medications

• GABAA agonist that promotes inhibitory function.
Dosing? (Induction, Maintenance)
• Induction: 1-2 mg/kg. This will buy you time until you figure out the problem.
• Maintenance: 25-150 mcg/kg/min
What are common problems with the pulse oximeter? (2)
• Poor connection at X3 monitor
• Poor connection with patient
What are common problems with the circuit? (2)
• Disconnected at anesthesia machine
• Disconnected from airway device
What are common problems with the endotracheal tube? (2)
• Tube is kinked
• Tube is plugged with secretions

• MoA? Depolarizing neuromuscular blocker (StatPearls: Depolarizing muscle relaxants act as acetylcholine (ACh) receptor agonists by binding to the ACh receptors of the motor endplate and generating an action potential. However, they are resistant to and not metabolized by acetylcholinesterase, leading to persistent depolarization of the muscle fibers, resulting in the patient's well-recognized muscle fasciculations and paralysis.)
• Phase 1 blockade?
• Structure? 2 acetylcholine molecules attached together (small volume of distribution due to charged ammonium group)
• Dosing? 1mg/kg in adults, 2 mg/kg in kids (due to more extracellular fluid in kids?)
• Metabolism? Pseudocholinesterase (circulating throughout bloodstream, eval with dibucaine number)

• GABAA agonist that promotes inhibitory function.
Dosing? (Induction, Maintenance)
• Induction: 1-2 mg/kg. This will buy you time until you figure out the problem.
• Maintenance: 25-150 mcg/kg/min
What are common problems with the pulse oximeter? (2)
• Poor connection at X3 monitor
• Poor connection with patient

• MoA? Nondepolarizing competitive antagonist
• ED95? 0.3 mg/kg, effective dose that provides 95% twitch reduction in 50% of the population
• Structure?
• Dosing? 0.6 mg/kg (2x the ED95)
• Metabolism?
• Intermediate-Acting Alternatives? In addition to rocuronium, vecuronium and atracurium (kidney and hepatic metabolism)
• Short-Acting Alternatives? Mivacurium (short-acting, metabolized by pseudocholinesterase histamine release)
• Twitch Monitoring: Nondepolarizing (fade), depolarizing (flat). T1 to T4 ratio (>90% goal). Post-tetanic count (https://www.openanesthesia.org/keywords/monitoring-depth-of-neuromuscular-blockade/)

• GABAA agonist that promotes inhibitory function.
Dosing? (Induction, Maintenance)
• Induction: 1-2 mg/kg. This will buy you time until you figure out the problem.
• Maintenance: 25-150 mcg/kg/min
What are common problems with the pulse oximeter? (2)
• Poor connection at X3 monitor
• Poor connection with patient

• SCC+TDM: Scan, Confirm, Call for Help + Temporize -> Diagnose & Manage
Actions for Scan, Confirm, Call for Help + Temporize? (2)
• 1. Turn up FiO2 to 100% with high flows. This will buy you time until you figure out the problem.
• 2. Scan from the machine to the patient to confirm the reading
What are common problems with the pulse oximeter? (2)
• Poor connection at X3 monitor
• Poor connection with patient
What are common problems with the circuit? (2)
• Disconnected at anesthesia machine
• Disconnected from airway device
What are common problems with the endotracheal tube? (2)
• Tube is kinked
• Tube is plugged with secretions
Actions for Diagnose & Manage? (3)
• 3. Switch ventilator setting to spontaneous ventilation and hand ventilate. This will allow you to assess compliance.
• 4. Auscultate lungs
• 5. Suction endotracheal tube
What could a tight rebreathing reservoir bag imply? (many)
• Obstructive Process (pubmed)
What could a collapsing rebreathing reservoir bag imply? (many)
• ??? (science direct)
What could lung auscultation revealing wheezing imply? Management? (3)
• Bronchospasm
• Management: Albuterol, deepen anesthesia, epinephrine 10-100 mcg
What could lung auscultation revealing decreased left-sided but normal right-sided breath sounds imply? Management? (1)
• Endobronchial intubation (e.g. likely right mainstem)
• Management: Reposition endotracheal tube
• Last Updated: 7/9/23, UpToDate

Acute Coronary Syndrome

#ACS

ACS more likely due to [***history],[***physical], and [***diagnostics]. DDx less likely due to no [***history], [***physical], and [***diagnostics].

Diagnostics

• - F/u EKG. May see t wave changes, ST ele, ST dep. Here are even more words and more words and even more words to see what happens.
• - Trend troponin q3h. May see elevations in MI. Infarction results in myocytes releasing cardiac enzymes. More words to see what happens.

Last Updated: 7/14/22, UpToDate

Aortic Dissection

Cardiac Tamponade

Pulmonary Embolism

Tension Pneumothorax