HERBAL MEDICATIONS

Drug.                    Main Use                         Side effect

St. John's wort - used for depression.             - up regulates Cytochrome p450 so speedy metabolism .                                                                          of drugs

Ginkgo              -used to enhance memory,in PVD.          -       Causes bleeding by inhibiting playlet activating  .      .                                                                                 factor. Mild MAOI.


Garlic.               - used to lower BP and in atherosclerosis -      increases chances of bleeding

Ginseng             - used as stimulant, content of energy drinks--increases risk of bleeding

Ephedra.            - used as stimulant , abuse potential.             - hypertension,tachycardia ,   palpitations, arythmias


Kava.              - used in anxiety treatment sedative              -  potentiation of sedative effects of     . .......                                                                                              anesthetics 

NERVE SUPPY OF LARYNX

Motor- All muscles of larynx are supplied by recurrent laryngeal nerve except cricothyroid which is supplied by external branch of  superior laryngeal nerve.

Sensory- above the vocal cords by internal branch of superior laryngeal nerve
                Below the vocal cords recurrent laryngeal nerve  so external to vocal cords by internal            .               branch of superior laryngeal nerve

Drug abuse in Anesthesiologists

Prevalence in Practiotioners- 1- 1.5%
Around 30% chance of relapse is allowed to return to work and in 1/3 rd the first manifestation of relapse is death.
Most common - opioiods others include Inhalation agents, ketamine, propofol







Prevalence 1-1.5%

Gullian Barre syndrome

Autoimmune in origin
Follows infections with campylobacter jejune, cmv,ebv mycoplasma
Ascending paralysis
Gone motor system Gone autonomic system
Pain in few and tingling and numbness in few
Lp shows increased protein without corresponding increase in WBC
Treat by immunoglobulin , plasmapheresis

Functional Residual Capacity

FRC- 25-30 ml/kg in kids and adults though increases in elderly

Decreased in obese , pregnant, supine position,sedation

Increases in  prone position emphysema and asthma

CVP pneumonic

Different waves of CVP

A wave- atrial contraction
C wave- chordae contraction aka isovolumic ventricular contraction
V wave- Vena caval blood against closed tricuspid valve in late systole after t wave
X descent- xx atrial relaxation xx
Y descent- right Yentricular relaxation

Remember XY is bigger in size than XX so X wave due to smaller RA relaxation and Y wave due to larger RV relaxation and X wave comes before Y wave since ladies first

No A wave- Atrial fibrillation- can be lethal on aortic stenosis
Cannon A wave- junctional rhythm due to atria contracting against closed tricuspid valve
tall Significant A wave- tricuspid Stenosis also silent Y descent in tricuspid stenosis

IV drug abuse- leading to tricuspid regurgitation - cv wave merge and  eliminates X descent so IV drug abuse eliminates the chances to get  a lady XX