Anaesthesia on the Move 1st Edition by Sally Keat, Simon Bate, Alexander Bown, Sarah Lanham 1444121537 9781444121537

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ISBN 10: 1444121537

ISBN 13: 9781444121537

Author: Sally Keat, Simon Bate, Alexander Bown, Sarah Lanham

The Medicine on the Move series provides fully flexible access to subjects across the curriculum in a unique combination of print and mobile formats ideal for the busy medical student and junior doctor. No matter what your learning style, whether you are studying a subject for the first time or revisiting it during exam preparation, Medicine on the Move will give you the support you need. This innovative print and app package will help you to connect with the topic of anaesthesia in preparation for exams and future clinical practice. By using this resource in print or as an app, you really will experience the opportunity to learn medicine on the move.

Anaesthesia on the Move 1st Table of contents:

Part I Pre-operative

1 Physiology

1.1 HOMEOSTASIS

CONTROL OF HOMEOSTASIS

1.2 RESPIRATORY PHYSIOLOGY

ROLE OF THE RESPIRATORY SYSTEM

Lung mechanics

Lung compliance and resistance

Compliance

Resistance

RESPIRATORY VOLUMES

Dead space

Alveolar ventilation

Gas exchange

Ventilation and perfusion

O2 and CO2 transportation in blood

Oxygen

Carbon dioxide

Control of ventilation

Medulla oblongata

Afferent neurones

Central chemoreceptors

Peripheral chemoreceptors

Lungs

Other brain areas

Efferent neurones

1.3 CARDIOVASCULAR PHYSIOLOGY

ELECTROPHYSIOLOGY OF THE HEART

Impulse initiation

Excitation–contraction coupling

CARDIAC CYCLE

Diastole

Systole

Cardiac output

Heart rate

Stroke volume

Afterload

SYSTEMIC CIRCULATION

Blood pressure

Control of blood pressure

CARDIOVASCULAR SYSTEM RESPONSE TO ANAESTHESIA

1.4 NEUROPHYSIOLOGY

CELLS OF THE NERVOUS SYSTEM

Neurone

ELECTRICAL PROPAGATION

Cellular compartment compositions

Potential difference

Current

Resting membrane potential

Action potentials

SYNAPSES

Function

Types of synapse

Electrical synapses

Chemical synapses

ORGANIZATION OF THE NERVOUS SYSTEM

THE AUTONOMIC NERVOUS SYSTEM

Function

Sympathetic nervous system

Transmitters and receptors

Paraympathetic nervous system

2 Preparing for surgery

2.1 BASIC PRINCIPLES OF ANAESTHESIA

2.2 PRE-OPERATIVE ASSESSMENT

AIMS OF PRE-OPERATIVE ASSESSMENT

PRE-OPERATIVE ASSESSMENT CLINIC

METHODS OF ASSESSMENT

2.3 ASSESSMENT OF SURGICAL RISK

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS (ASA) GRADING SYSTEM

CARDIAC RISK SCORING

EXERCISE TOLERANCE TESTING

2.4 ASSESSMENT OF AIRWAYS

CLINICAL ASSESSMENT OF THE AIRWAY

INDICATORS FOR DIFFICULT INTUBATION

2.5 INVESTIGATIONS TO CONSIDER

2.6 PRE-OPERATIVE MEDICATIONS

2.7 MANAGEMENT OF REGULAR MEDICATIONS

DRUGS TO CONSIDER BEFORE SURGERY

DRUGS TO STOP BEFORE SURGERY

WARFARIN BRIDGING PROTOCOLS

2.8 MANAGEMENT OF PRE-OPERATIVE CONDITIONS

CARDIOVASCULAR DISEASE

Hypertension

Ischaemic heart disease

Arrhythmias

Valvular disease

RESPIRATORY DISEASE

Asthma

Chronic obstructive pulmonary disease

Other respiratory problems

GASTROINTESTINAL DISEASE

Gastro-oesophageal reflux disease/hiatus hernia

ENDOCRINE DISEASE

Diabetes mellitus

Thyroid disease

RENAL DISEASE

Chronic renal failure

HAEMATOLOGICAL DISORDERS

Anaemia

Clotting disorders

NEUROLOGICAL DISORDERS

2.9 REDUCTION OF ASPIRATION RISK

NIL BY MOUTH

CONSIDERATION OF RAPID SEQUENCE INDUCTION

2.10 INFORMED CONSENT

ASSESSING CAPACITY

GIVING THE INFORMATION

DOCUMENTATION

Part II Practice of anaesthesia

3 In the anaesthetic room

3.1 INTRODUCTION

3.2 INDUCTION

PRE-ANAESTHETIC CHECKS

INTRAVENOUS ACCESS OBTAINED

MONITORING EQUIPMENT SET-UP

PATIENT IS PRE-OXYGENATED

INDUCTION AGENT DELIVERY

VENTILATION MAINTAINED

NEUROMUSCULAR BLOCKADE

AIRWAY SECURED

4 Airways and ventilation

4.1 AIRWAYS

ASSESSMENT OF THE AIRWAY

BASIC AIRWAY MANOEUVRES

AIRWAY ADJUNCTS

DEFINITIVE AIRWAYS

Endotracheal (ET) tube

Emergency airways (cricothyroidotomy)

Surgical airways (tracheotomy)

4.2 VENTILATION

REASONS FOR RESPIRATORY SUPPORT

POSITIVE PRESSURE VENTILATION

Ventilator phases and cycling

Modes of respiratory support

5 Oxygen

5.1 INITIATING OXYGEN THERAPY

ACUTE SETTING

5.2 ADMINISTERING OXYGEN

LOW-FLOW SYSTEMS

HIGH-FLOW SYSTEMS

5.3 MONITORING SATURATION OF HAEMOGLOBIN WITH OXYGEN

NON-INVASIVE PULSE OXIMETRY

BLOOD GASES FROM ARTERIAL BLOOD SAMPLING (Table 5.2)

Assess oxygenation

Assess acid-base disturbance

Consider cause of acid–base disturbance

Anion gap (Table 5.3)

6 Local and regional anaesthesia

6.1 ADVANTAGES TO REGIONAL ANAESTHESIA

6.2 AND ANALGESIA WITHIN THE SPINAL COLUMN: CENTRAL NEURAL BLOCKADE

SPINAL ANAESTHESIA

EPIDURAL ANAESTHESIA

PERIPHERAL NERVE BLOCK

7 Drugs in the anaesthetic room

7.1 GENERAL ANAESTHETICS

INTRAVENOUS ANAESTHETICS

Phenols: propofol (2,6-di-isopropylphenol)

Barbiturates: sodium thiopentone

Phencyclidine derivatives: ketamine

Benzodiazepines: midazolam

INHALED ANAESTHETICS

Isoflurane

Sevoflurane

7.2 MUSCLE RELAXANTS: NEUROMUSCULAR BLOCKERS

NON-COMPETITIVE/DEPOLARIZING NEUROMUSCULAR BLOCKING DRUGS

Suxamethonium

COMPETITIVE/NON-DEPOLARIZING NEUROMUSCULAR BLOCKING DRUGS

Atracurium

7.3 ANTI-CHOLINESTERASES

NEOSTIGMINE

7.4 LOCAL ANAESTHETICS

MODE OF ACTION

CLINICAL EFFECTS

Central nervous system

Cardiovascular system

Respiratory system

ESTER-LINKED AGENTS

Amethocaine

Cocaine

AMINE-LINKED AGENTS

Bupivacaine

Lidocaine

Prilocaine

Ropivacaine

Adrenaline

8 In the operating theatre

8.1 DELIVERING ANAESTHESIA

GASES IN THE OPERATING THEATRE

Oxygen

Nitrous oxide

Medical air

Vacuum

THE ANAESTHETIC MACHINE

Gas management system

Breathing system

Types of breathing systems

Mechanical ventilation

Checking the anaesthetic machine

Safety features

8.2 INTRA-OPERATIVE MONITORING

PULSE OXIMETRY

CAPNOGRAPHY

ECG

BLOOD PRESSURE (NON-INVASIVE)

BLOOD PRESSURE (INVASIVE)

TEMPERATURE

DEPTH OF ANAESTHESIA

CENTRAL VENOUS PRESSURE

BLOOD LOSS

PERIPHERAL NERVE STIMULATOR

MINIMUM ALVEOLAR CONCENTRATION

Practical uses of MAC

8.3 INTRA-OPERATIVE EMERGENCIES AND COMPLICATIONS

ASPIRATION OF GASTRIC CONTENTS

ANAPHYLAXIS

MALIGNANT HYPERTHERMIA

HYPOTENSION

ACUTE KIDNEY INJURY

Part III On the wards

9 Post-operative complications

9.1 COMMON COMPLICATIONS

IMMEDIATE

EARLY

LATE

9.2 SEPSIS

MORTALITY

PATHOPHYSIOLOGY

MANAGEMENT

9.3 PAIN

PHYSIOLOGY OF PAIN

TRANSMISSION OF PAIN

Regulation of pain transmission

WHY PROVIDE PAIN RELIEF?

ASSESSMENT OF PAIN SEVERITY

REVERSIBILITY

9.4 ANALGESIA

NON-STEROIDAL ANTI-INFLAMMATORY DRUGS

OPIOID ANALGESICS

Pathophysiology

PROVIDING ANALGESIA

Analgesia during surgery

Patient-controlled analgesia

Local anaesthesia for pain relief

Transcutaneous electrical nerve stimulation

REGIONAL BLOCKADE

SPINAL BLOCKADE

9.5 POST-OPERATIVE NAUSEA AND VOMITING

RISK FACTORS FOR DEVELOPING POST-OPERATIVE NAUSEA AND VOMITING

Patient risk factors

Anaesthetic risk factors

Surgical risk factors

ANATOMY AND PHYSIOLOGY OF VOMITING

9.6 ACUTE BLOOD LOSS

10 Post-operative fluids

10.1 FLUID REQUIREMENTS

10.2 FLUID COMPARTMENTS

FLUID COMPARTMENT COMPOSITIONS

Extra-cellular fluid (see Table 10.1)

Intra-cellular fluid (see Table 10.1)

10.3 REPLACEMENT FLUIDS

COLLOID

CRYSTALLOID

10.4 FLUID PRESCRIBING

RESUSCITATION

MAINTENANCE

10.5 FLUID BALANCE ABNORMALITIES

CAUSES OF ABNORMAL FLUID LOSS

ASSESSMENT OF FLUID STATUS

REPLACEMENT OF ADDITIONAL FLUID LOSS

FLUID CHALLENGE

10.6 ELECTROLYTES

SODIUM

Hyponatraemia (serum sodium <130 mmol/L)

Hypernatraemia (serum sodium >150 mmol/L)

POTASSIUM

Hypokalaemia (serum potassium 3.5 mmol/L)

Hyperkalaemia (serum potassium > 5.5 mmol/L)

CALCIUM (2.12–2.65 mmol/L)

Hypercalcaemia (serum calcium > 2.5 mmol/L)

Hypocalcaemia (serum calcium <2 mmol/L)

MAGNESIUM (serum magnesium 0.75–1.00mmol/L)

Hypomagnesaemia (serum magnesium <0.70mmol/L)

Hypermagnesaemia (serum magnesium < 1.05 mmol/L)

PHOSPHATE (0.8–1.5 mmol/L)

Hyperphosphataemia (serum phosphate > 1.5 mmol/L)

Hypophosphataemia (serum phosphate <0.8 mmol/L)

11 Recognizing and managing ill patients

11.1 INTRODUCTION

Part IV Intensive therapy unit/critical care

12 Structure of an intensive therapy unit

12.1 INTRODUCTION

12.2 ADMISSION

12.3 STAFF

CONSULTANT

MEDICAL STAFF ON THE UNIT

ITU NURSING STAFF

MICROBIOLOGIST

PHYSIOTHERAPY

DIETICIAN

PHARMACIST

13 Principles of critical care

13.1 ORGAN SUPPORT

RESPIRATORY

CARDIOVASCULAR

Heart rate

Heart rhythm

Afterload

RENAL

NEUROLOGICAL

Part V Self-assessment

14 Pre-operative

Questions

PRE-ASSESSMENT: EMQs

Question 1:

Question 2:

Question 3:

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Question 5:

Question 6:

PRE-ASSESSMENT: SBAs

Question 7:

Question 8:

Question 9:

Answers

PRE-ASSESSMENT: EMQS

Answer 1:

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PRE-ASSESSMENT: SBAS

Answer 7:

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Answer 9:

15 In the anaesthetic room

Questions

AIRWAY MANAGEMENT: EMQs

Question 1:

Question 2:

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Question 7:

AIRWAY MANAGEMENT: SBAs

Question 8:

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Answers

AIRWAY MANAGEMENT: EMQs

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AIRWAY MANAGEMENT: SBAs

Answer 9:

16 Practice of anaesthesia

Questions

MAINTENANCE OF ANAESTHESIA: EMQs

Question 1:

Question 2:

Question 3:

MAINTENANCE OF ANAESTHESIA: SBAS

Question 4:

GENERAL ANAESTHESIA: EMQs

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FLUID: EMQs

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FLUID: SBAs

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ELECTROLYTES: EMQs

Question 16:

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ECG: SBAs

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OXYGEN: EMQs

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OXYGEN: SBAs

Question 27:

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Answers

MAINTENANCE OF ANAESTHESIA: EMQs

Answer 1:

Answer 2:

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MAINTENANCE OF ANAESTHESIA: SBAs

Answer 4:

GENERAL ANAESTHESIA: EMQs

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FLUID: EMQs

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FLUID: SBAS

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ELECTROLYTES: EMQS

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ECG: SBAs

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OXYGEN: EMQS

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OXYGEN: SBAs

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17 Drugs in the anaesthetic room

Questions

INDUCTION OF ANAESTHESIA: EMQs

Question 1:

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INDUCTION OF ANAESTHESIA: SBAs

Question 13:

Answers

INDUCTION OF ANAESTHESIA: EMQs

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INDUCTION OF ANAESTHESIA: SBAs

Answer 13:

18 On the wards

Questions

PAIN MANAGEMENT: EMQs

Question 1:

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SEPSIS: EMQs

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Question 21:

VOLATILE GASES: EMQs

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Question 27:

REGIONAL ANAESTHESIA: SBAs

Question 28:

REGIONAL ANAESTHESIA: EMQs

Question 29:

Question 30:

Question 31:

PRE-OPERATIVE MEDICATIONS: EMQs

Question 32:

Question 33:

Question 34:

Answers

PAIN MANAGEMENT: EMQs

Answer 1:

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SEPSIS: EMQs

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VOLATILE GASES: EMQs

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REGIONAL ANAESTHESIA: SBAs

Answer 28:

REGIONAL ANAESTHESIA: EMQs

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Answer 31:

PRE-OPERATIVE MEDICATIONS: EMQs

Answer 32:

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19 Resuscitation and emergencies

Questions

INTRA-OPERATIVE EMERGENCIES: SBA

Question 1:

MUSCLE RELAXANTS: EMQs

Question 2:

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ADVANCED LIFE SUPPORT: EMQs

Question 5:

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Question 7:

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Question 9:

Question 10:

ADVANCED LIFE SUPPORT: SBAs

Question 11:

Answers

INTRA-OPERATIVE EMERGENCIES: SBAs

Answer 1:

MUSCLE RELAXANTS: EMQs

Answer 2:

Answer 3:

Answer 4:

ADVANCED LIFE SUPPORT: EMQs

Answer 5:

Answer 6:

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Answer 10:

ADVANCED LIFE SUPPORT: SBAs

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Sally Keat,Simon Bate,Alexander Bown,Sarah Lanham,Anaesthesia