Passed on by former CU Anes resident originally compiled by Dr. Fairbanks (now PD at MCW) Podcast Episodes 1-Volatiles 2-Temp 4-Obstructive lung dx 5-Restrictive lung dz 10-induction agents

Spinal/Epidural Anesthesia :::danger Contraindications: Allergy to LA, :arrow_up: ICP ::: Neuraxial anatomy Spinal cord extends from skull base -> L2 Dural sac extends from skull base -> S2 Midline approach - skin :arrow_right: subQ :arrow_right: supraspinous ligament :arrow_right: ligamentum flavum :arrow_right: epidural space :warning: dura mater :warning: subdural space :warning: arachnoid mater :warning: intrathecal space

Tier 1 knowledge topics Shock is defined as a state of tissue hypoxia due to decreased or dysregulated oxygen delivery or extraction resulting in end-organ damage. Hypotension (SBP < 90mmHg, MAP <70mmHg) hypoperfusion s/sxTachycardia cool and clammy skin versus warm and flushed low urine output (<0.5 mL/kg/hr) altered mental status

Resource Guides Regional Anesthesia

Chest Exam slides: hackmd.io/@elijahc/PEx-chest PEx QR Code You're going to treat a lot of chest problems 7+% of inpatient stays have pulmonary pathology (PNA, COPD, AHRF) How I think about Physical Exam (PEx) components

MSTP Clinical Capstone PEx: hackmd.io/@elijahc/PEx-chest CXR: hackmd.io/@elijahc/cxr Who am I? Anesthesia PGY-1 CU MSTP (2014-2022)

HPI A 25-year-old African-American male presents to the outpatient clinic with the sudden onset of jaundice and dark colored urine. He complains of back pain and fatigue. The patient is afebrile and denies recent travel. He does not smoke, drink alcohol or use recreational drugs and uses condoms whenever he engages in sexual activity. On further questioning, it is revealed that he took TMP-SMZ for diarrhea a few days ago. An uncle has a history of some type of blood disorder Diagram Edit this diagram Diagram Edit this diagram

In the united states, most of the time diarrhea is going to be viral and self-limiting. You should look for nausea, vomitting and diarrhea. If there's "vomitting from both ends" it's going to be gastroenteritis Differential %%{ init: { 'flowchart': { 'curve': 'basis'}} }%% flowchart TD origin[Diarrhea] --- dur((Duration)) dur -->|<2wks| acute[Acute] dur -->|4+ weeks| chronic[Chronic] acute -->|"#8853;WBC\n#8853;Fever\n#8853;Blood\n#8853;Pain"| Invasive acute -->|"#8861;WBC\n#8861;Fever\n#8861;Blood\n#8861;Pain"| Enterotoxic

Tier 1 knowledge topics Serum sodium in normal physiology is an indicator of volume status Hyponatremia Below is an easy algorithm for evaluating hyponatremia %%{ init: { 'flowchart': { 'curve': 'monotoneY'}}}%% flowchart TD %%hypona[Hyponatremia<br/>Na<132] --> q1{Natura?}

Diabetes Anemia Potassium Sodium Acute Kidney Injury Acid Base Asthma / COPD Pneumonia GI Bleed Antibiotics

Open technique Prep the neck and ensure all necessary materials are within reach. Palpate the larynx and identify thyroid cartilage, cricoid cartilage, and cricothyroid membrane if possible. Make a vertical midline incision approximately 3cm over where you believe the cricothyroid membrane is. Make a horizontal incision through the cricothyroid membrane and place either your finger or a bougie into the trachea to maintain patency of your tract. Place the Endotracheal or tracheostomy tube into the trachea. Inflate the cuff and check that you are in the trachea by listening for breath sounds, noting color change on the capnography, etc. Secure the airway with trach tape or collar wrap and place patient on mechanical ventilation. Seldinger Technique

Wide-complex %%{ init: { 'flowchart': { 'curve': 'basis'}}}%% flowchart LR reg(((Regular))) irreg(((Irregular))) %%hxdz(((Hx of<br/>fa:fa-heart disease))) subgraph unstable [Unstable] vt[VTach] pvt[VFib<br/>AF w/ WPW<br/>Polymorphic VT] shock(((Cardiovert)))

Divide the kidney into 3 distict regions which group your diagnoses Pre-renal aka Decreased Perfusion for any reason Post-renal aka Obstruction :::warning Urology consult: ULytes, UA, UCx, UPro:Cr

Outpatient Ischemic or non-ischemic? Nuclear Stress or LHC Systolic or Diastolic? EF < 40% HFrEF = Systolic CHF EF > 55% HFpEF = Diastolic CHF

EKG examples Arrythmia examples Infarct territories

:::info Neutropenia is ANC < 1000 ::: Treatment first IV Cefepime add IV Vanc after day 3 add IV Amphotericin after day 5 with resolution peel in reverse order, 24hr at a time

As someone who used to recieve and now has to give med student evals I created this for my own reference but also as a shareable resource. After asking me to identify clinical setting, specialty, and degree of involvement I'm asked to comment on at least 4 task/domains of your education. Domain snippets History Physical Exam Differential Diagnosis :::success Reporter

I only learned about the RIME framework when a fellow MS4 shared revealed how they used it as an "inside secret" to improve the evals they received and I never liked how underhanded that felt. Just like SOAP and formal HPI presentations are a pre-set format/order for sharing clinical information. Examples of trainee skills are often mapped by grading committees onto a domain like the RIME framework. RIME Framework The RIME framework is a way of conceptualizing a trainees maturation from medical student to independent physician. As students grow in knowledge, skills and attitudes, they generally progress through four stages: Reporter, Interpreter, Manager and Educator. Each stage requires an integration of knowledge, skills and attitudes. The more advanced stages require a higher degree of sophistication and confidence. This continuum is also context dependent, as a PGY1, where I'm expected on average to be at manager level, I'm practicing educator skills (literally right now) in some areas, but closer to interpreter level in others (like treating HRS). When I have a sense of what stage you're at in a given area, I'll try to help you reach the next level.

Definition Fasting glucose greater than 126mg/dL Random glucose >200mg/dL A1c >6.5% x2 measurements Inpatient Diabetes :::warning Hold ALL ORAL meds on admission :::

Reversible causes :::info Workup: TSH, RPR, B12, HIV, Bgl, LFTs, UA, EEG ::: Infection (HIV/Syphilis) Hepatic encephalopathy Uremic encephalopathy Sodium derangements DKA/HHS