UCL Anaesthesia and Perioperative Medicine Revision, Exercises of Medicine

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UCL Anaesthesia and

Perioperative Medicine

Revision

MB BS Anchor Day 2021 Google UCL Stephens

General stuff: Exams

• There is life outside medicine
• MBBS exams will soon seem like a memory
• You can’t get every question correct = fine!
• You might not finish all OSCE = fine!

Drug doses

• Adrenaline Cardiac Arrest = 1mg in 10 ml IV ‘minijet’
• Adrenaline Anaphylaxis = 0.3 - 0.5mg = 0.3- 0.5ml of 1mg/ml
• Others : ‘Ask my senior and look in BNF’

Only 50 minutes!! Search ..‘department of anaesthesia’

History Examination Investigation Discussion Management

DR

Danger Response? Side Effects CVS RS GI GU NS Other

Before During After

Contents Physiology – relevant only! = MAP = CO x SVR Anaesthesia- not much! Analgesia - how to classify + key drugs Preop assessment and drugs IV fluids Blood + Products ABG Risk Airway Critical Care, iSBARd Other stuff if we have time

Mean Arterial Pressure = CO x SVR

Mean Arterial Pressure = Cardiac Output x Systemic Vascular Resistance MAP - CVP = CO x SVR ‘Cardiogenic’ = of the heart = CO changes ‘Vaso…Veno …dilation/constriction’ = SVR changes tiny SV x HR

Mean Arterial Pressure = CO x SVR

What causes low blood pressure…. CO Cardiac causes or changes in blood volume SVR Sepsis and Anaphylaxis SV x HR Myocardium- muscle Rhythm- rate Valves - forward flow Oxygenated blood coming back to the heart = normal venous return Relax + fill properly

Anaesthesia Basics

• Triad of Anaesthesia
  • Hypnosis
  • Analgesia
  • +/-Neuromuscular paralysis

Anaesthesia- Hypnosis

Depresses

• (D)R
• Airway
• Breathing
• Circulation
• Disability
• Everything else MAP = CO x SVR

Anaesthesia depresses function

CVS RS GI GU NS Other

Anaesthesia- Hypnosis

Depresses

• (D)R
• Airway
• Breathing
• Circulation
• Disability
• Everything else

Anaesthesia depresses function

So what? If you can’t

• compensate /
• raise the CVS function …..you’re in trouble Ht Failure Breathlessness walking up stairs IHD