THE ROLE OF 10

what is the role of 10?
these are 10 points you can remember about a particular subjects.
these 10 points if you speak about during your viva session your examiner will be thrilled.
if you expand each point during written exam you can cover the subject effeciently.
if you apply them clinically you patient is saved.
Tetralogy of Fallot

1. the most common cyanotic heart disease in adult populations.
2. it includes: right ventricular outflow obstruction, right ventricular hypertrophy, VSD, and oerriding aorta.
3. pathophysiolgy: reduced pulmonary blood flow causing arterial hypoxemia and cyanosis and there is R-L shunt through VSD.
4. cyanotic spell: infundibular spasm or constriction causing reduction of pulmonary blood flow and increase in right ventricular pressure leading to increase of R-L shunt. (do not forget its management).
5. pink tet: refers to any noncyanotic patient with fallot with increased pulmonary blood flow due to large PDA or major Aortopulmonary arterial colateral.
6. palliative shunts: waterson, Apotts, central. blalock Taussig.
7. anesthetic goals: maintain intravascular volume, maintain SVR, avoid increase in PVR.
8. IM induction with katamine, glycopyrolate, succinyl choline.
9. maintainance: nitrous oxide + ketamine, pancuronium, mechanical ventilation with low airway pressure.
10. intraoperative monitoring: the difference between PaCO2 and ETCO2 will increase if intraoperative R-L shunt increase as in tet spell.