin goal:90-180 mg/dl , during most surgicalm operations

22. Chronic exogenous glucocorticoid therapy should not be discontinued abruptly

23. Regional anesthesia is beneficial for patients with:

23.1. Whom general anesthesia should be avoided

23.2. Whom pain may be difficult to control

23.3. Ex: patients with severe cardiopulmonary disease, PONV , obstructive sleep apnea ,chronic pain, subctance abuse

24. Reason to give intravenous fluid is to increase stroke volume

24.1. Use frank-starling law to predict volume responsiveness

25. All that wheezes is not asthma but also consider :

25.1. Mechanical airway obstruction

25.2. Congestive failure

25.3. Allergic reaction

25.4. Pulmonary embolus

25.5. Pneumothorax

25.6. Aspiration

25.7. Endobronchial intubation

26. Mechanical airway obstruction : any solid object work as foreign body and cause airway obstruction

27. Pulmonary embolus [PE] : is a blood clot that develops in a blood vessel elsewhere in the body [often th leg] travels to an artery in the lung and suddenly forms a blockage of the artery

28. TEG: thromboelastography

29. Agents types:

29.1. Depolarizing agents : Succinylcholine

29.2. Nondepolarizing agents: steroid agents[vecuronium, rocuronium]

29.3. Benzylisoquinolinium agents: [atracurium, cisatracurium]

29.4. Phase 1 : block with depolarizing agents

29.5. Phase 2 : block with nondepolarizing neuromuscular blocking agents

30. It is best practice to administer reversal agents to all patients receiving nondepolarizing neuromuscular blocking agents unless the T4:T1 is greater than 0.9

31. Cardiotoxicity because of hyperkalemia should be immediately treated with intravenous calcium chloride or calcium gluconate

32. MAC: minimum alveolar concentration

32.1. Is defined as the minimum alveolar concteration of inhaled anesthetic required to prevent movement in 50% of patients in response to surgical incision

33. The MAC of inhaled anesthetic decreased in cases :

33.1. old age or premature

33.2. Hyponatremia/ sodium level in blood less the normal

33.3. Hypothermia/ the body begins to lose heat faster than it's produced/ cause : prolonged exposures to to very cold temperatures / leads to lower body temperature

33.4. Opioids / illegal and legal drugs

33.5. Barbiturates / affecting the inhibitory neurotransmitters in the brain

33.6. α2 blockers

33.7. Calcium channel blockers

33.8. Acute alcohol intoxication

33.9. Pregnancy

34. The MAC increased by:

34.1. Hyperthermia

34.2. Chronic alcoholism

34.3. Hypernatremia /high sodium levels in blood

34.4. acute intoxication with CNS stimulants (e.g., amphetamine)