ABA APPLIED · High-yield rapid

Rapid cards

Scannable, board-shaped notes for every T3 leaf. Each card has a phone-fit thin digest (one-liner + the must-haves + the trap) and a deeper long view (sections, mechanism, pearls, references). Cards inherit the design-system T1 accent from their canonical taxonomy path.

15 cards authored

6 must-have

5 high-yield

4 standard

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Crisis Management
ob
Must-have
Emergent Cesarean Delivery — Anesthetic Crisis Management
Decision-to-incision timing, airway strategy, and team coordination when minutes matter
Educational reference only. Reviewed for clinical accuracy against current authoritative guidelines. Not a substitute for clinical judgment, institutional protocols, or current guidelines.
An emergent cesarean (Category 1 — immediate threat to maternal or fetal life) demands a parallel-track approach: prep the OR, call for help, ensure left uterine displacement, and choose the fastest appropriate anesthetic — extending an existing epidural or proceeding to RSI general anesthesia if no working neuraxial is in place.
If you forget
HEADLINE: Decision-to-delivery ≤ 30 min for Category 1; do NOT delay for nonessential prep.
Board trap
The examiner will ask: 'The epidural is in but the patient still has a T10 block at 8 minutes — what do you do?' Answer: do NOT wait for a denser block in a Category 1; convert to GA via RSI rather than risk fetal compromise from delay.
Key numbers
Decision-to-delivery target: ≤ 30 minutes (Category 1)
Succinylcholine RSI dose: 1.5 mg/kg IV
Rocuronium RSI dose: 1.2 mg/kg IV
Propofol induction: 2 mg/kg IV (ketamine 1–2 mg/kg if hemodynamically unstable)
Left uterine tilt: ≥ 15° (or manual displacement)
Chloroprocaine 3% epidural top-up: onset ~ 6–12 min
Reviewed Sep 13, 2026 for clinical accuracy by BoardsBridge Editorial Process
Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: ASA Obstetric Anesthesia 2016 · AAP NRP 2021 · SOAP OB Hemorrhage Bundle 2022 · SMFM Amniotic Fluid Embolism 2020
Re-review cadence: 12 months from reviewed date.
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Crisis Management
pharmacology
Must-have
Local Anesthetic Systemic Toxicity (LAST) Rescue
CNS and cardiovascular toxicity from systemic absorption of local anesthetic
Educational practice only. Reviewed for clinical accuracy against current authoritative guidelines. Not a substitute for clinical judgment, institutional protocols, or current guidelines.
LAST occurs when systemic local-anesthetic levels reach CNS/cardiovascular toxicity — almost always during or shortly after a block. Classic presentation is progressive CNS excitation then cardiovascular collapse.
If you forget
Push 20% lipid emulsion 1.5 mL/kg IV bolus the moment you suspect LAST.
Board trap
Initial CNS signs are EXCITATORY (perioral numbness, tinnitus, metallic taste, agitation, seizures) — give a small dose of benzodiazepine (midazolam 2–4 mg) BEFORE the seizure progresses to bupivacaine-induced cardiovascular collapse, which is far harder to reverse.
Key numbers
Maximum LA doses (mg/kg, healthy adult): lidocaine 4.5 (7 with epinephrine), bupivacaine 2 (3 with epinephrine), ropivacaine 3, levobupivacaine 2, prilocaine 6, chloroprocaine 11 (14 with epinephrine)
20% lipid emulsion: 1.5 mL/kg IV bolus over 1 min (~100 mL in 70 kg adult)
Repeat bolus ×2 at 5-min intervals if circulation not restored
Infusion: 0.25 mL/kg/min for 30–60 min after stability
Maximum total lipid dose: ~12 mL/kg in first 30 min
AVOID: propofol, vasopressin, CCBs, additional local anesthetic; lidocaine is contra-indicated as antiarrhythmic in LAST
Reviewed Sep 10, 2026 for clinical accuracy by BoardsBridge Editorial Process
Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: ASRA LAST Checklist 2020 · LAST Comprehensive Review 2024 · ABA Initial Content Outline 2023 · ASRA Antithrombotic Regional Anesthesia 2025
Re-review cadence: 12 months from reviewed date.
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Canonical example
Crisis Management
pharmacology
Must-have
Malignant Hyperthermia (MH) Crisis
Hypermetabolic crisis triggered by volatile anesthetics or succinylcholine
Educational practice only. Reviewed for clinical accuracy against current authoritative guidelines. Not a substitute for clinical judgment, institutional protocols, or current guidelines.
Hypermetabolic crisis from uncontrolled Ca²⁺ release via defective ryanodine receptor (RYR1 / related Ca²⁺ channels); triggered by volatile anesthetics or succinylcholine.
If you forget
Dantrolene 2.5 mg/kg IV bolus, repeat every 5 minutes until hypermetabolism resolves.
Board trap
Antipyretics (acetaminophen, NSAIDs) DO NOT work in MH — the hyperthermia is peripheral muscle hypermetabolism, not hypothalamic set-point elevation. Reaching for Tylenol burns time.
Key numbers
Dantrolene: 2.5 mg/kg IV bolus; repeat q5 min (often requires >10 mg/kg total)
Mix 20 mg vial with 60 mL sterile water (older formulation); Ryanodex (250 mg / 5 mL) reconstitutes in seconds
Trigger agents: ALL volatiles (sevoflurane, isoflurane, desflurane, halothane) + succinylcholine
Core temperature rise is OFTEN a late sign; ETCO₂ and tachycardia come first
Stop cooling at ~38.5°C to avoid overshoot / iatrogenic hypothermia
Post-crisis dantrolene 1 mg/kg IV q6h × 24–48h OR observe on ICU for recrudescence
MHAUS hotline (US): 1-800-644-9737 / mhaus.org
Reviewed Sep 10, 2026 for clinical accuracy by BoardsBridge Editorial Process
Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: MHAUS MH Crisis Treatment 2018 · MHAUS Post Crisis 2019 · ABA Initial Content Outline 2023
Re-review cadence: 12 months from reviewed date.
Correction log
2026-09-10
Issue: Peer-reviewer flagged: IABP mechanism and similar recommendations were adapted to clinical context; severe-AS card updated separately.
Resolution: No change required to MH card. IABP reference is to severe-AS card discussion, which was independently updated.
2026-09-10
Issue: Reviewer caught inverted expiratory-valve pearl in machine-checkout card. Same review pass caught AVERT calcium statement on severe-AS card.
Resolution: Updated machine-checkout card and severe-AS card to reflect MHAUS 2018 explicit guidance: give calcium (1 g CaCl2 IV) for life-threatening hyperkalemia or arrest.
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Crisis Management
trauma
Must-have
Massive Transfusion & Severe Acidosis (Trauma)
Hemostatic resuscitation in hemorrhagic shock with the lethal triad
Educational practice only. Reviewed for clinical accuracy against current authoritative guidelines. Not a substitute for clinical judgment, institutional protocols, or current guidelines.
Hemorrhagic shock requiring MTP — resuscitate with balanced 1:1:1 (pRBC : FFP : platelets), warm to >36°C, give TXA within 3h, anticipate and treat the lethal triad (hypothermia, acidosis, coagulopathy).
If you forget
Activate MTP early (don't wait for lactate 4 or for the patient to lose 2/3 of their blood volume).
Board trap
Resuscitating with crystalloid DILUTES clotting factors and worsens acidosis / coagulopathy. Balanced blood-product resuscitation beats crystalloid in hemorrhagic shock — the 'damage control resuscitation' principle. Excessive crystalloid before blood is the cause of iatrogenic worsening of the lethal triad.
Key numbers
MTP activation triggers: ABC score ≥2, penetrating trauma + HR >120 + SBP <90, >4 units pRBC in first hour, OR surgeon judgment for uncontrolled hemorrhage
First cooler (1:1:1): 6 pRBC + 6 FFP + 1 apheresis platelet (≈6 whole-blood equivalents)
Whole blood (if available) is increasingly preferred over component therapy for the first cooler in trauma (LOW-TBW study, PROPPR trial)
TXA (tranexamic acid): 1 g IV bolus within 3h of injury (ideally <1h), then 1 g over 8h; CRASH-2 and MATTERs evidence
Calcium replacement: 1 g CaCl₂ (or 3 g Ca gluconate) per 4 units pRBC (citrate chelation of ionized Ca²⁺ causes hypotension and tetany)
Warming: forced-air blanket + fluid warmer + heated ventilator circuit; aim core temp >36°C
Targets: lactate <4 mmol/L (or trending down), INR/PT <1.5, fibrinogen >150–200 mg/dL, plt >50 (or >100 if ongoing bleeding/CNS bleed), pH >7.2
Fibrinogen: cryoprecipitate 10 units (≈4 g fibrinogen) or fibrinogen concentrate 2–4 g if fibrinogen <150 mg/dL (or <200 in obstetric hemorrhage)
STOP MTP when hemostasis achieved + hemodynamics stable + products no longer required; don't taper — abrupt cessation
Reviewed Sep 10, 2026 for clinical accuracy by BoardsBridge Editorial Process
Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: ASA Perioperative Blood Management 2015 · AIM OB Hemorrhage 2022 · SCCM Surviving Sepsis 2026 · ABA Initial Content Outline 2023
Re-review cadence: 12 months from reviewed date.
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Crisis Management
pharmacology
Must-have
Perioperative Anaphylaxis
IgE-mediated or non-IgE anaphylactoid reaction under anesthesia
Educational practice only. Reviewed for clinical accuracy against current authoritative guidelines. Not a substitute for clinical judgment, institutional protocols, or current guidelines.
Anaphylaxis is a severe, life-threatening systemic hypersensitivity reaction with rapid onset; under anesthesia it presents as cardiovascular collapse + bronchospasm + cutaneous signs, often in the absence of preceding exposure history.
If you forget
Epinephrine IV titrated bolus — 10–100 mcg for hypotension; escalate to 1 mg IV q3–5 min if arrest.
Board trap
Three common culprit agents in the OR — neuromuscular blockers (especially rocuronium and succinylcholine, accounting for ~60% of cases), antibiotics (cefazolin given before incision), and chlorhexidine (skin prep, central line catheters, ultrasound gel). Don't ignore the obvious: STOP all running infusions, especially NMB.
Key numbers
Epinephrine IV titrated bolus: 10–100 mcg (1:100,000 dilution made by mixing 1 mL of 1:10,000 in 9 mL saline); repeat q1–2 min
IM epinephrine: 0.3–0.5 mg (1:1000) into anterolateral thigh; repeat q5–15 min
IV epinephrine for arrest: 1 mg (1:10,000) q3–5 min per ACLS
IV fluid bolus: 20 mL/kg isotonic crystalloid, repeat as needed
Most common OR causes: NMBs (~60%), antibiotics (cefazolin, penicillin, vancomycin), chlorhexidine, latex, sugammadex, colloids
Tryptase: draw 1–3 h after symptom onset for diagnosis; correlates with mast cell degranulation
Skin testing + serum specific IgE 4–6 weeks after the event for definitive etiology
Reviewed Sep 10, 2026 for clinical accuracy by BoardsBridge Editorial Process
Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: ANZCA Perioperative Anaphylaxis 2022 · ABA Initial Content Outline 2023 · ASA Obstetric Anesthesia 2023
Re-review cadence: 12 months from reviewed date.
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Crisis Management
cardiac
Must-have
Perioperative Malignant Arrhythmia
VT/VF/pulseless arrest under anesthesia — the universal algorithm
Educational practice only. Reviewed for clinical accuracy against current authoritative guidelines. Not a substitute for clinical judgment, institutional protocols, or current guidelines.
Any sustained VT, VF, or pulseless arrest in the OR — run the universal algorithm: ACLS + simultaneous search for the perioperative cause (the 5 Hs and 5 Ts, plus drug-error and MH).
If you forget
Defibrillate pulseless VT/VF IMMEDIATELY (every minute of delay drops survival 7–10%).
Board trap
Treat the CAUSE, not just the rhythm. Perioperative arrests have specific, reversible causes that standard out-of-hospital ACLS misses — hypoxia from circuit disconnect, hyperkalemia from blood/CRRT, anaphylaxis, MH, drug error (syringe swap), tamponade, PE from DVT, tension pneumothorax from central line. The 5 Hs and 5 Ts.
Key numbers
Defibrillation: biphasic 200 J (escalate to 300, then 360); monophasic 360 J
Epinephrine: 1 mg IV q3–5 min for pulseless rhythms (vasopressin removed from ACLS 2020)
Amiodarone: 300 mg IV bolus for refractory VF/pVT; second dose 150 mg; max 2.2 g/24h
Lidocaine: 1–1.5 mg/kg IV for refractory VF; second dose 0.5–0.75 mg/kg
Magnesium: 1–2 g IV for torsades de pointes or hypomagnesemia
Calcium: AVOID except in hyperkalemia, hypocalcemia, or CCB toxicity (1 g CaCl₂ or 3 g Ca gluconate)
Sodium bicarbonate: 1 mEq/kg IV for severe acidosis (pH <7.1) or hyperkalemia; not routine
5 Hs: hypoxia, hypovolemia, hypo/hyperkalemia, hydrogen ion (acidosis), hypothermia
5 Ts: tamponade (cardiac), tension pneumothorax, thrombosis (coronary = MI), thrombosis (pulmonary = PE), toxins (drug error, anaphylaxis)
Reviewed Sep 10, 2026 for clinical accuracy by BoardsBridge Editorial Process
Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: AHA Adult ALS 2025 · AHA ACC Perioperative Cardiovascular 2024 · ABA Initial Content Outline 2023
Re-review cadence: 12 months from reviewed date.
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Procedural / Technique
vascular
High-impact pattern
Awake Carotid Endarterectomy with Shunt
Regional cervical block, neurologic monitoring, shunt decision
Educational practice only. Reviewed for clinical accuracy against current authoritative guidelines. Not a substitute for clinical judgment, institutional protocols, or current guidelines.
Awake CEA uses cervical plexus block + light sedation so the patient can serve as the neurologic monitor; shunt inserted for clinical deterioration or sustained EEG changes.
If you forget
Awake + speaking patient = the gold-standard neuromonitor.
Board trap
Titrating sedation too aggressively — a 'lightly sedated' patient who becomes apneic or obtunded has lost the only monitor the surgeon relies on.
Key numbers
Shunt threshold: clinical deterioration (aphasia, contralateral weakness) OR EEG/MEP changes > 30% sustained
Routine shunting is surgeon-dependent; some centers use selective shunting, others routine
Cervical plexus block: deep + superficial at C2–C4
Block volumes: deep block 10 mL per level C2/C3/C4, superficial 5–10 mL subcutaneous along posterior border of SCM
Maximum lidocaine 4.5 mg/kg (7 mg/kg with epi) — total dose caps below toxic range
Target SBP within 20% of baseline during cross-clamp; lower limit = avoid ischemia
Target HR 60–80; severe bradycardia from carotid sinus stimulation treat with glycopyrrolate 0.2 mg IV or atropine 0.5 mg IV
Reviewed Sep 10, 2026 for clinical accuracy by BoardsBridge Editorial Process
Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: SVS Perioperative Vascular Care 2022 · AHA ACC Perioperative Cardiovascular 2024 · AAA Perioperative Care Review 2022 · ASRA Antithrombotic Regional Anesthesia 2025
Re-review cadence: 12 months from reviewed date.
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Crisis Management
ob
High-impact pattern
High Spinal / Epidural Block — Obstetric Crisis
Recognition and rescue of an ascending neuraxial block during labor analgesia
Educational reference only. Reviewed for clinical accuracy against current authoritative guidelines. Not a substitute for clinical judgment, institutional protocols, or current guidelines.
An unexpectedly high or rapidly ascending neuraxial block in a laboring parturient — manifested by dyspnea, upper-extremity weakness, hypotension, and bradycardia — is an obstetric airway and hemodynamic emergency requiring immediate left uterine displacement, oxygenation, vasopressor support, and preparation for intubation.
If you forget
HEADLINE: High block = airway + circulation emergency; treat before apnea.
Board trap
The examiner will ask: 'The patient becomes apneic and saturations fall to 82% — what is your IMMEDIATE action?' The trap is calling a code or waiting for help; the answer is bag-mask ventilation with 100% O2 in left uterine displacement while preparing to intubate.
Key numbers
Phenylephrine 50–100 mcg IV bolus
Ephedrine 5–10 mg IV
Glycopyrrolate 0.2–0.4 mg IV
Epinephrine 10–100 mcg IV for severe bradycardia
100% FiO2 via face mask
Left uterine displacement ≥15°
Sensory level above T4 = high block
Reviewed Sep 12, 2026 for clinical accuracy by BoardsBridge Editorial Process
Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: ASA Obstetric Anesthesia 2023 · ASA Obstetric Anesthesia 2016 · AHA Adult ALS 2025 · SOAP Thrombocytopenia Neuraxial 2021
Re-review cadence: 12 months from reviewed date.
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Clinical Disease
cardiac
High-impact pattern
ICD / Pacemaker at Elective Replacement Indicator (ERI)
Perioperative management when a cardiac device battery is approaching end-of-life
Educational reference only. Reviewed for clinical accuracy against current authoritative guidelines. Not a substitute for clinical judgment, institutional protocols, or current guidelines.
Pacemaker/ICD at ERI means the battery voltage has crossed the manufacturer's elective-replacement threshold: the device still functions but features are degrading (longer ICD charge times, altered rate response, reduced output), and a generator change is due within weeks to months before true End-of-Life.
If you forget
ERI is a warning, not failure — schedule generator change before EOL
Board trap
Examiner favorite: 'Does a magnet reliably convert a pacemaker at ERI to asynchronous pacing?' Answer: No — magnet response is often disabled or unpredictable at ERI/EOL. Do not rely on the magnet as your backup; place external pads and a transcutaneous pacer.
Key numbers
Battery voltage at ERI: ~2.5–2.8 V (manufacturer specific)
ICD capacitor charge time at ERI: may exceed 15–20 s (vs ~6–10 s normal)
Perioperative MAP goal: ≥60–65 mm Hg; SBP ≥90 mm Hg
Safe distance for monopolar cautery from generator: ≥15 cm (device-specific)
Preop interrogation window: within 3–6 months; at ERI, sooner
Succinylcholine in pacemaker-dependent patient: avoid (risk of oversensing/inhibition)
Reviewed Sep 11, 2026 for clinical accuracy by BoardsBridge Editorial Process
Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: ABA Initial Content Outline 2023 · AHA ACC Perioperative Cardiovascular 2024 · AHA Adult ALS 2025
Re-review cadence: 12 months from reviewed date.
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Monitoring
monitoring
High-impact pattern
IVC POCUS for Volume Status
Inferior vena cava ultrasound assessment of right-sided filling and fluid responsiveness
Educational reference only. Reviewed for clinical accuracy against current authoritative guidelines. Not a substitute for clinical judgment, institutional protocols, or current guidelines.
Subxiphoid long-axis or right anterior-axial IVC view measures maximal diameter and respiratory collapsibility to estimate right atrial pressure and screen for fluid responsiveness at the bedside.
If you forget
IVC <2.1 cm with >50% collapse on sniff → CVP ~3 mmHg (low) → likely fluid-responsive.
Board trap
Examiner asks: 'IVC is 2.4 cm with 60% collapse — what is the CVP?' Answer: intermediate (8 mmHg) — neither low nor high; do not commit to fluid bolus without a dynamic test.
Key numbers
2.1 cm — diameter cutoff separating low from high IVC
50% — collapsibility index cutoff on sniff
3 mmHg — estimated CVP when IVC <2.1 cm and collapses >50%
15 mmHg — estimated CVP when IVC >2.1 cm and collapses <50%
8 mmHg — intermediate CVP when criteria are mixed
2 cm — distance caudal to RA-IVC junction for measurement site
Reviewed Sep 13, 2026 for clinical accuracy by BoardsBridge Editorial Process
Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: ASA SCA Perioperative TEE 2010 · ASA SCA Perioperative TEE 2010
Re-review cadence: 12 months from reviewed date.
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Clinical Disease
cardiac
High-impact pattern
Severe Aortic Stenosis (AS) for Anesthesia
Pressure-overloaded LV, fixed cardiac output, hemodynamic fragility
Educational practice only. Reviewed for clinical accuracy against current authoritative guidelines. Not a substitute for clinical judgment, institutional protocols, or current guidelines.
Severe AS is a fixed-output, pressure-loaded ventricle that collapses under tachycardia, hypovolemia, or vasodilation; keep HR 60–70, normal preload, normal SVR.
If you forget
Slow heart rate, full preload, maintain SVR.
Board trap
Treating hypotension with a vasodilator (e.g., nitroglycerin or pure β-blocker) — AS patients need phenylephrine/norepinephrine for pressure, not afterload reduction.
Key numbers
Severe AS: valve area < 1.0 cm², mean gradient ≥ 40 mmHg, peak velocity ≥ 4 m/s
Anesthetic HR target: 60–70 bpm (slow AF if present, avoid SVT)
SBP target: keep within 20% of baseline; large drops precipitate ischemia
Preload: avoid hypovolemia (small LV cavity, fixed stroke volume)
Avoid: nitroglycerin, hydralazine, high-dose propofol bolus, remifentanil bolus, dopamine agonists
Defibrillation threshold is unchanged — standard ACLS applies if arrest
Reviewed Sep 10, 2026 for clinical accuracy by BoardsBridge Editorial Process
Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: ACC AHA Valvular Heart Disease 2020 · ASE Eacvi Aortic Stenosis 2017 · AHA ACC Perioperative Cardiovascular 2024
Re-review cadence: 12 months from reviewed date.
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Equipment
equipment
Important
Anesthesia Machine Pre-Use Checkout & Leak Test
ASA 2008 pre-use checkout procedure: mandatory every case, every machine
Educational practice only. Reviewed for clinical accuracy against current authoritative guidelines. Not a substitute for clinical judgment, institutional protocols, or current guidelines.
Every anesthesia machine requires a pre-use checkout before every case, using the ASA 2008 14-item guideline; a leak test is mandatory whether using a circle system, Bain circuit, or non-rebreather.
If you forget
Verify O₂ analyzer calibration, leak test the breathing system to < 200 mL/min at 30 cm H₂O, confirm audible low-O₂ alarm and oxygen supply failure alarm.
Board trap
Relying on 'the tech checked it' — the ASA expects the anesthesiologist to verify, at minimum, the four critical items: O₂ analyzer, leak test, audible alarms, and backup O₂ supply.
Key numbers
Acceptable leak rate: < 200 mL/min at 30 cm H₂O (some machines 250 mL/min; check manufacturer)
O₂ analyzer: calibrated to 21% (room air) AND 100% (FiO2 verification)
Low-O₂ audible alarm threshold: typically 30% FiO2 (or pipeline pressure < 40 psi)
Backup O2 cylinder: full (≥ 1000 psi); open only when pipeline fails
O2 pipeline pressure: 50 psi nominal; fail-safe at ~40 psi with nitrous/medical-air shutoff
Bain circuit: specific coaxial leak test (1 L flow with leak ≤ 100 mL/min at the inner tube outlet)
Flowmeter sequence (anti-hypoxic): O2 always downstream of N2O on the manifold — fail-safe guarantees hypoxic mixture prevention
Reviewed Sep 10, 2026 for clinical accuracy by BoardsBridge Editorial Process
Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: ASA Preanesthesia Checkout 2008 · ASA Difficult Airway 2022
Re-review cadence: 12 months from reviewed date.
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Monitoring
monitoring
Important
Damped Arterial Waveform — Fast-Flush Test
Sine wave damping = dynamic response test for accuracy of arterial line
Educational practice only. Reviewed for clinical accuracy against current authoritative guidelines. Not a substitute for clinical judgment, institutional protocols, or current guidelines.
A damped arterial waveform under-reads systolic and over-reads diastolic — verify with the fast-flush test and count oscillations to assess dynamic response.
If you forget
Fast-flush test: pull the fast-flush, observe square wave then 1–3 oscillations before returning to baseline.
Board trap
Treating the displayed MAP at face value when the line is overdamped — relying on inaccurate blood pressure readings can cause cerebral hypoperfusion or inappropriate vasopressor use.
Key numbers
Acceptable damping: 1–3 oscillations after fast-flush square wave before return to baseline
Damping coefficient (ζ): optimal ~0.7; overdamped > 0.7; underdamped < 0.4 (resonance artifact)
Natural frequency (f₀): 10–25 Hz for accurate dynamic response
Dynamic response is temperature-dependent: cold patients, K+ effects, clot in line — all reduce accuracy
Overdamped line under-reads systolic (15–30 mmHg), over-reads diastolic; MAP remains accurate
Reviewed Sep 10, 2026 for clinical accuracy by BoardsBridge Editorial Process
Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: AHA ACC Perioperative Cardiovascular 2024 · AHA Adult ALS 2025 · ASA SCA Perioperative TEE 2010
Re-review cadence: 12 months from reviewed date.
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Ethics & Medicolegal
ethics
Important
DNR in the OR — Patient Refuses to Suspend
Respect patient autonomy; document the discussion; honor the directive
Educational practice only. Reviewed for clinical accuracy against current authoritative guidelines. Not a substitute for clinical judgment, institutional protocols, or current guidelines.
Anesthesia does NOT automatically suspend DNR; if the patient refuses to suspend, the directive stands — proceed with anesthesia care, document the conversation, anticipate potential intraoperative conflict.
If you forget
Mandatory pre-op discussion: document whether DNR is suspended, modified, or maintained.
Board trap
Assuming DNR suspensions automatically under anesthesia — the ASA says explicit discussion is required and the patient's wishes govern.
Key numbers
ASA 2023 statement: requires explicit discussion before DNR status change in the perioperative setting
Three options for DNR: full suspension, modification (specify what to suspend), or maintain through surgery
Required documentation: separate consent form, pre-op note, ID band with code-status
If patient declines to discuss: document decline, proceed with anesthesia per facility policy (most honor refusal to suspend if confirmed by patient)
Intraoperative arrest: honor the directive as written — do NOT default to full code resumption unless that was specifically agreed
Reviewed Sep 10, 2026 for clinical accuracy by BoardsBridge Editorial Process
Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: ASA DNR Ethics 2023 · AHA SAH 2023
Re-review cadence: 12 months from reviewed date.
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Regional / Block
regional
Important
Interscalene Block with Phrenic Involvement
Diaphragmatic hemiparesis is universal at this level; know who can NOT tolerate it
Educational practice only. Reviewed for clinical accuracy against current authoritative guidelines. Not a substitute for clinical judgment, institutional protocols, or current guidelines.
Classic interscalene at C5/C6 causes 100% ipsilateral phrenic nerve palsy → diaphragmatic hemiparesis; avoid in patients who can't tolerate a 30% drop in pulmonary reserve.
If you forget
Contraindications to interscalene include severe COPD (FEV1 < 1 L), contralateral phrenic palsy, and severe restrictive disease.
Board trap
Doing an interscalene on a patient with a contralateral pneumonectomy or severe COPD because 'they need a shoulder block' — this precipitates respiratory failure intraoperatively or several hours postop.
Key numbers
Phrenic involvement: ~100% with classic interscalene at C5/C6
Diaphragmatic excursion drops by ~25–30% ipsilaterally
FVC reduction: 25–30% in healthy patients; up to 50% in COPD
Phrenic-sparing strategies: low-volume interscalene (5 mL), distal approach, supraclavicular — none fully eliminate
Local anesthetic volume: 15–20 mL traditional; 5 mL low-volume; efficacy preserved with US guidance
Recurrence of phrenic palsy: typically resolves within 6–24h as block resolves
Reviewed Sep 10, 2026 for clinical accuracy by BoardsBridge Editorial Process
Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: ASRA Antithrombotic Regional Anesthesia 2025 · LAST Comprehensive Review 2024 · ESRA ASRA Pediatric Complications 2022
Re-review cadence: 12 months from reviewed date.
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Emergent Cesarean Delivery — Anesthetic Crisis Management

If you forget

Board trap

Local Anesthetic Systemic Toxicity (LAST) Rescue

If you forget

Board trap

Malignant Hyperthermia (MH) Crisis

If you forget

Board trap

Massive Transfusion & Severe Acidosis (Trauma)

If you forget

Board trap

Perioperative Anaphylaxis

If you forget

Board trap

Perioperative Malignant Arrhythmia

If you forget

Board trap

Awake Carotid Endarterectomy with Shunt

If you forget

Board trap

High Spinal / Epidural Block — Obstetric Crisis

If you forget

Board trap

ICD / Pacemaker at Elective Replacement Indicator (ERI)

If you forget

Board trap

IVC POCUS for Volume Status

If you forget

Board trap

Severe Aortic Stenosis (AS) for Anesthesia

If you forget

Board trap

Anesthesia Machine Pre-Use Checkout & Leak Test

If you forget

Board trap

Damped Arterial Waveform — Fast-Flush Test

If you forget

Board trap

DNR in the OR — Patient Refuses to Suspend

If you forget

Board trap

Interscalene Block with Phrenic Involvement

If you forget

Board trap