Night-Before Exam Cram Tool

Quick-reference last-minute review: trigger sheet, differential buckets, numbers blitz, false-statement traps, and rapid oral-style prompts.
Best way to use this tonight: start with Trigger Sheet, then skim Numbers Blitz, then finish with False-Statement Trap Deck.
If you see... think...

Classic complication triggers

  • Petechiae + long-bone fracture → fat embolism
  • Cement + collapse + ↓EtCO₂ → BCIS
  • Beach chair + bradycardia + hypotension → Bezold-Jarisch reflex
  • Tourniquet deflation → ↑EtCO₂, ↑K, ↓pH
  • ACDF + trouble swallowing → dysphagia
  • Facial swelling after long robotic Trendelenburg case → airway edema / consider cuff leak test
If you see... think...

Airway / respiratory triggers

  • Unilateral breath sounds after PnP/Trendelenburg → endobronchial migration first
  • Rising EtCO₂ despite increasing ventilation → subQ emphysema / desufflate / still think MH if not responsive
  • Obese patient desaturates fast → reduced FRC + increased oxygen consumption
  • OHS → BMI > 30 + awake PaCO₂ > 45
If you see... think...

Positioning triggers

  • 20 cm head above heart → about 15 mmHg MAP drop at brain
  • Prone + long case + big blood loss → POVL risk
  • Steep Trendelenburg → ↑ICP, ↑CVP, ↓cerebral venous drainage, airway edema
  • Fracture table + perineal post → pudendal nerve risk
  • Fibular head compression → common peroneal nerve
Most testable

Money-list associations

  • Cemented hip → BCIS
  • Long-bone fracture → fat embolism
  • Beach chair → BJR + cerebral perfusion issue
  • Steep Trendelenburg → airway edema
  • Sciatic block missing nerve → saphenous
Memory cue
Beach chair = brain, cement = collapse, long bone = petechiae, Trendelenburg = tongue/airway swelling.
Compare / contrast

High-yield differential buckets

Falling EtCO₂ Rising EtCO₂ High PIP / unilateral breath sounds Airway edema / swelling
BCIS
Fat embolism
Venous gas embolism		 Tourniquet deflation
CO₂ absorption
Pneumoperitoneum hypercarbia		 Endobronchial migration
Capnothorax
Bronchospasm		 Steep Trendelenburg
Long robotic pelvic/prostate case
Post-ACDF neck concern is different: hematoma/swelling/dysphagia
Differentiate

BCIS vs fat embolism

  • BCIS: cement trigger, ↓EtCO₂, hypotension, hypoxia, arrhythmias
  • Fat embolism: long-bone/pelvic fracture context, petechiae, dyspnea, confusion; under GA can present with ↓EtCO₂ and instability
Differentiate

Endobronchial migration vs capnothorax

  • Endobronchial: unilateral breath sounds, carina shifts cephalad with PnP/Trendelenburg, pull ETT back while auscultating
  • Capnothorax: hypotension/hypoxia + unilateral breath sounds, assess breath sounds, desufflate, may need decompression depending on severity
Differentiate

OSA vs OHS

  • OSA: postop obstruction/hypoxemia risk, opioid-sparing, semi-upright, CPAP if needed
  • OHS: obesity + awake hypercapnia, reliance on hypoxic drive, even more sensitive to respiratory depressants
Repeated values

“40” deck

  • 40 in = male waist for metabolic syndrome
  • ≤ 40 = male HDL cutoff for metabolic syndrome
  • ≥ 40 BMI = class III obesity
  • > 40° = lumbar scoliosis surgery correlate
  • 40% = approximate compliance drop note with steep Trendelenburg / 45° head down
Metabolic syndrome

3 of 5 criteria

  • Waist: 40 men / 35 women
  • TG: 150
  • HDL: 40 men / 50 women
  • BP: 130/85
  • Glucose: 100
Tourniquet / beach chair

Numbers to know cold

  • 100 mmHg above SBP = tourniquet pressure rule
  • 2 hours = lecture max inflation
  • 15 min = reperfusion/deflation nuance before reinflation
  • 0.75 mmHg/cm = beach chair MAP drop
  • 20 cm = 15 mmHg
Ventilation / obesity

Respiratory numbers

  • 6–8 mL/kg = low tidal volume target
  • 5–10 cm H₂O = PEEP
  • < 30 = plateau pressure note
  • 50 mL/kg = EBV in obese lecture/discussion
  • PaCO₂ > 45 = OHS clue
Spine / POVL / VTE

More numbers

  • > 5 hr spine case = POVL risk
  • > 1 L EBL = POVL risk
  • > 30 min procedure = VTE risk
  • > 4 days immobilization = VTE risk
  • 50° thoracic / 40° lumbar scoliosis surgery correlate
False or NOT

Trap statements

  • Female is the major POVL risk factor ❌
  • Saphenous comes from sciatic ❌
  • Nitrous is the preferred insufflation gas ❌
  • A in STOP-Bang = android obesity ❌
  • Dysphagia is uncommon after ACDF ❌
False or NOT

More trap statements

  • Tourniquet deflation lowers potassium ❌
  • Steep Trendelenburg lowers ICP ❌
  • Obesity guarantees impossible intubation ❌
  • Female is a subQ emphysema risk factor listed in your robotic discussion ❌
  • HDL ≥ 50 is part of female metabolic syndrome diagnosis ❌
Use this actively

How to drill this

  • Cover the ❌ answer and say the corrected statement out loud.
  • Example: “A in STOP-Bang is not android obesity — it’s Age.”
  • Example: “Tourniquet deflation does not lower K — it raises K.”
Rapid-fire

10 quick prompts

  • Most common ACDF complication?
  • What nerve is missing from a sciatic block?
  • What happens to EtCO₂ after tourniquet deflation?
  • What is the MAP drop at the brain if the head is 20 cm above the heart?
  • What does petechiae make you think of?
  • What does cement + ↓EtCO₂ make you think of?
  • What’s the most likely first fix for unilateral breath sounds after PnP?
  • What does A in STOP-Bang stand for?
  • What are the male and female metabolic syndrome waist cutoffs?
  • What makes steep Trendelenburg dangerous at extubation?
Answers
Dysphagia; saphenous; it rises; about 15 mmHg lower; fat embolism; BCIS; consider pulling back ETT while auscultating; Age; 40 men / 35 women; airway edema.
Best night-before workflow

If I were cramming tonight

  1. Trigger Sheet
  2. Numbers Blitz
  3. False-Statement Trap Deck
  4. Sleep
Why this works
The night before, pattern recall usually helps more than trying to learn a whole new pile of details.