Narcotic analgesics such as morphine, codeine, and heroin are good at relieving dull constant pain as would be associated with tissue injury, or neoplasia. They act centrally on opiate receptors to gate pain.
They have many side effects. In low doses they are anti tussive, which is a useful property. In higher doses they produce Euphoria, drowsyness, respiratory depression, hyporeflexia, broncho constriction, inhibit smooth muscle in the GI tract, and constrict the pupils.
The narcotics also produce drug dependance, manifest by withdrawal symptoms on ceasation.u
MessageBox(
" Opiates have been used
many centuries
pain relief,
psychotropic effects. In 1971 receptors were found
the central nervous
gut, that opiates acted upon." &
In 1973, Hans Kostalitch,
John Hughes, working
Aberdeen, discovered endogenous compounds
son these
, explaining there existance.",\
buttonup
buttonup
Opiates have been used for many centuries for pain relief, and for psychotropic effects. In 1971 receptors were found in the central nervous system, and in the gut, that opiates acted upon.
In 1973, Hans Kostalitch, and John Hughes, working in Aberdeen, discovered endogenous compounds that acted on these receptors, explaining there existance.
Opiate receptors.
MessageBox
MessageBox(
" Withdrawal syndromes
drug has a physical
a psychological component.",\
Kmptoms
narcotics.",\
buttonup
buttonup
Withdrawal syndromes of any drug has a physical and a psychological component.
If you want help in calculating the answer, look at the calculation help in the Helpme menu.
No bupivacaine answer.
MessageBox
answer
answer
Yes thats right.
Correct answer.
MessageBox
answer
No are you sure about the units ? (remember 1000mg in a gram).
Units.
messagebox
answer
answer
0.275
No are you sure about the units ? (remember 1000mg in a gram).
Units.
messagebox
answer
answer
No are you sure about the units ? (remember 1000mg in a gram).
Units.
messagebox
answer
answer
No, are you sure about the units ? (remember 1000mg in a gram).
Units.
messagebox
answer
answer
0.0275
No are you sure about the units ? (remember 1000mg in a gram).
Units.
messagebox
answer
No, that's not the right dose of bupivacaine. Why not try again, feel free to use the help.
Wrong answer.
MessageBox
answer
answer
"answer"
MessageBox(
" If you want help
calculating the
C, look
calculation
Helpme
c.",\
"No bupivacaine
"7.5"
" Yes thats
"Correct
"0.75"
messagebox( sysWindowhandle,\
" No are
sure about
units ? (remember 1000mg
a gram).",\
"Units.",\
" No
o1000mg
"750"
" No
1000mg
"0.075"
" No,
000mg
" No,
dose
. Why
xtry
, feel free
"Wrong
"answer2"
" If
c.",\
"No adrenaline
T.",\
"0.015"
"0.0015"
" No
000mg
"0.00015"
" No
000mg
"0.15"
" No
000mg
"1.5"
" No,
000mg
" No,
buttonup
buttonup
answer
If you want help in calculating the answer, look at the calculation help in the Helpme menu.
No bupivacaine answer.
MessageBox
answer
answer
Yes thats right.
Correct answer.
MessageBox
answer
No are you sure about the units ? (remember 1000mg in a gram).
Units.
messagebox
answer
answer
No are you sure about the units ? (remember 1000mg in a gram).
Units.
messagebox
answer
answer
No are you sure about the units ? (remember 1000mg in a gram).
Units.
messagebox
answer
answer
0.075
No, are you sure about the units ? (remember 1000mg in a gram).
Units.
messagebox
answer
No, that's not the right dose of bupivacaine. Why not try again, feel free to use the help.
Wrong answer.
MessageBox
answer
answer
answer2
If you want help in calculating the answer, look at the calculation help in the Helpme menu.
No adrenaline answer.
MessageBox
answer2
0.015
Yes thats right.
Correct answer.
MessageBox
answer
0.0015
No are you sure about the units ? (remember 1000mg in a gram).
Units.
messagebox
answer
answer
0.00015
No are you sure about the units ? (remember 1000mg in a gram).
Units.
messagebox
answer
answer
No are you sure about the units ? (remember 1000mg in a gram).
Units.
messagebox
answer
answer
No, are you sure about the units ? (remember 1000mg in a gram).
Units.
messagebox
answer
No, that's not the right dose of adrenaline Why not try again, feel free to use the help.
Wrong answer.
MessageBox
answer2
Post operative oxygen
Post operative hypoxaemia may occur due to the effects of anaesthesia on the respiratory and cardiovascular systems, along with the increased oxygen demand that surgery produces.
In these cases additional oxygen is prescribed post operatively
Controlled oxygen therapy is used in patients whose ventilatory drive is provided by hypoxia (eg COAD patients). In these patients high concentrations of oxygen may cause ceasation of ventilation, thus limited (controlled) oxygen is used.
MessageBox(
" Post operative oxygen requirements may increase due
factors." &
" 1. Pain." &
" 2. Shivering." &
" 3. Increased muscle tone.",\
demand.",\
buttonup
buttonup
Post operative oxygen requirements may increase due to a number of factors.
1. Pain.
2. Shivering.
3. Increased muscle tone.
Increased oxygen demand.
MessageBox
MessageBox(
" In patients
fhigh arterial PaCO2, the ventilatory drive
often no longer provided
6 levels, instead PaO2
are responsible." &
Such
include chronic bronchitics,
on sedative drugs,
those
fchest injury.",\
"Hypoxic
buttonup
buttonup
In patients with high arterial PaCO2, the ventilatory drive is often no longer provided by PaCO2 levels, instead PaO2 levels are responsible.
Such patients include chronic bronchitics, patients on sedative drugs, and those with chest injury.
Hypoxic drive.
MessageBox
TitleText
Post operative therapy.
Oxygen therapy.
Activate the hotwords.
Click on the hotword to find out more.e.
Post operative fluid therapy
In fluid balance we look at the input of fluids and the ouput of fluids, and ensure they balance.
TitleText
Post operative therapy.
Fluid therapy.
Fluid balance.
Click on the hotword to find out more.e.
Intravenous
Metabolic (200ml)
Urine (min 500ml)
Skin (200-300ml)
Lungs (100ml)
Feaces (50ml)
Fistulas, vommit
Input
Output
Can be measured
Post operative pain relief
"butts"
0,75.3125,0
leavepage
leavepage
butts
TitleText
Post operative therapy.
Pain relief
l analgesia.
Click on the hotword to find out more.e.
A report from the royal college of surgeons of England in september 1990 suggested that post operative pain relief was inadequate.
They suggested that pain teams were set up, as we have now in Aberdeen.
Post operative pain - Methods
"butts"
0,75.3125,0
leavepage
leavepage
butts
TitleText
Post operative therapy.
Pain relief - methods.
Press the button to find out more
tword to find out more.e.
Post operative analgesia can be provided in a variety of ways.ways
Infiltration of wound by local analgesic;
Local / Regional analgesia
IM analgesia
IV analgesia
Oral analgesia
Patient Controlled Analgesia system
butts
MessageBox(
" Local
regional analgesia, including spinal
epidural
$ can be used post operatively
reduce pain. A cathater
situ
j allows
Lups
the drug
prolonged
A relief.",\
/ Regional
buttonup
buttonup
Local or regional analgesia, including spinal and epidural analgesia can be used post operatively to reduce pain. A cathater left in situ in epidural analgesia allows top ups of the drug for prolonged pain relief.
Local / Regional analgesia.
MessageBox
120,50,100
MessageBox(
" Intravenous analgesia,
fdrugs such
%morphine
pethidine, would appear the best method
administration,
terms
speed
onset,
dose absorbtion. But what you need
remember are
hcomplications associated
intravenous injections,
increase
systemic side effects also seen.",\
ia.",\
buttonup
buttonup
Intravenous analgesia, with drugs such as morphine and pethidine, would appear the best method of administration, in terms of speed of onset, and dose absorbtion. But what you need to remember are the complications associated with all intravenous injections, and the increase in systemic side effects also seen.
Intravenous analgesia.
MessageBox
120,50,100
MessageBox(
" Many patients post operatively will be prescibed oral analgesia, such
%aspirin
paracetamol, PRN. This
;easy
the surgeon,
allows administration
nurse." &
In most situations
method
pain relief
adequate
has fewer side effects. But remember absorbtion
differs between
"Oral
s.",\
buttonup
buttonup
Many patients post operatively will be prescibed oral analgesia, such as aspirin or paracetamol, PRN. This is both easy for the surgeon, and allows administration by any nurse.
In most situations this method of post operative pain relief is adequate for the patient, and has fewer side effects. But remember absorbtion is slow, and differs between patients.
Oral pain relief.
MessageBox
120,50,100
MessageBox(
" A relatively
qdevelopment, owing much
the invention
microprocessor, patient controlled analgesia
begining
gain popularity." &
able
administer analgesic,
they want
, often
are told
@drug
pain BEGINS
appear." &
Overdose
prevented
4being programmed
only allow a specified amount
be administered over a
period
I.",\
"Patient
a.",\
buttonup
buttonup
A relatively new development, owing much to the invention of the microprocessor, patient controlled analgesia is begining to gain popularity.
The patient is able to administer analgesic, at the push of a button, when they want to, often they are told to administer drug as the pain BEGINS to appear.
Overdose is prevented by the system being programmed to only allow a specified amount of drug to be administered over a set period of time.
Patient controlled analgesia.
MessageBox
120,50,100
MessageBox(
" Intramuscular injections
analgesic drug such
%morphine can provide pain relief, but you must remember that the
$ will
xbe instant,
dependant on
'circulation.",\
"IM analgesia.",\
buttonup
buttonup
Intramuscular injections of analgesic drug such as morphine can provide pain relief, but you must remember that the relief will not be instant, and is dependant on the circulation.
IM analgesia.
MessageBox
120,50,100
MessageBox(
" A wound can be infiltrated
Zanalgesic
)the
closure, often
surgeon,
]0.5% bupivicaine.",\
"Wound infiltration.",\
buttonup
buttonup
A wound can be infiltrated with local analgesic at the time of closure, often by the surgeon, using 0.5% bupivicaine.
Wound infiltration.
MessageBox
120,50,100
Medi-CAL
nnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnng Unit
University of Aberdeenberdeen
University of Aberdeen
Anaesthetics.assessment
explain
TitleText
Adult Respiratory Distress Syndrome.
Adult respiratory distress syndrome (ARDS, shock lung) is characterised by : hypoxiary distress, hypoxiaistress, hypoxia to hypoxia to hypoxia
Hypoxia and
X-ray changes
Death
HyperventilationC
Respiratory distress
NextPage
on ARDS."
"explain"
"the
default
"And that's
folks !"
ouseenter
mouseleave
mouseenter
buttonUp
mouseenter
Go to next page on ARDS.
explain
mouseleave
explain
buttonUp
explain
the end
And that's all folks !
default
Go to next page on ARDS.
ARDS - aetiology and treatment
Return to IPPV Q's.
ARDS Aetiology
TitleText
Adult Respiratory Distress Syndrome.
Aetiological factors in the development of ARDS are:g) is characterised by : hypoxiary distress, hypoxiaistress, hypoxia to hypoxia to hypoxia
1. Fluid overload
2. Inactivity, airways obstruction, atelectasis
3. Aspiration
4. Fat embolism
5. Blood transfusion
6. Oxygen toxicity
7. Shock pulm. vasc. resistance oedema
8. Sepsis
9. Acidosis, hypoxia
10. Micro embolism, DICCCCCCCCCCC
Treatment of ARDS should include artificial ventilation, controlled oxygen therapy, diuretics, fluid balance.
FirstPage
"Return
IPPV Q's."
"explain"
"ippv"
ouseenter
mouseleave
mouseenter
buttonUp
mouseenter
Return to IPPV Q's.
explain
mouseleave
explain
buttonUp
explain
Fluid balance 2
Fluid balance for the post operative patient is also affected by the following :
1. Fasting pre operatively
2. Intra operative blood loss
3. Intra operative evaporation, eg.open abdominal cavity
4. Increased loss from lungs due to dry anaesthetic gases
5. Post operative fasting
6. Oedema formation in tissues post operatively
7. Increase in ADH and aldosterone secretion in response to trauma
TitleText
Post operative therapy.
Fluid therapy.
Fluid balance.
Click on the hotword to find out more.e.
1. Fasting pre operatively
2. Intra operative blood loss
3. Intra operative evaporation, eg.open abdominal cavity
4. Increased loss from lungs due to dry anaesthetic gases
5. Post operative fasting
6. Oedema formation in tissues post operatively
7. Increase in ADH and aldosterone secretion in response to trauma
Fluid and electrolytes
The normal daily requirement of
sodium is 2mmol / kg
pottassium is 1mmol / kg
water is 2-3L
So for the average 70 kg male the daily requirement is:
140mmol sodium
70 mmol pottassium
For the first 48hrs only sodium, chloride and water are replaced. After this time, and in patients with pre existing electrolyte imbalance, potassium, calcium and other electrolytes are replaced.
TitleText
Post operative therapy.
Fluid therapy.
Daily reqiurements.
Click on the hotword to find out more.e.
Monitoring fluid balance
Fluid balance in the patient can be monitored in a number of ways.
Changes in blood pressure can indicate hydration, as can the heart rate.
A CVP line can be used.
The patients skin turgor can also indicate the state of hydration.
Fluid charts are extensively used, where measurable input and output are recorded.
TitleText
Post operative therapy.
Fluid therapy.
Fluid balance - monitoring
Click on the hotword to find out more.e.
IV fluids - distribution
Click on the buttons to see how each fluid distributes itself amongst the bodies fluid compartments.
TitleText
Post operative therapy.
Fluid therapy.
Body compartments.
Click on the hotword to find out more.e.
Plasma
"plasma"
120,i,75
120,i,75
120,i,75
buttonup
buttonup
plasma
120,50,100
plasma
plasma
plasma
plasma
plasma
plasma
0,100,0
plasma
plasma
"plasma"
"isf"
120,i,75
240,i,75
120,i,75
240,i,75
120,i,75
240,i,75
buttonup
buttonup
plasma
plasma
plasma
plasma
plasma
plasma
0,100,0
plasma
0,100,0
plasma
0.9% saline
"plasma"
"isf"
120,i,75
240,i,75
120,i,75
240,i,75
120,i,75
240,i,75
buttonup
buttonup
plasma
plasma
plasma
plasma
plasma
plasma
0,100,0
plasma
0,100,0
plasma
Glucose
:PHYSSIZE
:PHYSSIZE
plasma
:PHYSSIZE
IV fluids - distribution
Pain relief - Drugs
TitleText
Post operative therapy.
Pain relief - Drugs.
Press the button to find out more
tword to find out more.e.
Post operative analgesia can be provided by a variety of drugs.ays
Local analgesic
Aspirin, NSAIDS, Paracetomol
Narcotic analgesics
butts
"aspirin, NSAIDS, paracetamol"
buttonup
buttonup
aspirin, NSAIDS, paracetamol
120,50,100
"narcotic analgesics"
buttonup
buttonup
narcotic analgesics
120,50,100
MessageBox(
" See section on
regional analgesia.",\
"Local analgesic.",\
buttonup
buttonup
See section on local and regional analgesia.
Local analgesic.
MessageBox
120,50,100
Browse one page forwards.
Pain relief - Drugs
Tracheal intubation
Tracheal intubation
The endo tracheal tube is indicated to prevent aspiration, in ENT , facial , and neurosurgery (where a mask would interfere with the surgical proceedure), when artificial ventilation is to be used, and in resuscitation.
It is important to ensure that the tube has been placed in the trachea and not in the oesophagus, since unrecognised oesophageal intubation can cause death. Chest movement is NOT a sign that the trachea is intubated, but do listen for gurgling noise in the stomach area indicating oesophageal intubation, listen for breath sounds in both lung fields (as it is possible to intubate the right main broncus), and watch to ensure the patient is not becoming cyanosed.
TitleText
General Anaesthesia.
Tracheal intubation.ion.
Artificial ventilation
A patient who has been paralysed with a muscle relaxant is dependant for his life on Intermitent Positive pressure ventilation (IPPV). Outwith the operating theatre, two groups of patient require artificial ventilation, those with demonstrated respiratory failure, and those in whom respiratory failure is anticipated, eg those with gross cardiopulmonary disease.
"butts"
"ippv"
60,80,100
buttonup
buttonup
butts
butts
butts
0,100,0
TitleText
Artificial ventilation.
Click on the hotword to find out more. out more.
Induction 2
About 3/4 of all general anaesthetics today include the use of a muscle relaxant. They can be used to allow intubation, ECT therapy, abdominal surgery, and to relax the respiratory muscles for controlled ventilation.
An important complication of induction of anaesthesia is regurgitation of stomach contents and it's subsequent aspiration. The best method of preventing aspiration is tracheal intubation.
Pre-oxygenation of the patient with 100% oxygen for 2-3 mins allows for an increased period of apnoea before hypoxia develops, and is therefore useful proir to tracheal intubation.
MessageBox(
" The term muscle relaxant
applied
those drugs acting
)the neuromuscular junction. There are two types
], depolarising
." &
" It
important
realise that these
{respiratory muscles,
there use requires
availability
assisted ventilation !",\
"Muscle relaxants.",\
buttonup
buttonup
The term muscle relaxant is applied to those drugs acting at the neuromuscular junction. There are two types of muscle relaxant, depolarising and non depolarising.
It is important to realise that these drugs relax the respiratory muscles, and there use requires the availability of assisted ventilation !
Muscle relaxants.
MessageBox
MessageBox(
" The oesophageal sphinchter relaxes
%anaesthesia
induced. This along
! patient ( action
gravity,
increased intra abdominal pressure ) leads
regurgitation.",\
"Regurgitation.",\
buttonup
buttonup
The oesophageal sphinchter relaxes as anaesthesia is induced. This along with the position of the patient ( action of gravity, and increased intra abdominal pressure ) leads to regurgitation.
Regurgitation.
MessageBox
buttonUp
buttonUp
TitleText
General anaesthesia
Induction II
Click on the hotword to find out more.
Induction 1
fluid balance 2
Good Luck
Artificial ventilation
ARDS - aetiology and treatment
Aspirin, NSAIDS, paracetamol
TitleText
Artificial ventilation.
Consider the physiology of artificial ventilation.
What are the potential harmful effects of this therapy ?
Answer true, false or don't know to the questions below which relate to artificial ventilation.
Cardiac output may be reduced ?
Venous thrombosis in the legs may occur ?
Excessive pressure may result in damage to the patients lungs ?
Pneumothorax may result ?
butts
false
"tfd2"
MessageBox(
" During spontaneous ventilation intrathoracic pressure becomes negative,
increases venous
the heart (
Eump). However during artificial
abolished, thus
reduced, resulting
lowered cardiac output." &
There
also a direct
effect on
;tamponage),
pulmonary blood flow
?decreased due
. These two effects further
"Cardiac
buttonup
buttonup
0,50,100
120,50,100
During spontaneous ventilation intrathoracic pressure becomes negative, and this increases venous return to the heart (the thoracic pump). However during artificial ventilation this negative pressure is abolished, thus venous return is reduced, resulting in lowered cardiac output.
There is also a direct pressure effect on the heart (cardiac tamponage), and pulmonary blood flow is also decreased due to pressure. These two effects further reduce cardiac output.
Cardiac output.
MessageBox
Button
MessageBox(
" During spontaneous ventilation intrathoracic pressure becomes negative,
increases venous
the heart (
Eump). However during artificial
abolished, thus
reduced, resulting
lowered cardiac output." &
There
also a direct
effect on
;tamponage),
pulmonary blood flow
?decreased due
. These two effects further
"Cardiac
buttonup
buttonup
120,50,100
During spontaneous ventilation intrathoracic pressure becomes negative, and this increases venous return to the heart (the thoracic pump). However during artificial ventilation this negative pressure is abolished, thus venous return is reduced, resulting in lowered cardiac output.
There is also a direct pressure effect on the heart (cardiac tamponage), and pulmonary blood flow is also decreased due to pressure. These two effects further reduce cardiac output.
Cardiac output.
MessageBox
Button
"tfd2"
MessageBox(
" During spontaneous ventilation intrathoracic pressure becomes negative,
increases venous
the heart (
Eump). However during artificial
abolished, thus
reduced, resulting
lowered cardiac output." &
There
also a direct
effect on
;tamponage),
pulmonary blood flow
?decreased due
. These two effects further
"Cardiac
buttonup
buttonup
240,50,100
120,50,100
During spontaneous ventilation intrathoracic pressure becomes negative, and this increases venous return to the heart (the thoracic pump). However during artificial ventilation this negative pressure is abolished, thus venous return is reduced, resulting in lowered cardiac output.
There is also a direct pressure effect on the heart (cardiac tamponage), and pulmonary blood flow is also decreased due to pressure. These two effects further reduce cardiac output.
Cardiac output.
MessageBox
Button
false
"tfd3"
MessageBox(
" During spontaneous ventilation intrathoracic pressure becomes negative,
increases venous
the heart (
Eump). However during artificial
abolished, thus
reduced." &
The decreased
means that there
increased
stasis
legs
pelvis, increasing
risk
thrombosis.",\
"Venous
buttonup
buttonup
0,50,100
120,50,100
During spontaneous ventilation intrathoracic pressure becomes negative, and this increases venous return to the heart (the thoracic pump). However during artificial ventilation this negative pressure is abolished, thus venous return is reduced.
The decreased venous return means that there is increased venous stasis in the legs and pelvis, increasing the risk of thrombosis.
Venous thrombosis.
MessageBox
Button
MessageBox(
" During spontaneous ventilation intrathoracic pressure becomes negative,
increases venous
the heart (
Eump). However during artificial
abolished, thus
reduced." &
The decreased
means that there
increased
stasis
legs
pelvis, increasing
risk
thrombosis.",\
"Venous
buttonup
buttonup
120,50,100
During spontaneous ventilation intrathoracic pressure becomes negative, and this increases venous return to the heart (the thoracic pump). However during artificial ventilation this negative pressure is abolished, thus venous return is reduced.
The decreased venous return means that there is increased venous stasis in the legs and pelvis, increasing the risk of thrombosis.
Venous thrombosis.
MessageBox
Button
"tfd3"
MessageBox(
" During spontaneous ventilation intrathoracic pressure becomes negative,
increases venous
the heart (
Eump). However during artificial
abolished, thus
reduced." &
The decreased
means that there
increased
stasis
legs
pelvis, increasing
risk
thrombosis.",\
"Venous
buttonup
buttonup
240,50,100
120,50,100
During spontaneous ventilation intrathoracic pressure becomes negative, and this increases venous return to the heart (the thoracic pump). However during artificial ventilation this negative pressure is abolished, thus venous return is reduced.
The decreased venous return means that there is increased venous stasis in the legs and pelvis, increasing the risk of thrombosis.
Venous thrombosis.
MessageBox
Button
false
"tfd1"
MessageBox(
" Excessive pressure applied
the patients lung may result
damage
tissue,
even rupture
@lungs." &
generally accepted that
30cm
water
machine
ventilator should be avoided.",\
"Lung
buttonup
buttonup
0,50,100
120,50,100
Excessive pressure applied to the patients lung may result in damage to the lung tissue, or even rupture of the lungs.
It is generally accepted that pressure of 30cm of water at the machine end of the ventilator should be avoided.
Lung damage.
MessageBox
Button
MessageBox(
" Excessive pressure applied
the patients lung may result
damage
tissue,
even rupture
@lungs." &
generally accepted that
30cm
water
machine
ventilator should be avoided.",\
"Lung
buttonup
buttonup
120,50,100
Excessive pressure applied to the patients lung may result in damage to the lung tissue, or even rupture of the lungs.
It is generally accepted that pressure of 30cm of water at the machine end of the ventilator should be avoided.
Lung damage.
MessageBox
Button
"tfd1"
MessageBox(
" Excessive pressure applied
the patients lung may result
damage
tissue,
even rupture
@lungs." &
generally accepted that
30cm
water
machine
ventilator should be avoided.",\
"Lung
buttonup
buttonup
240,50,100
120,50,100
Excessive pressure applied to the patients lung may result in damage to the lung tissue, or even rupture of the lungs.
It is generally accepted that pressure of 30cm of water at the machine end of the ventilator should be avoided.
Lung damage.
MessageBox
Button
false
"tfd4"
MessageBox(
" Positive pressure
maintained
the airways during ventilation
attempt
minimise
2reduction
8anaesthesia. As a result
_peak inspiratory
must be increased
w. The
these two manoeuvres
that there IS a real risk
pneunothorax.",\
"Pneumothorax.",\
buttonup
buttonup
0,50,100
120,50,100
Positive pressure is maintained in the airways during ventilation in an attempt to minimise the reduction in frc during anaesthesia. As a result the peak inspiratory pressure must be increased to maintain ventilation. The result of these two manoeuvres is that there IS a real risk of pneunothorax.
Pneumothorax.
MessageBox
Button
MessageBox(
" Positive pressure
maintained
the airways during ventilation
attempt
minimise
2reduction
8anaesthesia. As a result
_peak inspiratory
must be increased
w. The
these two manoeuvres
that there
a real risk
pneunothorax.",\
"Pneumothorax.",\
buttonup
buttonup
120,50,100
Positive pressure is maintained in the airways during ventilation in an attempt to minimise the reduction in frc during anaesthesia. As a result the peak inspiratory pressure must be increased to maintain ventilation. The result of these two manoeuvres is that there is a real risk of pneunothorax.
Pneumothorax.
MessageBox
Button
"tfd4"
MessageBox(
" Positive pressure
maintained
the airways during ventilation
attempt
minimise
2reduction
8anaesthesia. As a result
_peak inspiratory
must be increased
w. The
these two manoeuvres
that there IS a real risk
pneunothorax.",\
"Pneumothorax.",\
buttonup
buttonup
240,50,100
120,50,100
Positive pressure is maintained in the airways during ventilation in an attempt to minimise the reduction in frc during anaesthesia. As a result the peak inspiratory pressure must be increased to maintain ventilation. The result of these two manoeuvres is that there IS a real risk of pneunothorax.
Pneumothorax.
MessageBox
Button
false
"ARDS"
buttonup
buttonup
120,50,100
Button
"tfd5"
"ARDS"
buttonup
buttonup
0,50,100
false
120,50,100
Button
"tfd5"
"ARDS"
buttonup
buttonup
240,50,100
false
120,50,100
Button
Shock lung may develop ?
FALSE
DON'T KNOW
FirstPage
artificial ventilation."
"explain"
ouseenter
mouseleave
mouseenter
buttonUp
mouseenter
Go to artificial ventilation.
explain
mouseleave
explain
buttonUp
artificial ventilation
explain
Go to artificial ventilation.
Local analgesia pharmacology
The local analgesic drugs have a common structure with a lipophylic and a hydrophylic end.
Mode of action.
Use dependant reversible block of sodium channels.
Acting on axons to reduce conduction of action potentials.
The pharmocological profile of the drugs differs.
Lignocaine has a rapid onset, a short duration of action, and is stable.
Prilocaine has a slightly longer onset time, and longer duration. It's big advantage is that it can be used safely intravenously.
Bupivicaine has a slower onset, ana a prolonged duration.O
MessageBox(
" Smaller diameter axons are more sensitive
the effects
Zanalgesics. Thus administration causes a differential block." &
Pain fibres
|affected
ulowest concentration,
latter leading
VASODILATION. As
1 rises, temperature sensation, touch, deep pressure
finally motor
"Local
- action.",\
buttonup
buttonup
Smaller diameter axons are more sensitive to the effects of local analgesics. Thus administration causes a differential block.
Pain fibres and ANS fibres are affected at the lowest concentration, the latter leading to VASODILATION. As the concentration rises, temperature sensation, touch, deep pressure and finally motor fibres are affected.
Local analgesics - action.
MessageBox
TitleText
Local and regional anaesthesia.
Pharmacology of local analgesics
Activate the hotwords.
find out more.e.
Local analgesia doses
Adrenaline is often given with local analgesic drugs to reduce the absorbtion of the solution.
The concentration of local analgesic drugs are expressed in terms of a percentage strength, whereas the concentration of adrenalline is expressed as a fraction in a litre of fluid.
Since overdose of either drug can be lethal it is important to appreciate how to calculate the quantity of drug that you may be administering.
Click on the 'examples' button to try some example calculations.
TitleText
Local and regional anaesthesia.
Concentrations of local analgesics
Click on the hotword to find out more.e.
buttonUp
buttonUp
EXAMPLES
e"Calculation help"
c"helpme"
calculationhelp
enterbackground
leavebackground
calculationhelp
enterbackground
Calculation help
helpme
leavebackground
Calculation help
calculationhelp
%help
FirstPage
"Local analgesia doses"
buttonUp
buttonUp
Local analgesia doses
"answer"
enterPage
enterPage
answer
answer
buttonup
buttonup
Try some more please
Calheader
Calculations of doses of drugs.kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk
calculate
A calculator is available from the Tools menu.
Help with calculations is available from the Helpme menu
What dose of lignocaine is in 3ml of 2% lignocaine ?
and stroke volume, calculate the Cardiac Output of a subject with a heart rate of 164 bpm and a stroke volume of 0.38 litres.
dicate the activity of the subject in the check box.
answer
Request box
Type answer in box
Units box
mg of lignocaine
Then press the accept answer button
Accept answer
%help
Local analgesic % strength is :
No. Grammes in 100ml of solution.
10ml of 0.5% lignocaine contains
grammes of lignocaine
milligrammes of lignocaine
So the answer is 60mg of lignocaine.
:PHYSSIZE
:PHYSSIZE
"%help"
buttonup
buttonup
%help
"answer"
"answer2"
enterPage
enterPage
answer
answer2
answer
buttonup
buttonup
Try some more please
Calheader
Calculations of doses of drugs.kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk
calculate
A calculator is available from the Tools menu.
Help with calculations is available from the Helpme menu
What dose of bupivacaine, and adrenaline is in 3ml of 0.25% bupivacaine with 1 in 200,000 adrenaline ?
f a subject with a heart rate of 164 bpm and a stroke volume of 0.38 litres.
dicate the activity of the subject in the check box.
answer2
Request box
Type answers in boxes
Units box
mg of adrenalinee
Then press the accept answer button
Accept answer
answer
Units box
mg of bupivacaine
%help
Local analgesic % strength is :
No. Grammes in 100ml of solution.
10ml of 0.5% lignocaine contains
grammes of lignocaine
milligrammes of lignocaine
So the answer is 60mg of lignocaine.
:PHYSSIZE
:PHYSSIZE
"%help"
"adrenhelp"
buttonup
buttonup
%help
adrenhelp
adrenhelp
Adrenaline doseage can be calculated as following :
10ml of 1 in 200,000 adrenaline contains
grammes of adrenaline
milligrammes of adrenaline
So the answer is 0.05mg adrenaline..e answer is 60mg of lignocaine..............
"adrenhelp"
buttonup
buttonup
adrenhelp
:PHYSSIZE
:PHYSSIZE
The toxic effects of local analgesic agent (such as would be seen in inadvertant IV administration ) are:
TitleText
Local and regional anaesthesia.
Inadvertant IV injection.
Activate the hotwords.
tword to find out more.e.
1. Tinnitus and circumoral parathesia are early signs
2. Central nervous system effects
3. Acute cardiovascular collapse - secondary to hypoxia.
Treatment should be immediate.
It is important that ALL medical staff are able to perform this basic resuscitationnnnnnnnsic resuscitation
MessageBox(
" The effect
Zanalgesic on the CNS include feeling
unease, anxiety, panic, euphoria, convulsion, central depression.
finally coma..",\
jeffects.",\
buttonup
buttonup
The effect of IV local analgesic on the CNS include feeling of unease, anxiety, panic, euphoria, convulsion, central depression. and finally coma..
CNS effects.
MessageBox
MessageBox(
" Cardiovascular collapse should be counteracted be raiseing the patients legs (auto transfusion),
HIV fluids rapidly infused." &
Oxygen must be provided.
Hintubation, ventilation,
aborting
convulsions.",\
"Treatment
toxic effects.",\
buttonup
buttonup
Cardiovascular collapse should be counteracted be raiseing the patients legs (auto transfusion), and by IV fluids rapidly infused.
Oxygen must be provided. by intubation, ventilation, and aborting any convulsions.
Treatment of toxic effects.
MessageBox
Spinal and Epidural
Spinal and Epidural analgesia have points of similarity and of contrast.
In both a needle is introduced between the spinous processes of two vertebrae, and through the ligamentum flavum.
In the case of spinal analgesia the needle (which is finer) is further advanced to pierce the dura and enter the sub arachnoid space.
Since in epidural analgesia the dura is not breached more drug is required to have the same effect.
As you know local analgesics act on all nerve fibres, including autonomic fibres. Both spinal and epidural analgesia produce hypotension via there effects on the autonomic fibres. Patients should always be monitered intra and post operatively.
TitleText
Local and regional anaesthesia.
Spinal and Epidural analgesia.
Click on the hotword to find out more.e.
References
"answer"
enterPage
enterPage
answer
answer
Calheader
Calculations of doses of drugs.kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk
calculate
A calculator is available from the Tools menu.
Help with calculations is available from the Helpme menu
What dose of Prilocaine, in 2.75ml of 1% Prilocaine ?
1 in 200,000 adrenaline ?
drenaline ?
f a subject with a heart rate of 164 bpm and a stroke volume of 0.38 litres.
dicate the activity of the subject in the check box.
Request box
Type answers in boxes
Then press the accept answer button
Accept answer
answer
Units box
mg of Prilocainee
%help
Local analgesic % strength is :
No. Grammes in 100ml of solution.
10ml of 0.5% lignocaine contains
grammes of lignocaine
milligrammes of lignocaine
So the answer is 60mg of lignocaine.
:PHYSSIZE
:PHYSSIZE
"%help"
buttonup
buttonup
%help
"answer"
MessageBox(
" If you want help
calculating the
C, look
calculation
Helpme
c.",\
u.",\
" Yes thats
"Correct
messagebox( sysWindowhandle,\
" No are
sure about
units ? (remember 1000mg
a gram).",\
"Units.",\
"600"
" No
p1000mg
"6000"
" No
1000mg
"0.6"
" No,
000mg
"0.06"
" No
000mg
" No,
. Why
xtry
, feel free
"Wrong
buttonup
buttonup
answer
If you want help in calculating the answer, look at the calculation help in the Helpme menu.
No answer.
MessageBox
answer
answer
Yes thats right.
Correct answer.
MessageBox
answer
No are you sure about the units ? (remember 1000mg in a gram).
Units.
messagebox
answer
answer
No are you sure about the units ? (remember 1000mg in a gram).
Units.
messagebox
answer
answer
No are you sure about the units ? (remember 1000mg in a gram).
Units.
messagebox
answer
answer
No, are you sure about the units ? (remember 1000mg in a gram).
Units.
messagebox
answer
answer
No are you sure about the units ? (remember 1000mg in a gram).
Units.
messagebox
answer
No, that's not right. Why not try again, feel free to use the help.
Wrong answer.
MessageBox
answer
answer
Physiology - respiratory
The commonest way in which general anaesthesia effects the respiratory system is respiratory depression. There is also an increase in the physiological dead space, a reduction in the functional residual capacity, and a V:Q mismatch.
The potentially deleterious effects of anaesthesia on oxygenation and on carbon dioxide elimination are minimised by the anaesthetist in two ways. Firstly he uses 30% oxygen in the inspired mixture, and secondly many patients are on controlled ventilation.
MessageBox(
" Respiratory depression
manifest
%a reduction
the minute volume
respiration. This occurs due
4frequency
breathing." &
" Close observation
rreservoir bag
simplest way
monitor
patient.",\
default
buttonup
buttonup
Respiratory depression is manifest as a reduction in the minute volume of respiration. This occurs due to a reduction in the frequency or the volume of breathing.
Close observation of the reservoir bag is the simplest way to monitor the patient.
Respiratory depression.
MessageBox
default
MessageBox(
" With a decrease
cardiac output, pulmonary blood flow
decreased. Thus some alveoli recieve less
therefore gas exchange
these
reduced. This
increase
; physiological dead
"Physiological
buttonup
buttonup
With a decrease in cardiac output, pulmonary blood flow is decreased. Thus some alveoli recieve less blood, and therefore gas exchange in these alveoli is reduced. This is an increase in the physiological dead space.
Physiological dead space.
MessageBox
MessageBox(
" When a patient lies down the diaphagm rises,
leads
a reduction
'volume
1lungs
expiration (ie
Nfunctional residual capacity (frc)). The
further reduced
Hanaesthesia.
- acts
%a buffer
concentration
inspired gases, thus
effect
[.",\
"Functional
buttonup
buttonup
When a patient lies down the diaphagm rises, this leads to a reduction in the volume of the lungs at the end of expiration (ie the functional residual capacity (frc)). The frc is further reduced by anaesthesia. The frc acts as a buffer to changes in concentration of inspired gases, thus this effect is reduced.
Functional residual capacity.
MessageBox
MessageBox(
The ventilation : prefusion ratio
the lungs
altered during anaesthesia
Hthree factors." &
" 1.
dpatient
lying down" &
" 2. Cardiac output
decreased" &
" 3. Respiratory depression.",\
"V : Q
buttonup
buttonup
The ventilation : prefusion ratio of the lungs is altered during anaesthesia by three factors.
1. The patient is lying down
2. Cardiac output is decreased
3. Respiratory depression.
V : Q ratio.
MessageBox
TitleText
Physiology of anaesthesia.
Respiratory system.
Activate the hotwords.
:PHYSSIZE
Pre-Operative assessment 1
"fbc flow"
"butts"
0,75.3125,0
leavepage
leavepage
fbc flow
butts
The aim of the pre-operative assessment is to determine that the patient's physical status is appropriate for their particular operation, and also to obtain any relavent information from the History, Examination, and any investigations.
Do the probable benefits outweigh the hazards or risks ?
Does the patient suffer from a condition that can be significantly improved before elective surgery ?
What investigations do you carry out ?, and on which patients ?
The next few pages give some indication.
MessageBox(
"As a general rule
patient undergoing
operation should be
optimal physical condition. The risks
anaesthesia increase
presence
severity
co-existing disease. Problems identified
;-operatively may lend themselves
treatment,
allow
anaesthetic management
be altered.",\
"Fit
surgery.",\
buttonup
buttonup
As a general rule any patient undergoing an operation should be in optimal physical condition. The risks of anaesthesia increase with the presence and severity of co-existing disease. Problems identified pre-operatively may lend themselves to treatment, or allow the anaesthetic management to be altered.
Fit for surgery.
MessageBox
MessageBox(
"The assessment also delineates baseline function,
allow comparison
intraoperative
post-
change.",\
"Assessment.",\
buttonup
buttonup
The assessment also delineates baseline function, to allow comparison with any intraoperative or post-operative change.
Assessment.
MessageBox
TitleText
h e
Pre-operative Assessment 1.
Activate the hotwords.
Respiratory disease
Post operative pain relief
Diabetes
There is an old adage for diabetics that says " better to sweet than sour ", this refers to the fact that it takes several days for a controlled diabetic who is not given insulin to become acidotic and comatosed, but only 20 minutes to sink into insulin shock.
Thus on the morning of the operation only half the normal dose of insulin is given, and a 5% dextrose infusion is started. Blood suger is repeatedly measured, and short acting insulin used if required.
Post operatively a sliding scale of insulin requirement is used, where urinary glucose concentration is measured and an appropriate amount of insulin is given if needed.
MessageBox(
" The dose
insulin
tailored
the individual patient.",\
"Insulin
:.",\
Show
"slidscale"
buttonup
buttonup
The dose of insulin is tailored to the individual patient.
Insulin dose.
MessageBox
slidscale
TitleText
Disease.
Insulin dependent diabetes mellitus
Activate the hotwords.
scale
slope
slidscale
For urine sugar of Give units of insulin
1+ 5
2+ 10
3+ 15
4+ 20
An example sliding scale for post operative insulin.
"slidscale"
buttonup
buttonup
slidscale
"scale"
U"slope"
nthe
6315, 748
6135, 838
6105, 883
6000, 973
5970, 1018
5925, 1048
5895, 1093
5850, 1138
5775, 1153
5700, 1198
5640, 1213
5565, 1243
5490, 1303
5430, 1348
5370, 1408
5295, 1453
5220, 1498
5130, 1573
5070, 1618
5010, 1663
4905, 1753
4815, 1798
4740, 1858
4665, 1888
4605, 1933
4590, 1933
4530, 1993
4470, 2053
4395, 2083
4335, 2158
4320, 2158
4260, 2203
4110, 2293
4110, 2308
4020, 2353
4020, 2368
3915, 2443
3915, 2458
3825, 2518
3720, 2608
3705, 2608
3600, 2713
3585, 2713
3405, 2818
3390, 2818
3285, 2893
3195, 2968
3180, 2968
3030, 3058
3030, 3073
3015, 3073
2880, 3178
2865, 3193
2685, 3343
2685, 3358
2670, 3358
2475, 3493
2460, 3493
2625, 3418
buttonUp
buttonUp
scale
slope
scale
scale
slope
NIDDM
Oral hypoglycaemic agents are withheld on the morning of the operation.
Blood sugar is measured prior to operation, and glucose is given if required.
Post operatively the blood sugar is measured to assess the need for additional glucose.
TitleText
Disease.
Non - insulin dependent diabetes mellitus
Activate the hotwords.
Pre medication
Premedication has a number of aims, as listed below.
1. To relieve anxiety
2. To abolish or reduce undesirable parasympathetic activity
3. To reduce post-operative vommiting
4. To control co-existing disease (as previously explained)
buttonUp
buttonUp
buttonUp
buttonUp
buttonUp
buttonUp
TitleText
Pre-medication.
Click on the hotword to find out more.
Anxiolytics
Anxiolytics.
The relief of anxiety is the most important function of premedication.
It may be achieved by analgesia if pain is present pre operatively, or by the use of sedatory drugs.
However the most potent form of anxiolytic therapy is the pre opeative visit to the patient by the anaesthetist.
Despite much media coverage of operations, especially television, many patients know little of the routine of the surgical ward or theatre, and it is this fear of the unknown that produces the greatest anxiety.3
TitleText
Pre - medication
Anxiolytics.
Parasympathetic
Parasympathetic
Parasympathetic overactivity in the anaesthetised patient can lead to bradycardia, excessive secretion of saliva or bronchial mucus, or as bronchoconstriction.
This may be due to the phamacological actions of drugs such as the muscle relaxant succinyl choline, or as a result of irritation of the respiratory tract.}
TitleText
Pre - medication
Parasympathetic overactivity.
Antiemetics
Antiemetics
Post operative vommiting has many causes, for example the use of opioid analgesia peri operatively.
Nausea, wretching, or vommiting can often be prevented, and an attempt should be made to do so.
Drugs such as the phenothiazines and droperidol can be used.
TitleText
Pre - medication
Antiemesis.etic overactivity.
Pre medication
Anxiolytics
Antiemetics
Induction 1
Induction of anaesthesia can be defined as
" the induction of sleep by chemical hypnosis ".
The usual methods of anaesthesia induction are :
1. Intravenous.
2. Inhalation.
3. Intramuscular.
4. Rectally.
"IV induction"
buttonUp
buttonUp
IV induction
buttonUp
buttonUp
MessageBox(
" Intramuscular induction
anaesthesia can be used
patients undergoing repeated
children. Drugs such
%ketamine
P.",\
n.",\
buttonup
buttonup
Intramuscular induction of anaesthesia can be used in patients undergoing repeated anaesthesia, and in children. Drugs such as ketamine can be used.
Intramuscular induction.
MessageBox
MessageBox(
" Rectal induction
anaesthesia can be used
patients undergoing repeated
children. Drugs such
%thiopentone
S, but care
needed
%absorbtion
dependant on
amount
feacal material present,
venous drainage routes.",\
buttonup
buttonup
Rectal induction of anaesthesia can be used in patients undergoing repeated anaesthesia, and in children. Drugs such as thiopentone can be used, but care is needed as absorbtion is dependant on the amount of feacal material present, and on the venous drainage routes.
Rectal induction.
MessageBox
TitleText
General anaesthesia
Induction I
Click on the hotword to find out more.
IV induction
IV induction
This is the usual method of choice for induction of anaesthesia. It is rapid and relatively pleasent for the patient. It is brief but long enough to allow inhalation anaesthesia to take over.
There is a real risk of overdose, which can cause temporary or lethal respiratory and cardiac complication. Intra - arterial injection is another possible hazard, as is anaphylaxis.
In children and others with difficult veins, other methods of induction are often used.
TitleText
General anaesthesia induction.
Intravenous
Inhalation
Inhalation
With inhalational induction of anaesthesia the potentially frightening use of the needle is avoided, thus it is usefull in children. It can also be used in patients with poor veins.
This method of induction is slower than intravenous induction, and often an excitatory period occurs.
TitleText
General anaesthesia induction.
Inhalation.
Aspirin, NSAIDS, paracetamol
Aspirin, NSAIDS.
The pharmacology of asprin, NSAIDS and paracetamol are similar in terms of there mode of action, they all act on the Eicosanoids. In this respect they reduce pain by inhibiting the production of Prostaglandins.
TitleText
Pain relief.
Aspirin, NSAIDS, paracetamol
Drug therapy 1
"butts"
60,80,100
"Brady"
"tachy"
"arrhy"
"Hypok"
"HypoG"
"HypoT"
"Thromc"
"heam"
"acvc"
default
leavepage
leavepage
butts
butts
Brady
tachy
arrhy
Hypok
HypoG
HypoT
Thromc
default
Some drugs may adversely affect the patient peri-operatively, due to their side effect profile. Using your basic knowledge of therapeutics many of these can be predicted. But always remember the unpredictable.
However it is also important to remember that stopping a drug treatment suddenly can also have undesirable consequences.
TitleText
Anaesthetics and drug therapy.
Drug therapy 1
NIDDM
Diuretic therapy
4replylist
"Dr." &
"butts"
60,80,100
"Brady"
"tachy"
"arrhy"
"Hypok"
"HypoG"
"HypoT"
"Thromc"
"heam"
"acvc"
"chf"
default
enterpage
leavepage
enterpage
replylist
leavepage
butts
butts
Brady
tachy
arrhy
Hypok
HypoG
HypoT
Thromc
default
Mrs. G is a 61 year old woman who has been treated for mild hypertension by her GP with a thiazide diuretic for four years. Physical examination showed a BP of 130/80 mmHg. What are the potential undesirable effects of Mrs G's treatment ?m pre operatively ?form pre operatively ?
Dr.e. Spectator
butts
"Brady"
"tachy"
"arrhy"
"Hypok"
"HypoG"
"HypoT"
"Thromc"
"heam"
"acvc"
buttonup
buttonup
0,50,100
Brady
tachy
arrhy
Hypok
HypoG
HypoT
Thromc
Bradycardia
"Brady"
"tachy"
"arrhy"
"Hypok"
"HypoG"
"HypoT"
"Thromc"
"heam"
"acvc"
buttonup
buttonup
0,50,100
Brady
tachy
arrhy
Hypok
HypoG
HypoT
Thromc
Tachycardia
"Brady"
"tachy"
"arrhy"
"Hypok"
"HypoG"
"HypoT"
"Thromc"
"heam"
"acvc"
buttonup
buttonup
120,50,100
Brady
tachy
arrhy
Hypok
HypoG
HypoT
Thromc
Arrhythmias
"Brady"
"tachy"
"arrhy"
"Hypok"
"HypoG"
"HypoT"
"Thromc"
"heam"
"acvc"
buttonup
buttonup
0,50,100
Brady
tachy
arrhy
Hypok
HypoG
HypoT
Thromc
Hypotension
"Brady"
"tachy"
"arrhy"
"Hypok"
"HypoG"
"HypoT"
"Thromc"
"heam"
"acvc"
buttonup
buttonup
120,50,100
Brady
tachy
arrhy
Hypok
HypoG
HypoT
Thromc
Hypokalaemia
"Brady"
"tachy"
"arrhy"
"Hypok"
"HypoG"
"HypoT"
"Thromc"
"heam"
"acvc"
buttonup
buttonup
120,50,100
Brady
tachy
arrhy
Hypok
HypoG
HypoT
Thromc
Hyperglycaemia
"Brady"
"tachy"
"arrhy"
"Hypok"
"HypoG"
"HypoT"
"Thromc"
"heam"
"acvc"
buttonup
buttonup
120,50,100
Brady
tachy
arrhy
Hypok
HypoG
HypoT
Thromc
Thrombocytopenia
"Brady"
"tachy"
"arrhy"
"Hypok"
"HypoG"
"HypoT"
"Thromc"
"heam"
"acvc"
buttonup
buttonup
0,50,100
Brady
tachy
arrhy
Hypok
HypoG
HypoT
Thromc
Acute cardiovascular collapse
"Brady"
"tachy"
"arrhy"
"Hypok"
"HypoG"
"HypoT"
"Thromc"
"heam"
"acvc"
buttonup
buttonup
0,50,100
Brady
tachy
arrhy
Hypok
HypoG
HypoT
Thromc
Haemorrhage
TitleText
Anaesthetics and drug therapy.
Diuretics.
Hint - try all the options.
arrhy
Yes, diuretics can cause electrolyte inbalance, which may lead to cardiac arrhythmias.
hypok
Yes the use of some diuretics can lead to hypokalaemia.
hypog
Thiazide diuretics can cause hyperglycaemia.
thromc
Thrombocytopenia can occur with thiazide diuretic tretment.
brady
No bradycardia is not a recognised side effect of diuretic treatment
tachy
No tachycardia is not a recognised side effect of diuretic treatment
hypot
No hypotension is not a recognised side effect of diuretic treatment
No diuretic treatment is not a recognised cause of heamorrhage.tment
No acute cardiovascular collapse is not a recognised side effect of diuretic treatment
Browse one page forwards.
Diuretic therapy
beta antagonists
What are the potential undesirable effects of treatment with beta adrenoreceptor antagonists ?nists ? treatment ?ur years. Physical examination showed a BP of 130/80 mmHg. What are the potential undesirable effects of Mrs G's treatment ?m pre operatively ?form pre operatively ?
TitleText
Anaesthetics and drug therapy.
Beta antagonists.
Hint - try all the options.
brady
Yes beta antagonist therapy can cause bradycardia.
hypot
Yes you may see hypotension in a patient taking beta antagonists.
tachy
No tachycardia is not a recognised side effect of beta antagonist treatment (try bradycardia)
arrhy
No, beta antagonists do not cause cardiac arrhythmias.which may lead to cardiac arrhythmias.
hypok
No, beta antagonists do not cause hypokelaemia.hmias. which may lead to cardiac arrhythmias.
hypog
No, beta antagonists do not cause hyperglycaemia.ias. which may lead to cardiac arrhythmias.
thromc
No, beta antagonists do not cause thrombocytopenia.s. which may lead to cardiac arrhythmias.
No, beta antagonists do not cause heamorrhage..hmias. which may lead to cardiac arrhythmias.
No, beta antagonists do not cause acute cardiovascular collapse.lead to cardiac arrhythmias.
butts
"Brady"
"tachy"
"arrhy"
"Hypok"
"HypoG"
"HypoT"
"Thromc"
"heam"
"acvc"
"chf"
buttonup
buttonup
120,50,100
Brady
tachy
arrhy
Hypok
HypoG
HypoT
Thromc
Bradycardia
"Brady"
"tachy"
"arrhy"
"Hypok"
"HypoG"
"HypoT"
"Thromc"
"heam"
"acvc"
"chf"
buttonup
buttonup
0,50,100
Brady
tachy
arrhy
Hypok
HypoG
HypoT
Thromc
Tachycardia
"Brady"
"tachy"
"arrhy"
"Hypok"
"HypoG"
"HypoT"
"Thromc"
"heam"
"acvc"
"chf"
buttonup
buttonup
0,50,100
Brady
tachy
arrhy
Hypok
HypoG
HypoT
Thromc
Arrhythmias
"Brady"
"tachy"
"arrhy"
"Hypok"
"HypoG"
"HypoT"
"Thromc"
"heam"
"acvc"
"chf"
buttonup
buttonup
120,50,100
Brady
tachy
arrhy
Hypok
HypoG
HypoT
Thromc
Hypotension
"Brady"
"tachy"
"arrhy"
"Hypok"
"HypoG"
"HypoT"
"Thromc"
"heam"
"acvc"
"chf"
buttonup
buttonup
0,50,100
Brady
tachy
arrhy
Hypok
HypoG
HypoT
Thromc
Hypokalaemia
"Brady"
"tachy"
"arrhy"
"Hypok"
"HypoG"
"HypoT"
"Thromc"
"heam"
"acvc"
"chf"
buttonup
buttonup
0,50,100
Brady
tachy
arrhy
Hypok
HypoG
HypoT
Thromc
Hyperglycaemia
"Brady"
"tachy"
"arrhy"
"Hypok"
"HypoG"
"HypoT"
"Thromc"
"heam"
"acvc"
"chf"
buttonup
buttonup
0,50,100
Brady
tachy
arrhy
Hypok
HypoG
HypoT
Thromc
Thrombocytopenia
"Brady"
"tachy"
"arrhy"
"Hypok"
"HypoG"
"HypoT"
"Thromc"
"heam"
"acvc"
"chf"
buttonup
buttonup
0,50,100
Brady
tachy
arrhy
Hypok
HypoG
HypoT
Thromc
Acute cardiovascular collapse
"Brady"
"tachy"
"arrhy"
"Hypok"
"HypoG"
"HypoT"
"Thromc"
"heam"
"acvc"
"chf"
buttonup
buttonup
0,50,100
Brady
tachy
arrhy
Hypok
HypoG
HypoT
Thromc
Haemorrhage
"Brady"
"tachy"
"arrhy"
"Hypok"
"HypoG"
"HypoT"
"Thromc"
"heam"
"acvc"
"chf"
buttonup
buttonup
120,50,100
Brady
tachy
arrhy
Hypok
HypoG
HypoT
Thromc
Congestive heart failure
Yes beta antagonist therapy can cause congestive heart failure.
Browse one page forwards.
Cardiovascular disease
Ischaemic heart disease in a patient undergoing surgery present a serious risk. The functional reserve of the heart is reduced, and stressors may lead to further ischaemia or infarction. Also remember that these patients are probably on medication.
Similarly patients in cardiac failure are unable to respond to the increased demand on the circulatory system that anaesthesia and surgery imposes, they also have poor organ perfusion, an increased risk of venous thrombosis and chest infection, and reduced uptake of inhaled gases.
Anti hypertensive therapy should be continued in patients with hypertension.
MessageBox(
In the patient
fangina pectoris,
important
determine
4level
activity that produces
." &
myocardial infarction less than 3 months ago has a 40% chance
reinfarcting under anaesthesia. Thus
these patients elective surgery
postponed
possible.",\
"Ishaemic heart disease.",\
buttonup
buttonup
In the patient with angina pectoris, it is important to determine the level of activity that produces the pain.
A patient with a history of myocardial infarction less than 3 months ago has a 40% chance of reinfarcting under anaesthesia. Thus in these patients elective surgery is postponed when possible.
Ishaemic heart disease.
MessageBox
MessageBox(
"Surgery other than that
life should
xbe performed on patients
funtreated cardiac failure,
%there
a major risk
perioperative pulmonary oedema." &
" Even therapy a few hours beforehand can significantly improve
unction.",\
"Cardiac
buttonup
buttonup
Surgery other than that to save life should not be performed on patients with untreated cardiac failure, as there is a major risk of perioperative pulmonary oedema.
Even therapy a few hours beforehand can significantly improve cardiac function.
Cardiac failure.
MessageBox
MessageBox(
" The cardiovascular
more stable
anti hypertensive therapy
maintained. There
also less risk
rebound hypertension
cerebrovascular catastrophe." &
" Anaesthesia
Ztends
reduce blood pressure (see physiology).",\
"Physiological dead
buttonup
buttonup
The cardiovascular system is more stable if anti hypertensive therapy is maintained. There is also less risk of rebound hypertension and cerebrovascular catastrophe.
Anaesthesia also tends to reduce blood pressure (see physiology).
Physiological dead space.
MessageBox
TitleText
Disease.
Cardiovascular disease.
Activate the hotwords.
other drugs
Calcuim channel blockers can cause myocardial depression and conduction slowing, leading to a decreased cardiac output. This along with there vasodilatory properties may cause profound hypotension.
Anti-coagulants increase the risk of heamorrhage and hemotoma formation intra and post-operatively.
Steroid treatment is important surgically as steroids suppress the adrenal cortex, reducing the response to trauma. Also steroids can cause Acute cardiovascular collapse.
MessageBox(
"Remember anticoagulant such
%wafarin have a
\half" &\
" life, but stopping them
day
operation " &\
" can allow normalisation
anticoagulation." &
" Anticoagulation therapy should be stopped
" patients except those
fprosthetic heart valves.",\
"Anticoagulants.",\
buttonup
buttonup
Remember anticoagulant such as wafarin have a long half
life, but stopping them the day before the operation
can allow normalisation of anticoagulation.
Anticoagulation therapy should be stopped in all
patients except those with prosthetic heart valves.
Anticoagulants.
MessageBox
MessageBox(
"The precise cause
the acute cardiovascular collapse
xknown. It
xrelated
plasma cortisol levels. Treatment
Hintravenous hydrocortisone.",\
"Acute
j.",\
buttonup
buttonup
The precise cause of the acute cardiovascular collapse is not known. It is not related to plasma cortisol levels. Treatment is by intravenous hydrocortisone.
Acute cardiovascular collapse.
MessageBox
TitleText
Anaesthetics and drug therapy.
Calcium channel blockers, anti-coagulants, and steroids. Activate hotwords.
other drugs
cases
Cardiovascular disease
Anaemia
Diseases
Diseases
Certain diseases produce specific problems for the anaesthetist, either in the pre-operative assessment, or in peri-operative management of the patient.
TitleText
Disease.
Pre-operative Invetigations
Post operative oxygen
Anaemia
A patient with anaemia will normally be compensating for the decrease in oxygen carrying capacity of their blood by increasing both cardiac output and ventilation.
Remember anaesthesia reduces both of these.
During surgery, any heamorrhage will further reduce circulating heamoglobin levels.
Using an equation to calculate the available oxygen, it has been suggested that for elective surgery a heamoglobin of 10g / 100ml or above is appropriate.
Correct management of the anaemic patient is essensial.#
MessageBox(
The management
the anaemic patient must include diagnosis
)cause
2a." &
" Blood transfusion
be used ONLY
satisfy
m10g / ml criteria,
indicated, should be given
)least 24hrs
operation.",\
"Management
anaemia.",\
buttonup
buttonup
The management of the anaemic patient must include diagnosis of the cause of the anaemia.
Blood transfusion is not to be used ONLY to satisfy the 10g / ml criteria, and when it is indicated, should be given at least 24hrs before the operation.
Management of anaemia.
MessageBox
TitleText
Disease.
Anaemia.
Activate the hotwords.
name and id
4ReplyList
) < 3
"ID"
B"nameok"
"now
"turn
B"idok"
enterpage
enterpage
nameok
now id
turn page
ReplyList
"arial"
B"idok"
"turn
buttonup
buttonup
arial
italic
turn page
tony s
Please type your name in the box below, then press the OK button.
now id
Now enter your year of study, and press the OK button.ton.
turn page
NOW TURN THE PAGE
TitleText
Logging on page.orial - fractures of the wrist, by A Shuker BSc (Med. Sci.)...
nameok
"arial"
B"nameok"
B"idok"
"now
buttonup
buttonup
arial
italic
nameok
now id
Pre-operative tests on Mr W
4replylist
"Dr." &
"Hb"
"u&e"
"ecg"
"cxr"
"lfts"
"asa"
"urine"
"weight"
"temp"
"butts"
60,80,100
default
enterpage
leavepage
enterpage
replylist
leavepage
urine
weight
butts
butts
default
weight
:PHYSSIZE
:PHYSSIZE
TitleText
Pre-operative Assessment .
Investigations on Mr. W
Hint - Try them all..
Mr. W is a fit 75 year old man presenting for right inguinal hernia repair. Physical examination is unremarkable, and he is on no medication.
What investigations should you perform pre operatively ???
butts
"u&e"
"ecg"
"cxr"
"lfts"
"asa"
"urine"
"weight"
"temp"
buttonup
buttonup
0,50,100
urine
weight
Hb & FBC
"u&e"
"ecg"
"cxr"
"lfts"
"asa"
"urine"
"weight"
"temp"
buttonup
buttonup
0,50,100
urine
weight
U's & E's
"u&e"
"ecg"
"cxr"
"lfts"
"asa"
"urine"
"weight"
"temp"
buttonup
buttonup
120,50,100
urine
weight
"u&e"
"ecg"
"cxr"
"lfts"
"asa"
"urine"
"weight"
"temp"
buttonup
buttonup
0,50,100
urine
weight
LFT's
"u&e"
"ecg"
"cxr"
"lfts"
"asa"
"urine"
"weight"
"temp"
buttonup
buttonup
120,50,100
urine
weight
"u&e"
"ecg"
"cxr"
"lfts"
"asa"
"urine"
"weight"
"temp"
buttonup
buttonup
120,50,100
urine
weight
Report his ASA grade
"u&e"
"ecg"
"cxr"
"lfts"
"asa"
"urine"
"weight"
"temp"
buttonup
buttonup
120,50,100
urine
weight
Ward urine analysis
120,80,100
"u&e"
"ecg"
"cxr"
"lfts"
"asa"
"urine"
"weight"
"temp"
default
buttonup
buttonup
urine
weight
default
Measure temperature
120,80,100
"u&e"
"ecg"
"cxr"
"lfts"
"asa"
"urine"
"weight"
"temp"
default
buttonup
buttonup
urine
weight
weight
weight
default
Measure his weight
Dr.e. Spectator
No. Patients should only have there Heamoglobin level measured and a full blood count, if this is indicated.
No. Patients should have there urea and electrolyte levels measured if this is indicated.a full blood count.
Yes thats right. Mr. W, although showing no signs of cardiac disease, is over 45 years old, thus an ECG would be done.
No, liver function should be tested only in patients undergoing major surgery, or with suspected liver failure.
Yes thats right. Mr. W is over 70 years old thus a chest X-ray should be performed.
Yes thats right. The ASA grade will be usefull.
Mr. W's ASA is ASA1.sured and a full blood count.
urine
Yes thats right. This is a simple test, and useful..oglobin level measured and a full blood count.
weight
Yes thats right.
But I'm sure the nurses will have already done this for you ?a full blood count.
Yes thats right.
But I'm sure the nurses will have already done this for you ?a full blood count.
Browse one page forwards.
Medi-CAL
nnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnng Unit
University of Aberdeenberdeen
University of Aberdeen
Anaesthetics.assessment
explain
FirstPage
Jvisited
"explain"
ouseenter
mouseleave
mouseenter
buttonUp
mouseenter
Go to the last visited page.
explain
mouseleave
explain
buttonUp
explain
pturw
"explain"
enterpage
enterpage
explain
What to do
Post operative fluid therapy
Monitoring fluid balance
name and id
Physiology - cardiovascular
Parasympathetic
Respiratory disease
Disease of the respiratory system may affect oxygenation, carbon dioxide elimination, the uptake of inhaled gases, and increase the incedence of chest infection post operatively.
A patient with an acute URTI will benefit from the postponement of the operation.
The asthmatic patient requires both investigation, and management pre, intra, and post operatively.
A patient with chronic bronchitis also requires investigation and managment.
MessageBox(
" The effects
anaesthesia
reducing
immunological response,
also
sedative drugs on respiratory clearance have lead
j reasonning that patients
upper
Dtract infection should
xundergoe elective surgery,
2preads
lower
M." &
" In children
particularly important due
the relative narrowness
their airways. ",\
"URTI.",\
buttonup
buttonup
The effects of anaesthesia in reducing the immunological response, and also the effects of sedative drugs on respiratory clearance have lead to the reasonning that patients with an upper respiratory tract infection should not undergoe elective surgery, in case the infection spreads to the lower respiratory tract.
In children this is particularly important due to the relative narrowness of their airways.
URTI.
MessageBox
MessageBox(
" Pre operative investigation
patient
fsigns
symptoms
asthma should include recent chest X-ray
lung function tests, response
bronchodilators
arterial blood gases" &
" If the
smokes,
effort
be made
them
stop",\
"Investigation
buttonup
buttonup
Pre operative investigation of patient with signs or symptoms of asthma should include recent chest X-ray and lung function tests, response to bronchodilators and arterial blood gases
If the patient smokes, all effort should be made to get them to stop
Investigation of asthma.
MessageBox
MessageBox(
" During anaesthesia
often necassary
dbronchodilator therapy
3 asthmatic patient." &
" Anti histamines are also used",\
"Management
I.",\
buttonup
buttonup
During anaesthesia it is often necassary to continue bronchodilator therapy in the asthmatic patient.
Anti histamines are also used
Management of asthma.
MessageBox
MessageBox(
" Pre operative investigation
a patient
fsigns
symptoms chronic bronchitis should include recent chest X-ray
lung function tests, response
bronchodilators (
assess
asthmatic component),
arterial blood gases" &
" If the
still smokes,
effort
be made
them
stop",\
"Investigation
buttonup
buttonup
Pre operative investigation of a patient with signs or symptoms chronic bronchitis should include recent chest X-ray and lung function tests, response to bronchodilators (to assess any asthmatic component), and arterial blood gases
If the patient still smokes, all effort should be made to get them to stop
Investigation of chronic bronchitis.
MessageBox
MessageBox(
"The main thrust
treatment
improve respiratory function.
8best way
acchieve
Hphysiotherapy
clearance
secretions.",\
"Management
chronic bronchitis.",\
buttonup
buttonup
The main thrust of treatment is to improve respiratory function. The best way to acchieve this is by physiotherapy to improve the clearance of secretions.
Management of chronic bronchitis.
MessageBox
TitleText
Disease.
Respiratory disease.
Activate the hotwords.
"pagnum"
"totpag"
explain
txClassName
button
defStroke
0,0,0
Medi-CAL
nnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnng Unit
University of Aberdeenberdeen
University of Aberdeen
Anaesthetics.assessment
backPage
"Browse one
"explain"
default
ouseenter
mouseleave
mouseenter
buttonUp
mouseenter
Browse one page back.
explain
mouseleave
explain
buttonUp
explain
default
NextPage
"Browse one
forwards."
"explain"
"the
default
"And that's
folks !"
ouseenter
mouseleave
mouseenter
buttonUp
mouseenter
Browse one page forwards.
explain
mouseleave
explain
buttonUp
explain
the end
And that's all folks !
default
FirstPage
"explain"
ouseenter
mouseleave
mouseenter
buttonUp
mouseenter
Go to the first page.
explain
mouseleave
explain
buttonUp
explain
PAGE NUMBER
What to do
e"Introduction"
e"physiology"
e"diseases"
e"Pre-operative assessment"
e"ASA classification"
e"Drug therapy"
e"general anaesthesia"
regional"
e"References"
e"Glossary"
e"post
e"pain relief"
e"cases"
enterpage
enterpage
Introduction
physiology
diseases
Pre-operative assessment
ASA classification
Drug therapy
general anaesthesia
local and regional
References
Glossary
post operative therapy
pain relief
cases
TitleText
Anaesthetics workbook CAL
by A Shuker BSc (Med. Sci.).v.1.0). (Med. Sci.)...
What to do
Use the mouse to click on the button of your choice.
Hotwords, shown in bold underline, become active when you place the mouse operated cursor over them and press the LEFT mouse button. Try pressing this Hotword now!
If you want to know more about the tutorial or if you are unsure about using the mouse or the computer select 'help me' from the menu.
The action of a button is displayed in the bottom middle when the mouse operated cursor is placed over the button.
Instructions are often given in the top left corner, in red text.
red text.
help hotword
messagebox (
"Activating a HOTWORD will usually present you
fa dialog
Gthat may contain definitions, references, hints
tips, prompts
other forms
encouragement. Other options
dbe linked
fHOTWORDS." &
k& "Press OK
d.",\
"Information Box.",\
buttonDown
buttonDown
Activating a HOTWORD will usually present you with a dialog box or text box that may contain definitions, references, hints and tips, prompts or other forms of encouragement. Other options may be linked with HOTWORDS.
Press OK to continue.
Information Box.
messagebox
Click the browse forwards button to starttstart
Browse one page forwards.
other benefits
The pre-operative assessment can also have other benefits.
The patient can discuss with the anaesthetist what he is to do, and thus reduce anxiety (often better than premedication).
If the assessment is done by the anaesthetist, then the risks of mistaken identity, or performing the wrong proceedure are reduced. }
TitleText
Pre-operative Assessment .
Other benefits..on Mrs. S
Introduction
e"Introduction"
e"Pre-operative assessment"
e"ASA classification"
e"Drug therapy"
e"References"
e"Glossary"
e"physiology"
e"diseases"
e"general anaesthesia"
regional"
e"post
e"pain relief"
e"cases"
enterpage
enterpage
Introduction
Pre-operative assessment
ASA classification
Drug therapy
References
Glossary
physiology
diseases
general anaesthesia
local and regional
post operative therapy
pain relief
cases
This toolbook should take no more than 60 minutes to complete.
It aims to guide you, the undergraduate medical student, towards areas of knowledge which are considered important.
As in all CAL packages the information it contains is by no means complete or exaustive, and should be supplemented by reading either textbooks or the references suggested.
During your two week attachment to the department of anaesthetics you will also gain practical experience, and a large part of the time will be spent with Anaesthetists in theatre.
The contents of this CAL package will be examined on in the final degree examination in Surgery.
TitleText
Introduction.
Objectives.
Use the scroll bar to scroll through the text.
Browse one page forwards.
Physiology - respiratory
Pre-operative Invetigations
"Hb"
"u&e"
"ecg"
"cxr"
"lfts"
"asa"
"urine"
"weight"
"temp"
"butts"
60,80,100
default
leavepage
leavepage
urine
weight
butts
butts
default
TitleText
Pre-operative Assessment .
Investigations
The following are a list of tests, click on the button next to each test to reveal when it should be used.ow
Heamoglobin and full blood count.
Urea and electrolytes
Liver function tests
Chest X-ray
ASA grade
Urine analysis for glucose / protien
Oral temperature
Weight
butts
"fbc flow"
FBC should be performed on
patients. However
screening method
costly. They
Hcertainly be carried out on
M that have suspected anaemia."
buttonup
buttonup
fbc flow
120,50,100
"Urea
electrolytes should be performed on patients that are" &\
" clinically dehydrated
odematous,
/have a
fluid loss" &\
" eg diarrhoea,
gain eg IV fluids,
?suspected renal" &\
" impairment,
on diuretic therapy,
on medication
sensitive
balance eg Digoxin."
buttonup
buttonup
Urea and electrolytes should be performed on patients that are
clinically dehydrated or odematous, that have a history of fluid loss
eg diarrhoea, or fluid gain eg IV fluids, that have suspected renal
impairment, that are on diuretic therapy, or that are on medication that
is sensitive to electrolyte balance eg Digoxin.
120,50,100
"An ECG should be performed on
male patients over 45 years old" &\
female
a recent
xavailiable." &\
" An
ualso be carried out on
age that have symptoms" &\
heart disease,
signs
buttonup
buttonup
An ECG should be performed on all male patients over 45 years old
and female patients over 55 years old if a recent ECG is not availiable.
An ECG should also be carried out on patients of any age that have symptoms
of heart disease, or signs of heart disease.
120,50,100
700 apparently
wpatients have preoperative abnormalities" &\
liver function tests. Thus
worthwhile screening
cwho" &\
undergo prolonged anaesthesia,
major surgery."
buttonup
buttonup
1 in 700 apparently normal patients have preoperative abnormalities
in liver function tests. Thus it is worthwhile screening all patients who
are to undergo prolonged anaesthesia, or major surgery.
120,50,100
"A Chest X-ray should be performed on
patients over 70 years
" age. A chest X-
Halso be carried out on
+ that" &\
" have symptoms
signs
cardiovascular disease
respiratory
," &\
" Also those
)high risk
Tuberculosis,
undergoing" &\
" thoracic surgery."
buttonup
buttonup
A Chest X-ray should be performed on all patients over 70 years of
age. A chest X-ray should also be carried out on patients of any age that
have symptoms or signs of cardiovascular disease or respiratory disease,
Also those patients at high risk of Tuberculosis, and any patient undergoing
thoracic surgery.
120,50,100
"ASA grades"
buttonup
buttonup
120,50,100
ASA grades
urine
"Ward testing
urine
simple, rapid,
accurate,
usefully screens patients
glycosuria
protienuria."
buttonup
buttonup
Ward testing of urine is simple, rapid, and accurate, and usefully screens patients for glycosuria or protienuria.
120,50,100
"The patients temperature should be within the
wrange. If
above
wthere may be infection
neoplasia lurking, requiring further investigation."
buttonup
buttonup
The patients temperature should be within the normal range. If it is above normal there may be infection or neoplasia lurking, requiring further investigation.
120,50,100
weight
"All children should be weighed
also useful
adults,
%drugs are often given on a body weight basis."
buttonup
buttonup
All children should be weighed and it is also useful to weigh adults, as drugs are often given on a body weight basis.
120,50,100
fbc flow
Is a recent FBC available.
Is there a need to repeateat to repeat
Is there a high chance of blood loss intra operatively ?
Need FBCFBC Need FBC a need to repeat
Is there a history of recent blood loss ?
Need FBCCFBC Need FBC a need to repeat
Is the patient clinically anaemic ?
Need FBCCCFBC Need FBC a need to repeat
Specific clinical indication,
eg. renal failure.
Need FBCCCFBC Need FBC a need to repeat
FBC not needed.
"FBC flow"
buttonup
buttonup
FBC flow
Introduction
IV induction
Local analgesia doses
Post operative pain - Methods
References
erences
"refs"
enterpage
enterpage
import refs
Go to the last visited page.
References.
import refs
"anaref.txt"
syserrornumber
"There
no reference file available, contact A Shuker"
refs"
"PLEASE WAIT"
"explain"
default
buttonup
buttonup
anaref.txt
There is no reference file available, contact A Shuker
import refs
PLEASE WAIT
explain
anaref.txt
anaref.txt
explain
default
fileName
C:\UTLS\WINUTL\adres.crd
Import reference's
TitleText
Updated references are available on this page by pressing the button. Sci.)...
The end
4ReplyList, Logged
"anacal.txt"
default
Thank you for completing this toolbook.
Please click exit to finish.
TitleText
The End.rative pain relief.
Methods of pain relief - cases. box
then press the accept answer buttontonn
( dical CAL
Times New Roman
Arial
System
Arial
Arial
MS Sans Serif
Arial
Arial
Arial
Small Fonts
System
Arial
Arial
MS Sans Serif
MS Sans Serif
Arial
Arial
j?0>g=
? {q|g
MS Sans Serif
Arial
Arial
Medusa
Arial
Small Fonts
Arial
Medusa
Times New Roman
BlackChancery
Arial
Medical CAL - Anaesthetics CAL l
Wingdings
toolbook\work\utl\anthelp.tbk
fAppName
toolbook
About
Toolbook tutorial version 1, by A.Shuker 1993.
leavebook
Pre-Operative assessment 1
CO Calc Page
ASA grades
ASA Grades.
The ASA grades give a useful overall assessment of anaesthetic risk physical status, which is universally accepted. The risk classification is as follows:
A normal healthy patient with a localised condition requiring surgery.
A patient with a mild or well controlled systemic condition. eg. mild hypertension, well controlled diabetes, old age.
A patient with a severe systemic condition limiting lifestyle. eg. angina, a recent myocardial infarction.
A patient with a severe systemic condition threatenig life. eg. advanced cardiac, pulmonary or renal disease.
A moribund patient not expected to survive 24 hours with or without operation. This catagory may include a previously fit patient with, for example, uncontrolled heamorrhage, as well a an elderly patient with a terminal disease.
This letter is placed before the numerical classification if the operation is an emergancy.
TitleText
The American society of Anaesthesiologists (ASA) grades.g the button. Sci.)...
Go to the last visited page.
ASA grades
The end
other benefits
Fluid and electrolytes
Physiology - cardiovascular
The main effect of general anaesthesia on the cardiovasvular system is to reduce the cardiac output. It does this in several ways including vasodilation, myocardial depression, effects on the baroreceptors , and reduced venous return.
Obviously, reduction in the cardiac output is important as it reduces the oxygenation of the tissues.
MessageBox(
" Venodilation occurs soon
induction
anaesthesia,
relaxation
vascular smooth muscle. This
followed
Harterial
u." &
" Cardiac output
only reduced significantly
those patients whose venous
dependant upon wide spread vasoconstriction.",\
"Vasodilation.",\
buttonup
buttonup
Venodilation occurs soon after induction of anaesthesia, and is due to the relaxation of vascular smooth muscle. This is followed by arterial dilation.
Cardiac output is only reduced significantly in those patients whose venous return is dependant upon wide spread vasoconstriction.
Vasodilation.
MessageBox
MessageBox(
" The myocardium
directly depressed.",\
"Myocardial depression.",\
buttonup
buttonup
The myocardium is directly depressed.
Myocardial depression.
MessageBox
MessageBox(
" The baroreceptor's
wresponse
reduce the heart rate
frising blood pressure. General anaesthesia causes
c discharge
increase, although
athreshold
stimulation, central processes,
efferent activity are decreased.",\
"Baroreceptors.",\
buttonup
buttonup
The baroreceptor's normal response is to reduce the heart rate with rising blood pressure. General anaesthesia causes baroreceptor discharge to increase, although the threshold to stimulation, central processes, and efferent activity are decreased.
Baroreceptors.
MessageBox
MessageBox(
" Reduced movement
the diaphagm,
relaxation
skeletal muscle
+anaesthetised patient further reduce venous
thus cardiac output.",\
"Baroreceptors.",\
buttonup
buttonup
Reduced movement of the diaphagm, and relaxation of skeletal muscle in the anaesthetised patient further reduce venous return, and thus cardiac output.
Baroreceptors.
MessageBox
TitleText
Physiology of anaesthesia.
Cardiovascular system.
Activate the hotwords.
Exit the application.
Pre operative tests on Mrs. S
4replylist
"Dr." &
enterpage
enterpage
replylist
weight
:PHYSSIZE
:PHYSSIZE
TitleText
Pre-operative Assessment .
Investigations on Mrs. S
Hint - Try them all..
Mrs. S is a 35 year old Asthmatic woman who has menorrhagia due to a fibroid uterus. Physical examination shows a distended abdomen and inspiratory wheeze. She is on a ventolin inhaler as required.
What investigations should you perform pre operatively ?
Dr.e. Spectator
Yes thats right. Mrs. S's case this is very important as there is a risk of anaemia due to blood loss.rs. S's case this is very important as there is a risk of anaemia due to blood loss.
No. Mrs. S is less than 55 years old and has no history of cardiac disease, thus an ECG would not be done.uld be done.
Yes thats right. Mrs S is an asthmatic therefore a chest X-ray should be performed. However she may be attending an out-patient clinic, a recent chest X-ray may be available, and suitable..ble.
Yes thats right. The ASA grade will be usefull.
Mrs. S's ASA is ASA2.ured and a full blood count.
urine
Yes thats right. This is a simple test, and useful..oglobin level measured and a full blood count.
weight
Yes thats right.
But I'm sure the nurses will have already done this for you ?a full blood count.
Yes thats right.
But I'm sure the nurses will have already done this for you ?a full blood count.
butts
"u&e"
"ecg"
"cxr"
"lfts"
"asa"
"urine"
"weight"
"temp"
buttonup
buttonup
120,50,100
urine
weight
Hb & FBC
"u&e"
"ecg"
"cxr"
"lfts"
"asa"
"urine"
"weight"
"temp"
buttonup
buttonup
0,50,100
urine
weight
U's & E's
"u&e"
"ecg"
"cxr"
"lfts"
"asa"
"urine"
"weight"
"temp"
buttonup
buttonup
0,50,100
urine
weight
"u&e"
"ecg"
"cxr"
"lfts"
"asa"
"urine"
"weight"
"temp"
buttonup
buttonup
0,50,100
urine
weight
LFT's
"u&e"
"ecg"
"cxr"
"lfts"
"asa"
"urine"
"weight"
"temp"
buttonup
buttonup
120,50,100
urine
weight
"u&e"
"ecg"
"cxr"
"lfts"
"asa"
"urine"
"weight"
"temp"
buttonup
buttonup
120,50,100
urine
weight
Report her ASA grade
"u&e"
"ecg"
"cxr"
"lfts"
"asa"
"urine"
"weight"
"temp"
buttonup
buttonup
120,50,100
urine
weight
Ward urine analysis
120,80,100
"u&e"
"ecg"
"cxr"
"lfts"
"asa"
"urine"
"weight"
"temp"
default
buttonup
buttonup
urine
weight
default
Measure temperature
120,80,100
"u&e"
"ecg"
"cxr"
"lfts"
"asa"
"urine"
"weight"
"temp"
default
buttonup
buttonup
urine
weight
weight
weight
default
Measure her weight
No, liver function should be tested only in patients undergoing major surgery, or with suspected liver failure.
No. Patients should have there urea and electrolyte levels measured if this is indicated.a full blood count.
Browse one page forwards.
Pre-operative tests on Mr W
Diabetes
Induction 2
Tracheal intubation
Pre operative tests on Mrs. S
beta antagonists
Inhalation
Smoking
The hazards of smoking are many, but with particular reference to the patient about to have an anaesthetic the following difficulties arise.
It is always worth asking a patient to stop smoking. Even stopping the day before the operation results in a drop in the concentration of carboxyhaemoglobin, and it may help them stop for good.
MessageBox(
"Carbon monoxide inhaled
fcigarette smoke binds tightly
haemoglobin, forming carboxyhaemoglobin. Up
/ can be altered
way, considerably decreasing the available oxygen
tissues." &
" A further problem
that pulse oximetry
unable
distinguish
, thus
over estimates
patient's
saturation.",\
"Carboxyhaemoglobin.",\
buttonup
buttonup
Carbon monoxide inhaled with cigarette smoke binds tightly to haemoglobin, forming carboxyhaemoglobin. Up to 15% of haemoglobin can be altered in this way, considerably decreasing the available oxygen to the tissues.
A further problem is that pulse oximetry is unable to distinguish oxyhaemoglobin from carboxyhaemoglobin, thus it over estimates the patient's oxygen saturation.
Carboxyhaemoglobin.
MessageBox
TitleText
Pre-operative Assessment .
Smoking.
Activate the hotwords.
Smoking
Local analgesia pharmacology
Alcohol
Excessive alcohol consumption by a patient can potentially lead to a number of hazards.
Liver enzymes can be induced (short term use) or inhibited (long term use), thus the metabolism of anaesthetic drugs can be affected. Liver failure may also occur, here all sedatives and narcotic drugs are contra-indicated.
The efficacy of centrally acting depressant drugs is reduced .
There is also a diminished adrenocortical response to stress, reduced host defense, and bone marrow depression.
The pre-operative preparation of a patient with a large alcohol intake must include ensuring adequate nutrition. Post-operativly symptoms of alcohol withdrawal may be seen.
MessageBox(
"Vitamin suplementation particularly
fthiamine, pyridoxine, nicotinic
pantothenic acid,
vitamin K.",\
"Nutrition.",\
buttonup
buttonup
Vitamin suplementation particularly with thiamine, pyridoxine, nicotinic and pantothenic acid, and vitamin K.
Nutrition.
MessageBox
TitleText
Pre-operative Assessment .
Alcohol.
Activate the hotwords.
Alcohol
Spinal and Epidural
cases
"patients"
4replylist
enterpage
leavepage
enterpage
patients
leavepage
patients
replylist
Press on the button to enter the Anaesthetics CAL case note package. In it you will be introduced to a number of different clinical situations, that you as the doctor will need to manage.
GOOD LUCK !
Cases"
"explain"
Zfilename,filter,title
"Patient Files (*.PAT)|*.
| Casefiles (*,CBK)| *.cbk| All
.*) |*.*|"
"New
-- call COMMDLG.DLL routine via FILEDLG.
the requested full path
CommDlgOpenFile(
X"user"
bringWindowToTop(
toolbook
bringwindowtotop(
[ doesn't
even un-iconize
47,119"
default
ouseenter
mouseleave
mouseenter
buttonup
mouseenter
Go to Cases
explain
mouseleave
explain
buttonup
Patient Files (*.PAT)|*.PAT| Casefiles (*,CBK)| *.cbk| All files (*.*) |*.*|
New Patient
CommDlgOpenFile
bringWindowToTop
sysWindowHandle
bringwindowtotop
default
toolbook
filename
filter
title
Button
patients
Go to Cases
cases
name and id
4ReplyList
) < 3
"ID"
B"nameok"
"now
"turn
B"idok"
enterpage
enterpage
nameok
now id
turn page
ReplyList
"arial"
B"idok"
"turn
buttonup
buttonup
arial
italic
turn page
Please type your name in the box below, then press the OK button.
now id
Now enter your year of study, and press the OK button.ton.
turn page
NOW TURN THE PAGE
TitleText
Logging on page.orial - fractures of the wrist, by A Shuker BSc (Med. Sci.)...
(.txt)