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introduction to criticAl cAre ● 453 pressure may be necessary to optimize tissue perfusion. Beyond fluids, vasoactive agents can be utilized in order to augment blood pressure. Other therapy can be used to improve each of the components of oxygen delivery while at the same time trying to reduce oxygen demand. It is important to search for and treat the underlying cause of shock while continuing resuscitation. Measures of tissue perfusion, including ScvO 2 (or SvO 2 if a pulmonary artery catheter is in place) and lactate can be followed to assess the response to treatment and guide further therapy. Vasoactive Agents Commonly Used in Shock Vasoactive agents are indicated for management of patients with shock who do not respond adequately to fluid therapy. These medications may include vasopressors, vasodilators, chronotropes, and inotropes. Many of the vasoactive medications used to treat shock have more than one mechanism of action. Table 28.5 lists some of the commonly used vasoactive agents along with their mechanism of action (also see Chap. 7). Septic Shock Septic shock is a form of distributive shock caused by infection and should be managed in concordance with the formal guidelines that have been devised by the “Surviving Sepsis Campaign.” In addition to the management principles used to treat any form of shock, it is crucial to search for and control the source of infection with the early initiation of broad-spectrum antibiotics and surgical debridement, if necessary. Table 28.6 lists an overview of the management of septic shock. Table 28.5 Commonly used vasoactive agents in shock. Agent Mechanism of action dopamine chronotropy (b1), inotropy (b1), vasoconstriction (a at higher doses) dobutamine chronotropy (b1), inotropy (b1), vasodilation (b2) epinephrine chronotropy (b1), inotropy (b1), vasoconstriction (a at higher doses) norepinephrine chronotropy (b1), inotropy (b1), vasoconstriction (a) Phenylephrine vasoconstriction (a) vasopressin vasoconstriction (v1)
454 ● AnesthesiA student survivAl Guide Table 28.6 Overview of the management of septic shock. (1) resuscitation (a) hemodynamic Goals • MAP ³65 mmhg • Urine Output ³0.5 ml/kg/h • CVP 8–12 mm Hg (12–15 mm Hg if mechanically ventilated) • ScvO ³70% (or svo ³65%) 2 2 (b) Begin with fluid resuscitation if the patient is hypotensive (c) Add a vasopressor if the patient is not responding appropriately to fluid resuscitation • Use an arterial line if vasopressors are required • Norepinephrine or dopamine are first-line vasopressors • Vasopressin may be added to norepinephrine (d) Consider a blood transfusion (especially if Hb
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Anesthesia Student Survival Guide
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Editors Jesse M. Ehrenfeld, MD, MPH
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Foreword As anesthesiologists and H
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Contents Case Studies xvii Section
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ContEntS ● xi 19 Physiology and A
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Contributors Basem Abdelmalak, MD S
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David C. Lai, MD Partner, Allenmore
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CASE STUDIES In order to focus your
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CASE StUDIES ● xix inhalation ane
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CASE StUDIES ● xxi around the job
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CASE StUDIES ● xxiii ● Although
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CASE StUDIES ● xxv ● You plan a
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CASE StUDIES ● xxvii ● What oth
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CASE StUDIES ● xxix Chapter 23 Ca
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CASE StUDIES ● xxxi of her left h
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CASE StUDIES ● xxxiii speechless.
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CASE StUDIES ● xxxv things go ver
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How to Be a “Star” Student, Car
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hOw tO Be A “stAr” student, CAr
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Pre-Op Holding Area Preoperative Ev
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History of Anesthesia and Introduct
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history of AnesthesiA And introduct
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Pharmacology Section II
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30 ● AnesthesiA student survivAl
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The Preoperative Patient Evaluation
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THe PreoPerATIve PATIenT evAluATIon
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Therapy-based indications radiation
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Table 8.5 Formulation an anesthetic
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Anesthesia Equipment and Monitors B
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AnesthesiA eQuiPment And mOnitOrs
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● ● ● AnesthesiA eQuiPment An
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Table 11.3 Data typically obtained
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Anesthetic Techniques: General, Sed
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Anesthetic techniques: GenerAl, sed
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Table 12.2 Stages of general anesth
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Table 12.6 (continued) Anesthetic t
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Anesthetic Techniques: Regional Ant
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Figure 13.2 Surface anatomy for neu
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Table 13.1 Risks of neuraxial anest
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Anesthetic techniques: reGionAl ●
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Table 14.6 Advantages, disadvantage
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Table 14.11 Transfusion of bloodpro
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Chapter 15 IV, Gastric Tube, Arteri
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iv, GAstric tube, ArteriAl & centrA
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Common Intraoperative Problems Fran
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Pneumothorax Uncommon, but may spon
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COMMON INTRAOPERATIVE PROBLEMS ●
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Table 16.3 Common intraoperative dy
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Table 16.3 (continued) Problem Diff
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Systems Physiology and Anesthetic S
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Chapter 20 Physiology and Anesthesi
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PhysioloGy And AnesthesiA for Gener
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Anesthesia for Urological Surgery P
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AnesthesiA for uroloGicAl surGery
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Physiology and Anesthesia for Pedia
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PhysioloGy And AnesthesiA for PediA
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Table 22.6 Common pediatric emergen
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Physiology and Anesthesia for Elder
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PhysioloGy And AnesthesiA for elder
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Chapter 24 Ambulatory Surgery and O
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AmbulAtOry Surgery ANd Out-Of-Or (O
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Page 424 and 425: 402 ● AnesthesiA student survivAl
Page 434 and 435: Perioperative Acute and Chronic Pai
Page 436 and 437: PerioPerAtive ACute And ChroniC PAi
Page 450 and 451: Chapter 27 Postoperative Anesthesia
Page 452 and 453: POstOPerAtive AnesthesiA CAre unit
Page 464 and 465: Introduction to Critical Care Bever
Page 466 and 467: introduction to criticAl cAre ● 4
Page 470 and 471: SVR = [(MAP - CVP)/CO] ´ 80 introd
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Page 490 and 491: Chapter 29 Professionalism, Safety,
Page 492 and 493: ProfessionAlism, sAfety, And teAmwo
Page 502 and 503: Chapter 30 Quality Assurance, Patie
Page 504 and 505: QuAlity AssurAnce, PAtient And Prov
Page 520 and 521: Chapter 32 Clinical Simulation in A
Page 522 and 523: Table 32.1 Matrix of categories of
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CliniCAl simulAtion in AnesthesiA e
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ASA Difficult Airway Algorithm Appe
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518 ● ANESTHESIA STUDENT SURVIVAL
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