1 What is hypertonic saline? Normal saline is 0.9% sodium chloride. Hypertonic saline is 7.5% sodium chloride (eight times as concentrated as normal saline). Key Points: Ion Concentrations in Crystalloid Solutions 1. One-half normal saline or 0.45% NaCl: 77 mEq…
1 Is breathing really overrated? It may be. A Japanese yoga master survived just fine breathing once per minute for 1 hour (see reference ). But, when medical students and residents prioritize activities that they really enjoy, year after year,…
1 Why do patients need mechanical ventilation? There are three basic categories of need when it comes to mechanical ventilation (MV): (1) inadequate respiratory drive; (2) inability to maintain adequate alveolar ventilation; and (3) hypoxia. The decision to provide MV…
1 What is congested in CHF? The lungs. 2 Why the lungs? When cardiac output falls, the kidney releases renin. Renin converts angiotensinogen to angiotensin I in the liver. Angiotensin I is converted to angiotensin II by angiotensin-converting enzyme (ACE)…
1 Define shock Shock is: Not just low blood pressure Not just decreased peripheral perfusion Not just limited systemic oxygen delivery Ultimately, shock is decreased tissue respiration. Shock is suboptimal consumption of oxygen and excretion of carbon dioxide (CO 2…
1 Are all cardiac dysrhythmias clinically important? Most are not. Many of us have isolated premature ventricular contractions (PVCs) or premature ventricular depolarizations (PVDs) all the time. Superbly conditioned athletes frequently exhibit resting heart rates in the 30s. A clinically…
1 What is cardiac arrest and sudden cardiac death? Cardiac arrest is the sudden cessation of effective cardiac pumping function. Sudden cardiac death is the unexpected natural death from a cardiac cause within 1 hour of onset of symptoms, in…
Surgery is a participatory, team, and contact sport. Present yourself to patients, residents, and attendings with enthusiasm (which covers a multitude of sins), punctuality (type A people do not like to wait), and cleanliness (you must look, act, and smell…