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·       Cyanosis in the newborn is defined as an arterial saturation <90% and a PO2 <60 torr ·       To help differentiate between cardiogenic and non-cardiogenic causes initially obtain an arterial saturation on room air and obtain a subsequent measurements on 100% oxygen ·       Infants w/neurogenic or pulmonary causes of cyanosis will demonstrate increases in arterial blood saturation on 100% oxygen while infants with congenital heart disease show minimal elevation ·       There are 3 general sources of arterial desaturation in neonates with structural heart disease: 1.) Lesions with decreased pulmonary blood flow (tetralogy of Fallot, severe pulmonary stenosis/atresia, and tricuspid atresia) 2) Admixture lesions, in which desaturated systemic venous blood mixes with intracardiac blood, and then enters the aorta (transposition of great vessels...

Tracheostomy has a mortality rate of <1% but has a total complications rate as high as 40%. The complication rate is higher in the ICU and emergency patients. The complications can be divided into: 1- Immediate   *Hemorrhage   *Tube misplacement (e.g. into main bronchus)   *Occlusion of tube by cuff herniation   *Occlusion of the tube tip against carina or tracheal wall   *Pneumnothorax 2-Delayed   *Blockage of the tube by secretions which can be sudden or gradual; this is rare with adequate humidification and  suction   *Infection of the stoma   *Overinflation of the cuff leads to ulceration and distension of the trachea   *Mucosal ulceration because of excessive cuff pressures, asymmetrical inflation of the cuff or tube migration 3-Late   *Granulomata of the trachea may cause respiratory difficulty after extubation   *Persistent sinus at the tracheostomy site   *Tracheal dilation   *Trache...

Physical Examination Differences between Aortic Stenosis and Hypertrophic Cardiomyopathy Feature Aortic Stenosis Hypertrophic Cardiomyopathy Murmur location Sternal border to neck Sternal border to apex Murmur with Valsalva maneuver No change or decrease Increase Ejection click Frequent in congenital stenosis Rare Regurgitant diastolic murmur Common Rare Carotid pulse Delayed upstroke Brisk upstroke A 2 Soft or absent Normal

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Characteristics of Ligamentum Flavum at Different Vertebral Levels Site Skin to Ligament (cm) Thickness of Ligament (mm) Cervical — 1.5–3.0 Thoracic — 3.0–5.0 Lumbar 3.0–8.0 5.0–6.0 Caudal Variable 2.0–6.0

The 2008 GIFTASUP report has come out strongly against the routine use of 0.9% saline, principally because of the risk of developing hyperchloraemic metabolic acido- sis. This starts with the greater contribution of adding 154 mmol/L of chloride to a plasma concentration of around 100mmol/L compared to adding 154mmol/L sodium to a plasma concentration of 140 mmol/L. The relative increase in chloride concentration provides a disproportionate rise in strong anions reducing the bicarbon- ate concentration as predicted by the Stewart equations.  In addition to the acidosis, saline produces a number of other problems. Abdominal discomfort is occasionally experienced and there is some research evidence that saline produces reduced gastro- intestinal perfusion compared to balanced solutions.  Hyperchloraemia produces an increase in renal eicosanoid release leading to renal vasoconstriction and reduced glomerular filtration rate.  With a calculated osmolality of 308mOsm/k...

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Three nerves share the airway innervation  . . . . . . . . . . Three major neural pathways supply sensation to airway structures  Terminal branches of the ophthalmic and maxillary divisions of the trigeminal nerve supply the nasal cavity and turbinates. The oropharynx and posterior third of the tongue are supplied by the glossopharyngeal nerve. Branches of the vagus nerve innervate the posterior epiglottis and more distal airway structures.

Physiological Variables Associated with Successful Resuscitation Variables Amount Myocardial blood flow 15-20 mL/min/100 g Arterial diastolic pressure 40 mm Hg Coronary perfusion pressure 15-25 mm Hg End-tidal carbon dioxide >10 mm Hg

Device/System Oxygen Flow Rate (L/min) F IO 2  Range   Nasal cannula 1 0.21–0.24 2 0.23–0.28 3 0.27–0.34 4 0.31–0.38 5–6 0.32–0.44 Simple masks 5–6 0.30–0.45 7–8 0.40–0.60 Masks with reservoirs 5 0.35–0.50 Partial rebreathing mask-bag 7 0.35–0.75 15 0.65–1.00 Nonrebreathing mask-bag 7–15 0.40–1.00 Venturi masks and jet nebulizers 4–6 (total flow = 15) 0.24 4–6 (total flow = 45) 0.28 8–10 (total flow = 45) 0.35 8–10 (total flow = 33) 0.40 8–12 (total flow = 33) 0.50

Weight gain (12-20 kg) Enlarging gravid uterus Increasing total body water and interstitial fluid Increasing blood volume Deposition of new fat Enlargement of the breasts Respiratory system Decrease in respirator reserve volume Decrease in functional residual capacity (20%-30%) Increased oxygen consumption More rapid desaturation Airway Increased oral, nasal, pharyngeal, and tracheal mucosal edema Vascular engorgement of oral, pharyngeal, and nasal capillaries Edema of face and neck Advancement of Mallampati classification with pregnancy Advancement of Mallampati classification with bearing down during labor Cardiovascular system Inferior caval syndrome (supine hypotensive syndrome) requiring left uterine tilt Gastrointestinal system Steadily increasing intragastric pressure as pregnancy progresses Decreased lower esophageal sphincter tone due to increasing progesterone Symptomatic gastroesophageal reflux Distortion of gastric anatomy Increased gastric...

CABG should be performed in patients with asymptomatic ischemia or mild angina who have significant left main coronary artery stenosis. (Level of Evidence: A   ) CABG should be performed in patients with asymptomatic ischemia or mild angina who have left main equivalent: significant (greater than or equal to 70%) stenosis of the proximal LAD and proximal left circumflex artery.  (Level of Evidence: A   ) CABG is useful in patients with asymptomatic ischemia or mild angina who have 3-vessel disease. (Survival benefit is greater in patients with abnormal LV function; eg, ejection fraction [EF] less than 0.50 and/or large areas of demonstrable myocardial ischemia.)  (Level of Evidence: C)