TOP 100 SECRETS

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1、TOP100SECRETSThesesecretsare100ofthetopboardalerts.Theysummarizetheconcepts,principles,andmostsalientdetailsofanesthesiology.1.Patientsshouldtakeprescribedb-blockersonthedayofsurgeryandcontinuethemperioperatively.Becausethereceptorsareup-regulated,withdrawalmaypre

2、cipitatehypertension,tachycardia,andmyocardialischemia.Clonidineshouldalsobecontinuedperioperativelybecauseofconcernsforreboundhypertension.2.Undermostcircumstancesperi-inductionhypotensionrespondsbesttoadministrationofintravenousfluidsandtheuseofdirect-actingsymp

3、athomimeticssuchasphenylephrine.3.Todeterminetheetiologyofhypoxemia,calculatetheA-agradienttonarrowthedifferentialdiagnosis.þ4.Calculatingtheaniongap(Na[HCO3þCl])inthepresenceofametabolicacidosishelpsnarrowthedifferentialdiagnosis.5.Estimatingvolumestatusrequir

4、esgatheringasmuchclinicalinformationaspossiblebecauseanysinglevariablemaymislead.Alwayslookforsupportinginformation.6.Rapidcorrectionofelectrolytedisturbancesmaybeasdangerousastheunderlyingelectrolytedisturbance.7.Whenothercauseshavebeenruledout,persistentandrefra

5、ctoryhypotensionintraumaorothercriticallyillpatientsmaybecausedbyhypocalcemiaorhypomagnesemia.8.Thereisnosethemoglobin/hematocritlevelatwhichtransfusionisrequired.Thedecisionshouldbeindividualizedtotheclinicalsituation,takingintoconsiderationthepatient’shealthstat

6、us.9.Anoutpatientwithableedingdiathesiscanusuallybeidentifiedthroughhistory(includingmedications)andphysicalexamination.Preoperativecoagulationstudiesinasymptomaticpatientsareoflittlevalue.10.Thoroughairwayexaminationandidentificationofthepatientwithapotentiallydi

7、fficultairwayareofparamountimportance.The“difficult-to-ventilate,difficult-to-intubate”scenariomustbeavoidedifpossible.Anorganizedapproach,asreflectedintheAmericanSocietyofAnesthesiologists’DifficultAirwayAlgorithm,isnecessaryandfacilitateshigh-qualitycareforpatie

8、ntswithairwaymanagementdifficulties.11.Nosinglepulmonaryfunctiontestresultabsolutelycontraindicatessurgery.Factorssuchasphysicalexamination,arterialbloo