Anesthesia Extern Reading (bulk)
WEEK 1 (Monday - Friday, points 1-5)
[1]
We will be encouraging you to learn about ASA monitoring techniques that we use.
You can either read about ASA Monitors in your Anesthesia text of choice such as Fundamentals of Anesthesia by Professor Barash (all freely available on Yale’s medical library website) or on OpenAnesthesia.
1. What are the 4 main components of patient physiology that the ASA standards for basic monitoring aim to assess?
2. What are the some of the ways of monitoring circulation?
3. How can we measure oxygenation?
4. What are the 4 most accurate thermometer locations under general anesthesia?
5. Why do our monitors show EKG leads II and V5? What are we looking for in these leads and why are they good choices for such? Are there other leads appropriate to monitor?
6. How can we ensure adequate ventilation?
Quiz questions:
https://forms.gle/y3m5uVzfzbqd5EnbA
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[2] please read about Airway Management:
1. What is the Malampatti classification, what are the "grades?"
2. What are some of the predictors of difficult ventilation? Difficult intubation?
3. What is the Cormack-Lehane scale?
4. Why do we preoxygenate?
5. What are our options if we can't pass the tube with DL? How long do we have if someone is adequately preoxygenated?
Quiz questions:
https://forms.gle/6PiuUXJiSwTwaRUv6
[3] , you should focus on Tools for Airway Management. Here is an article on LMAs (laryngeal mask airways).
1. What are the indications and contraindications for LMAs?
2. How do you choose the appropriate size?
3. What is the appropriate technique for insertion?
4. What are the most common problems encountered with LMA insertion?
5. How do you troubleshoot an LMA that is malfunctioning (has an air leak, or is not delivering adequate tidal volumes)?
6: What is an intubating LMA and when is it used?
Quiz questions:
https://forms.gle/84VbjSUdaAUtxpXX9
[4] please read about Laryngospasm and Bronchospasm. You can choose your source in looking up information about these ailments, OpenAnesthesia.org has good material.
1. What is the difference between laryngospasm and bronchospasm?
2. What are some common causes of both laryngospasm and bronchospasm?
3. What is the emergency treatment for both?
4. What are commonly used bronchodilators?
Quiz questions:
https://forms.gle/siifpLokU42EMmZn8
[5] please read about indirect laryngoscopy.
1. How is the glidescope designed differently from a standard laryngoscope?
2. What about the McGrath, King Vision, and C-Mac?
3. What are the advantages and disadvantages of indirect laryngoscopy?
4. What are the anatomical landmarks we use when assessing the airway with a flexible intubating scope? How do you know your up from down? Right from left?
Quiz questions:
https://forms.gle/PbC4g2A9ADbbC9sN7
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WEEK 2 (Monday - Friday points 6-10)
[6]
Learn about the various anesthetics (and anesthetic adjuvants) that we use. Of course these anesthetics must be delivered to the patient, and many times we do so via an IV (intravenous catheter), so your skill to focus on this week is to become a master at IV placement/ venous cannulation. To get an introductory lesson on IV placement, you can watch the procedural video on our website: https://medicine.yale.edu/anesthesiology/media/videos/?tab=Procedures
In order to prepare for your week, please start by reading up about the most famous of our anesthetics, Propofol. You can either read about propofol in your Anesthesia text of choice such as Fundamentals of Anesthesia by Professor Barash (all freely available on Yale’s medical library website) or on OpenAnesthesia.
1. What is propofol’s mechanism of action?
2. What does propofol provide? Amnesia? Analgesia? Muscle relaxation?
3. What effect does propofol have on a patient’s respiratory status?
4. How is propofol metabolized?
5. What is propofol infusion syndrome?
Quiz Questions:
https://forms.gle/YRqQ7ZFVZPkcTV8m9
[7]
Keep working on IVs, don't be shy to ask residents to let you place them when patients are asleep (it is a good way to learn, and then you can be more confident when they are awake!). It is also always worth *asking* to place other lines (A-lines, central lines) if you feel OK about IVs, just shake it off if the attending says no-- it was worth a shot!
**Note: it may be more difficult in pedi, depending on the attending, as these IVs are important to get right, fast, given the potential for rapid decompensation-- so please don't be offended if you are not allowed to place IVs on your pedi days!
For tomorrow, please read about Volatile Anesthetics:
1. What, generally, is believed to be the mechanism of action of the commonly used volatile anesthetic gases (isoflurane, sevoflurane, desflurane)?
2. What do the volatiles provide? Amnesia? Anesthesia? Analgesia? Muscle relaxation?
3. What is Mean Alveolar Concentration (MAC)?
4. What are characteristics of our most commonly used volatile anesthetics? Smell? Which ones do we avoid in asthmatics? Which one has a special vaporizer?
Quiz Questions:
https://forms.gle/jceauA4CuLgHxs366
[8] read about two anesthetics: Etomidate and Ketamine.
Etomidate: https://en.wikipedia.org/wiki/Etomidate
1. How does etomidate work?
2. What is the main difference between etomidate and propofol?
3. When is the optimal time to choose etomidate over propofol?
Ketamine: https://www.openanesthesia.org/ketamine_receptor_effects/
1. What is ketamine’s mechanism of action?
2. In which facet of anesthetic care (amnesia? analgesia? etc.) does ketamine best help?
Quiz Questions:
https://forms.gle/EVBmyMF4zpQhQ78p9
[9]
Please read about benzodiazepines and dexmedetomidine (precedex) tonight.
Benzodiazepines:
1. When and why are they used in anesthesia? Which ones are most commonly used?
2. What is their mechanism of action?
3. In which patient populations would you avoid them?
4. If a patient is taking a benzo regularly at home, how will this affect their anesthetic?
Dexmedetomidine (precedex):
1. What is its mechanism of action?
2. Where is it most commonly used?
3. What are the consequences of using a loading dose?
Quiz Questions:
https://forms.gle/hYQmXj8Y3BAVtrsf9
[10]
Please read about muscle relaxants tomorrow:
Depolarizing muscle relaxants (succinylcholine):
1. How does succinylcholine (sux) work?
2. How is it metabolized?
3. What is the onset time and duration of action?
4. When is sux indicated? Contraindicated?
Non-depolarizing neuromuscular blockers (NMBs):
1. What are the most commonly used NMBs?
2. What is their mechanism of action?
3. What is train-of-four (TOF) monitoring? How and why is it used with non-depolarizing NMBs?
4. Can you use non-depolarizing NMBs for rapid sequence induction?
5. How do you reverse the effects of NMBs?
Quiz Questions:
https://forms.gle/c9AFK6GebhDuoy1r6
WEEK 3 (Monday-Friday points 11-15)
[11] please read about intravenous fluid management.
1. How do you calculate perioperative fluid losses? Maintenance fluids? Surgical losses?
2. What are the dangers associated with arbitrary fluid administration?
3. What are the differences between normal saline, lactated ringers, plasmalyte, and albumin? When would you use one over the other? Are there reasons to avoid any of these fluids?
4. Other than crystalloids and colloids, are there other alternatives that can be used for volume expansion? How do blood products factor in?
Quiz Questions:
https://forms.gle/tmm7C4rqwEuXZeXy8
[12]
Please read up about massive transfusion.
1. What are the current guidelines for massive transfusion blood product ratio guidelines?
2. What are the components of FFP? Cryo?
3. What is "pooled cryoprecipitate"?
4. Why do platelets carry the highest risk of infection?
5. What are the risks of transfusion? (TRALI, TACO, metabolic alkalosis, hyperkalemia, hypocalcemia)
6. What is the difference between hemolytic and nonhemolytic transfusion reactions?
Quiz Questions:
https://forms.gle/nRAPvV6Qm6fj7PKP6
[13]
Please read about anticoagulants.
1. What are common anticoagulants we use?
2. When we use heparin, what lab test do we use to monitor anticoagulation on the floor vs. in the OR?
3. What is HIT?
4. What are alternatives for patients with a history of HIT?
5. What is andexxa (coagulation factor Xa)?
Quiz Questions:
https://forms.gle/52eheRp9ASVhnXLd8
[14]
Please read about arterial blood gases (ABG).
1. What are the components to an ABG? What information does an ABG provide?
2. What are common causes of anion-gap metabolic acidosis?
3. What are common causes of non-anion gap metabolic acidosis?
4. What is the strong ion difference?
5. What are common causes of respiratory acidosis in the OR vs. the floor?
6. What are common causes of respiratory alkalosis?
Quiz Questions:
https://forms.gle/YrEECsvWUewB2HFb9
[15]
Tomorrow please read about the following electrolyte disturbances:
1. Hyperkalemia - how would you treat it? What would you see on EKG?
2. Hypokalemia - how would you treat it? What would you see on EKG?
3. Hypercalcemia - how would you treat it? What would you see on EKG?
4. How would you correct hypernatremia? What are potential complications?
5. How would you correct hyponatremia? What are potential complications?
Quiz Questions:
https://forms.gle/pGD7ia4n5h2X7VLe8