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Surgery Lecture 2nd Patook
Surgery Lecture 2nd Patook
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pulse
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nerves
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adductor
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>
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branch
↳ .
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int
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muscle
↓
above
sensory to
cord
larynx
vocal .
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> branch in close
-
relation to sup .
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> Recurrent
-
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.
all muscles
↓ is passing ↳ glazynx
except cricothymid
tracheo esophageal > sensory below the
grove
-
.
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Congenital
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>
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>
-
41-bag and mask
ventillation .
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pancreatitis.
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normal
& distilled diameter
.
(Saline water
not
used < I Fr = 0 .
33 mm
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.
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5 &
males
. &
Retained
Foley's > removed
-
by usa
guided puncture of
-
ballon
1-
epidural anesthesia
-
last structure
-
pierce
↓
Toohy needle lig
-
flavum
-longtime
surgery markings are
present swings
2-
spinal needle
Spinal
anesthesia (LA) .
>
- lumbar puncture -
in
subarachmid
types & - space
↓
spinal -laststructure
layers
skin
needle
pierce
↳ ↓
- subcut arachnoid
mater
>
-
supraspinous
-
interspinous ↳
. Herum > epidural
Can
> lig
-
-
use for
- mater
dura space lumbar
mater
- arach .
puncture
SAS
26- purple
> IV
- Cannula
size >
-
newborn
.
24 1
.
Paeds .
22
.
adults .
207
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omx1
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agentcauses
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d - bronchial astman ·
IY
.
haldthane
isofluranehalothane
causes .
B hepatitis Vaporizer
>
-
heart
. is
- 36
-
-55
-90
Bier's block (IVRA)
↳ main complication
↳LAS T
Dose
>
- lignocaine 5mg/kg LigtAdryimg/kg
- Bopivacaine 2mg/kg
LAST
↳ DOC
↓
20 % intralipid
emulsion
13 -
CYLINDERS - Store carrier
gases
.
blackbody ,
white
>
- M20 +
blue sund
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Pipeline
A
0
-
-
1 5
,
2
,
5
- white black
T white
,
"laughing gas
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31
-
5 blue - 760 psi ·
-
>
vaccum >
-
yellow - diffusion hypoxia
104
> MAC -
-
.
14-LMA-
laryngeal mask
airway
.
device (SAD)
esupraglottic airway .
-
LMA classic
&Is+
generation umA
LMA damaged
↳ 2 tubes ↳
supreme
↳ airw
ay E
↳
gastric for single use
For
fast track (intubating)
LMA
>
-
intubation
&
ma used o
upa
-daycare
surgery
most
[
preferred
↳ non-disposable
in
day areSX
LMA ambu ↳
I-gel -
kno
cuff .
↳ laryngeal tube
· is made
o
thermoelastic material
15-laryngoscope never lifts up votal
card
&
McCoy
E
Macintosh
↳ adults (Mc)
Miller L
↓
children (MC)
video
yngo
scape
4-6 cm above Carina
#
16-Endotracheal tubes
pole tube
south
pilot ↓
z
RAE
tube E
armored tubes
③ "Hexometallic
o
prevents
subglottic
Stere
ET tube a
Taspiration L uncuffed t O
Y
be
↓
Fibreoptic
banchoscopy
Mocheck
correct
pl a cement paediatrics
Doub le lumen ( Ventilating
>
one
lung
⑤
-
tube
↳ used in thoracic SX
17- AIRWAY ADJUNCTS .
Oropharyngeal gred e
airway
a
>
-
nasopharyngeal
airway !
Bougie .
-
[
Gar difficult intb alo
Stylette
↓
in
helps
ET tubes curving
.
-
18
Oxygen delivery device
.
Fioz + 100%
nasal cannular (
40%
pangs Fio-
Y litlmin .
Non-rebreathingU
mask (NRBM)
+80 % -
FiQ 9 15//min
nasal
-high to
canula (HFNC)
FiQL - 100% &
70 4 min
ventio
mask
mcnewe
plex 19-surgical position is injury
Brachial position
head up
down
headvital capacity Gulner
neuve
-me FRCH
and
↑
&
↑ &
Reverse
·
BP
con paley
↳
↑10, 10p)
&
-GBP;
venous
air
embolism
or
↓
RAMP
& position
rapid management
↓
airway in obese
pt.
CAPNOGRAPH
20- ETCO2 is measured at -
due to
↳ 35-45mm can
be
anaphylaxis
G gHg -
dominant
-
aut
>
-
succinglcholine
stepladder pattern nperaerbia
↳ DOC - dantrlene
ETCOn Lmu
time
-
↳
-
Rebreathing
give musce
relaxant
Cor
>
- Double plateau sign > Faulty
- etco
,
sampling
-PE #M line .
↳ ↓ ETCO
21-Preanesthetic medication
orders
regarding
continue all
1 -
Antihypertensive ->
ACE inhib
except >
-
ARB
Antidiabetic
I >
-
2- cause
refractory
↳ OHA tomit day on
hypotension
Insulin
>
-
of surgery
. continue
Thypoe thyroxine If
3-
Thysid ↳ hyper- antithred.
on day y
surgery
M
Tocilar pillar
PUSH >
-
- ↳ Would
in OPD L soft palate
Hard palate
-
& &
-
& intra-operative
2- Cormack - Lehane system
+ 100 -
Fully
in
aware
coma
-0-
it 40-60(GA)
ideally must be -
&
carrier
>
-
Mos
t ↓ -
absorb
to
when it becomes
don't
white >
- ETCO2 graph
come to line(base line)
(timetochang
the
N20 is
having max MAC , so its less
can't
potent ,
neuce it cause GA alone
.
t
inhalational -halothane
it
requires other
agent
to
produce effect↳ 2nd
gas effect
- so When M20
hal
and the is
negoe
if takes O
2
3
rdgas effect
-
Y Of
FINk effect
D
iffusional
hypoxia .
>
-
if psig liters
↳
Psix. given
>
- it barry lites
barry 5 5 .
Fergiven ↓ ↓
Cos
Or
nitr
oxid e
1-Brain stem death
2-shock
.
3 septic shock with bundles
Y - ARDS
5- VAP
6-
tracheostomy
7 -
pancreatitis
I-wearing and
critically ill
pt transfer
.
I
, Areg V5 , V6 >
-
Lateral Wall M1 - Lt. circumbly
ant wallm/
Vi Vu -
.
me
=
auF A
II ,
III , >
-
inf . wall
lead 11 >
-
arrthymia
lead V5
>
- ischemia (75% ) . .
v5 +
Vy -
is chemia detection
-90 %
V5 + 11
+ Vu > -
1
17 96 %
CVP
-
constrictive
pericerditis -> Steep X , Steep y descent
&
TEE Findings
most sensitive
and
specific<
-
↓
RV/ LV diastolic
collapse
.
Cup
- risky complication 4
from pul artery
Catheter placement
is less than
5%
↳ 0 .
at
- a
tip of pul . Catheter enters pul. artery
>
- 35-45
approx .
cm
0
5-6 , 0
mild -> 5
.
-7 :
-6
.
↑ moderate
we
arein
ficity
> guild
7
spas
fir
-neuve
F
I
25
.
mg/kg
immed .
Iv bols.
Max lo .
mg
/kg .
Serumtryptak
Glienzy
agni me
# IgE
Ty
pe ↳
7
immune
media
OC
ted
HS
-
-
↓
reaction ↓
adrenaline
N
*
most
dangers
buncho
mc
sign >
-
hypotension
first
hallmark- -
spasa
least common(late)
> -
urticari a
anaphylactid complement
mediated
AMBU BAG
G > EnV5M6
-
>
- Ey
Us
M6
↳ for prognosis
E
minimum
GCs >-
3
mAX - 15
Lower limb innervation
leg compartments Lu
15 , S1 , Sc S3
, ..
②plantar
on
S kneeflexio
E
>·
-
S
Foot Tibial
eversion P nerve Sciatic nerve
% PN-
↳ DF
extension --
Tibial
>
.
-
damage
Foot drop popilitealag
an
superficial Deep penneal
peroneal
nerve
nerve
CAnt
Tibial nevve) Post tibial
- neuve
leg Camp)
.
↳
gastronemius
· .
ef
↳ peroneus longus chile
↳ Tib ant
brevis
.
A planter's
peroners > dig ext
-
long
(S1)) +soleus
.
.
a
muse
L
-
on .
extensors Flex
>
dig long
-
.
.
,
dorsiflexion >
-
Flex halluc .
long
skin dersumfoot >
-
Flexor refinaculum
on
↓
in 1st
webspace n Tarsaltunnel
syn
(L5) lat
plantar Med A
p lantar
neuve .
nerve
- muscles Ifsole
↳ sking sole
.
*
dersum
.
>
-
.
newe
zemeral
SPN
in
branch porttibial
neuver
↳ -
↑
a
DPN
.
neve ↳ 25
Pul embolis
Monstable
.
↓ > - TEE
least ↳ Stable - CT PA
↓
stethoscopy
.
Tiamdrive
spirnolactone
↑
it sparing heypokalAlekmiala
&
.
m
&
aldosterme
excess
↳ allcalo *
↳ hypokaleme
aldosterone deficiency
D
↳ Hyperkalemen
acides
①
↳
DOC for Pl >
- labetalol
↓
it no
hydralizine
an
Mason
Pre-eclampsia
↓
>
- no
seizure
&
GA eclampsie - seizure
severe pre-eclampsie (HELPP syn ) .
↳ GA
VW Disease
CBF =
55 ml/min/100 gm
75-105
CPP = mm
Htg
MAP 90-110
ICP
=
5- 15
mm
mm Htg
=
Itg
CPP =
MAP-ICP
↓ CP
-
↳ hypervent
-
mannitol
-zefaltte Haldane
alkal ↳ effect
C n
X ↑
m
.
& ↳ Bohr's
↳ M .
Acid
.
-SCA
That
>
-
>
- preg.
neuve HUMERUS FRACTURE
axillary
&
&
↳
Radial
neuve
↓
median #nar nerve
nerve .
↑ mcFn Ghrs
↓
MC cause death
g
after BT DUT
T virchoo's
triad .
↳ Ally above
.
Anesthesia Stages
>
- intubation -
> orbicularis oculi
- extubation -
adductor
policin
>
-
<-Cyfracture >
- Mills best for
intubation
.
than
Bless year
z
criterial/
zur
extubation
↓
insp press
.
> IoCMH,O
X
induction
by -
inhalation
agents .
Quinsy
&
CPR
-
mc-
> colfarea (popliteal
teins
↓
Pneumatic stocking
virchow's 4
triad .
Ms SUT
>
-
Stable
pt
↳ Yadenine
unstable 16 , 12 12)
,
↳ cardioversion
Sui - unstable C
-ardioversion
>
stable -
vagaland
↓
-
manear
>
adenosine 16 , 12, 1)
asthma - verapamil
pt diaparmedol (3 ,
6
,
6)
-weiss and
Mallory
Boerhaave syndrome
SHOCK
SAS-CSF Sub arachnoid
and
circle
G
Will is
> -
haemorrhage a ↑
mc cause 7↓
-
bleeding
↳trauma in sas
- -
⑰S
⑮ -
=>
②> -
spontaneous
YSAS
⑭T O
D
berry
rupture X
Sylvian
aneurysm zissure
-1-S
↓
CIF ~
X
↳ loss consciousness
- g -
rewast headache
- glize -↓
⑭
> neck
-
stifner and
-
thunderclap
headachevomiting
.
star g
.
death
-Xanthochromia
.
↑
W
lumbar
puncture
nuchal
- rigidity
-
10C - NCCT
my - conservatic .
>
-
-
DOC - nimodipine (((B)
X ↑
--
starg
·
I& death
↓
⑫ ⑦ presence
>
-
B
O
Pr ↑ ar
O Gelombpuncture
-
-
X
↳ ⑰
S
Triple HHHPtherapy
↳ vasospasm after
thermia
↳ hyper