*part Ii Stuff To Remember

Front 1

World Federation Neurosurgeons (WFNS) SAH grading

Back 1

Score correlates with mortality

Front 2

Child-Pugh Classification

Back 2

Operative mortality:

Score:
5-6 = Class A = low risk < 5%
7-9 = Class B = moderate risk 25%
10-15 = Class C = high risk > 50%

Front 3

Apgar Score

Back 3

- Apgar’s are taken at 1 and 5min
- Memory aid:
 Activity (muscle tone)
 Pulse
 Grimace (reflex irritability)
 Appearance (colour)
 Respiration

Front 4

CHADS2

Back 4

CHADS2=0, no therapy or Aspirin only is recommended
­CHADS2=1, either Aspirin or Warfarin is recommended (depending on patient preferences)
­CHADS2 ≥ 2 should be managed with lifelong Warfarin (target INR 2.0-3.0)

­Overall risk of stroke in non-valvular AF is around 5% per year
­Warfarin reduces risk of CVA from 5% to 1% per annum
Risk of major bleed 0.5% per annum

Front 5

Aortic Stenosis Severity (Echo)

Back 5

AHA Guidelines

Front 6

Mitral Stenosis Severity (Echo)

Back 6

AHA Guidelines

Front 7

Pulmonary Hypertension Severity (Echo)

Back 7

­Based on mean PAP:
 Mild: 25-35
 Moderate: 35-45
 Severe: >45mmhg
­
Based on RVSP:
 >40 has likely PHTN
 50-60 moderate
 >60mmhg as severe

Front 8

RIFLE Criteria

Back 8

Front 9

LeFort Fractures

Back 9

Front 10

Obstructive Lung Disease Severity

Back 10

Severity based on FEV1% of predicted values (GOLD report on COPD 2011)
ᵒ Mild (stage 1) : >80% predicted
ᵒ Moderate (stage 2): 50-80% predicted
ᵒ Severe (stage 3): 30-50% predicted
ᵒ Very Severe (stage 4) : <30% predicted

Front 11

STOP BANG

Back 11

Snoring: loud snoring (can be heard through closed doors)
Tiredness: daytime somnolence
Observed apnoea
Plood pressure: Hx of hypertension

BMI: >35
Age: >50
Neck Circumference: >40cm
Gender: male

>3 = High risk of OSA → refer for sleep testing

Front 12

ARDS Severity

Back 12

Front 13

Soda Lime - Contents and reaction

Back 13

Contains:
94% calcium hydroxide
5% sodium hydroxide
1% potassium hydroxide
An indicator – such as ethyl violet
Silica – increases hardness of the granules, minimising formation of alkaline dust which can be an airway irritant if inhaled

The active ingredient is the sodium hydroxide, which acts as a catalyst, and is not actually consumed in the reaction:

CO2 + H20 ↔ H2CO3
2NaOH + H2CO3 → Na2CO3 + 2H2O + heat
Na2CO3 + Ca(OH)2 → CaCO3 + 2NaOH + heat

Front 14

Diastolic Heart Failure Echo Assessment

Back 14

Transmitral flow velocity
­ E wave: peak filling velocity in early diastole
­ A wave: peak filling velocity in late diastole
­ E/A relationship
 Normal:
E/A is > 1
As atrial kick only contributes 30% of filling
 Mild DD aka ‘Impaired relaxation’
E/A is <1
Relaxation is impaired and atrial contraction contributes relatively more to ventricular filling
 Moderate DD aka ‘Pseudonomral filling’
E/A normalises to E>A
Compliance and relaxation reduced → impaired early diastolic filling and raised LAP → E >A
Differentiated from normal by assessing transmitral flow with valsalva
 Severe DD aka ‘Restrictive filling’
E >> A
LV compliance is extremely low → high LAP → high velocity E wave

Front 15

PONV

Apfel Simplified Risk Score

Eberhart Simplified Risk Score

Back 15

Apfel Simplified Risk Score – In Adults
­Four risk factors
 Female sex
 Non-smoker
 Hx of PONV or motion sickness
 Use of postoperative opioids
­ Risk Score:

0 RF (baselines risk) = 10%, 1 RF = 20%, 2 RF = 40%, 3RF = 60%, 4 RF = 80%


Eberhart Simplified Risk Score – In Children
­Four risk factors
 Age > 3
 Surgery >30 mins
 Hx of POV, or PONV in 1st degree relative
 Strabismus surgery
­ Risk Score:

0 RF (baselines risk) = 10%, 1 RF = 10%, 2 RF = 30%, 3RF = 55%, 4 RF = 70%

Front 16

MELD Score

Back 16

Model for End-Stage Liver Disease (MELD) Score

Uses bilirubin, creatinine and INR

MELD = 3.78[Ln serum bilirubin (mg/dL)] + 11.2[Ln INR] + 9.57[Ln serum creatinine (mg/dL)] + 6.43

Score correlates to 3month mortality