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BLOOD LOSS MANAGEMENT
AIRWAY CLASSIFICATION Mallampatl Classification: Class 1: Visualize the soft palate, fauces, uvula, anterior and posterior Tons liar pillars Class 2: Visualize the soft palate, fauces, & uvula only Class 3: Only the soft palate and base of the uvula are visible Class 4: Only the soft palate can be seen Laryngoscopic Vlew Grades: Grade 1: Full v1ew of ent•re glottis opening Grade 2: Posterior portion of the glottis opening 1s VISible Grade 3: Only the epiglottis is visible Grade 4: Only the soft palate IS visible
ASA CLASSIFICATIONS 1-Normal healthy patient 11-Mlld systemic disease {(!I functional limitations) Ill-Severe systemic disease {some functlonallimltation) IV-Severe systemic disease w/ constant threat to hfe V-Morlbund patient who is not expected to surv~ve without surgery VI-Brain dead patient whose organs are being removed for donation
NORMAL BLOOD GAS VALUES pH::7.35 7.45 Pa0 2:90-100 PaC01:::\S-4S HCO!c22·26 BEz:· 2 to 2 Sa0f'95·98%
RESPIRATORY FORMULAS V02., 10 x ki("
VC01 = 8x kg11•
Alveolar Air Equation (F101 x (PI> - PH10)) - PaC01/0.8 Arterial 0 2 Content/100 ml bid (Hgb x1.34 x Sa0 2) + (PaO~ K 0.003)
Estimated Blood Volume (EBV); Premature mfant:95 ml/kg • Full-term lnfant=8S ml/kg • Infant to 12 mo::80 ml/kg • Adult/child male =75 ml/kg
• Adult/chlld female: 65 ml/kg • Morbid Obese=60 ml/k& {BMI > 40) Allowable Blood Loss (ABL): ([EBV x HctsrAIInJ>55
Super Morbid Obesity
Stop trlgering agent Immediately Hyperventilate with 100% O, at high flow Administer Oantrolene 2.5 mg/kg IV Repeat Q 5-10 min until symptoms controlled Max dose 10mg/kg Correct metabolic acidosis Correct hyperkalemia Actively cool patient Check labs Q l5 min until stable Maintain urine output> 2 ml/kg/hr with hydration, Mannitol, or laslx
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Preemies s 1 kg
2.5
Preemies 1-Z.S ka
3.0
Term neonate- 6 mo
3.0·3.5
6mo- 1yr
3.5-4.0
1-2 yrs
4.0-4.5
1
1' to 5 kg
up to 4 mL (air)
1~
5 -10 kg
up to 7 ml
2
1Q.20 kg
up to 10 ml
z~
2Q.30 kg
up to 14 ml
3
>30 kg
up to20 ml
4
Adu lt
up to 30 ml
BeyondZyrs Tube Depth
(age/2) +12
Dedicated to the Class of 2012 By: Debra Maloy · Jeff Carroll · Amanjot Dhaliwal· Yvonne Murphy· Shana Thompson
Texas Wesleyan GAADUAfl !JitOOitAHS 01' N Uitll ANIIfH IUIA
Anesthesia Cheat Sheet
1. 2. 3. 4.
Analgesia lightheadedness Tinnitus Tongue/Orcumoral numbness/ tingling/funny taste in mouth 5. Seizures 6. Unconsciousness
If un responsive to standard t herapy, in addit ion to standard CPR: • Bolus lntrallpid 20% IV 1.5 ml/kg over 1 minute • lntrallpid 20% 0.25 ml/kg/min immediately after bolus • Continue chest compressions to circulate lipids • Repeat bolus q3-5 min up to 3ml/kg total dose until circulation is restored • Increase infusion to O.Sml/kg/min if BP declines. Continue infusion until hemodynamic stability is restored. • Max total dose 8ml/kg Is recommended
Supply: 200mcg/2ml Mix in NS 48ml Result 4mcg/ml Bolus lmcg/kg x 10 min, then 0.2-0. 7 mcg/kg/hr
• www.lipidrescue.Q!& Female; Age < 40; History of PONV, Motion sickness, Vertigo; Surgeries- laparotomy, laparoscopy, major breast, strabismus, intraocular, dental, middle ear, tonsils, adenoids, neuro (intracranial), gynecolog1c, testicular, scrotum, kidney stones
Treatment
Neostigmine
Edrophonlum
0 .5-1.0 ms/kg
1-2
5-15
Atropine 7-15 Wkll
2
40%
2 drugs
3
>60%
3+ drugs
95
35
lOU
38.5
95.9
35.5
102.2
39
96.8
36
103.1
39.5
97.7
36.5
104
98.6
37
104.9
40.5
99.5
37.5
105.8
41
° F : ((9/5) X 0 C) +32
°C :(5/9) X ( 0 F- 32)