My Medical Center

Fact#1: Otalgia is defined as pain localizing to the ear

Fact#2: Otalgia arising from within the ear is known as primary otalgia.

Fact#3: Otalgia that originates from outside the ear is known as referred otalgia.

Fact#4: The clinician must have a good understanding of the nerve supply to the ear to be proficient at diagnosing the cause of otalgia.

Fact#5: The ear is supplied by the first and second cervical nerves, and branches from cranial nerves V, VII, IX, and X.

Aortic aneurysm is a focal dilation of all three layers of the aorta to greater than 1.5 times normal. An aneurysm may be found in the thoracic aorta, the abdominal aorta, or both. Aneurysms are initially asymptomatic, and may be incidental findings on imaging studies. However, they inexorably progress in size at an accelerating rate. The risk of rupture, an event with 90% mortality, increases with diameter.Incidence: 15,000 deaths per year in the United States. Most are due to abdominal aneurysms, with thoracic and thoracoabdominal aneurysms making up 1% to 4% of the total

At combination of tachycardia and arterial hypertension during total anaesthesia the anaesthesiologist should always exclude a hypercapnia and hypoxia which cause symptoms of the raised sympathetic activity. This life-threating complications can be prevented beforehand by:

✓ monitoring CO₂ concentration in the end of an expiration

✓ pulse oximetry

✓ analysis of arterial blood gases.

Here are nine main reasons of intraoperative hypoxemia:

✓ drop of FiO₂
✓ reduction of alveolar ventilation
✓ disturbance of gases diffusion
✓ pulmonary edema
✓ embolism of pulmonary arteries
✓ bronchospasm
✓ pneumothorax
✓ secret accumulation in trachea
✓ one-lung ventilation

Hemodialysis is indicated at following cases:

✓ hyperazothemia (blood urea > 25-30 mmol/l, creatinin > 0.7 mmol/l)

✓ anuria (day diuresis < 100ml) within 24 hours, oliguria (day diuresis < 400ml)   within 48 hours after patient admission in intensive care unit

✓ blood potassium >6 mmol/l, refractory to conservative treatment

✓ heavy metabolic acidosis (pH < 7.1, BE < 12 mmol/l), refractory to conservative treatment

In ventilation modes, based on volume control, peak inspiratory flow of the air is a measure of preset respiratory volume: the more quantity of a flow, the more quickly ventilator will submit mandatory respiratory volume, i.e. inspiration time (Ti) decreases. Quantity of a flow influences dynamics of airways pressure: at a high air flow - pressure grows more quickly, level of peak pressure is higher (this is a risk of barotrauma!), the inspiratory pause is longer and inspiration time is more shortly. With low air flow at the airways - pressure in respiratory tracts accrues more slowly, level of peak pressure is less, the inspiratory pause is shorter and inspiration time is enlarged.

The professor-psychiatrist has visited hospital for insane persons and answered the head physician how do they define, whether the patient has recovered or is sick still.

- We fill a bath with water and put a teaspoon on the edge. Than we offer the patient to remove water from the bath. If the patient takes a spoon, it means he is still sick. And if he pulls out a stopper from the bath - it means he's healthy.

- Hmm, that decision has not come to my head! - exclaimed the professor. - If you would offer me that task, I had gone to ask you for a ladle...

CVC - Central Venous Catheterization as well as other procedures in anesthesiology has its indications: 

1. inaccessibility of a peripheral veins
2. necessity for carrying out long and intensive infusions and or transfusion therapy in pre- or the postoperative period
   
3. long and traumatic operations with the prospective big volume of blood loss
   
4. operations with extracorporeal detoxification
   
5.   necessity for monitoring of central haemodynamics indicators (central venous pressure, pressure in cavities of heart, etc.)