Ben Middleton - Physics in Anaesthesia

Physics in

Anaesthesia

If you cant explain it simply, you dont understand it well enough.

Albert Einstein

Second Edition

Physics in

Anaesthesia

Ben Middleton, Justin Phillips and Simon Stacey

With contributions from Rik Thomas

Second edition Scion Publishing Ltd, 2021

ISBN 978 1 911510 80 2

First edition published in 2012 (978 1 904842 98 9)

All rights reserved. No part of this book may be reproduced or transmitted, in any form or by any means, without permission.

A CIP catalogue record for this book is available from the British Library.

Scion Publishing Limited

The Old Hayloft, Vantage Business Park, Bloxham Road, Banbury OX16 9UX, UK
www.scionpublishing.com

Important Note from the Publisher

The information contained within this book was obtained by Scion Publishing Ltd from sources believed by us to be reliable. However, while every effort has been made to ensure its accuracy, no responsibility for loss or injury whatsoever occasioned to any person acting or refraining from action as a result of information contained herein can be accepted by the authors or publishers.

Readers are reminded that medicine is a constantly evolving science and while the authors and publishers have ensured that all dosages, applications and practices are based on current indications, there may be specific practices which differ between communities. You should always follow the guidelines laid down by the manufacturers of specific products and the relevant authorities in the country in which you are practising.

Although every effort has been made to ensure that all owners of copyright material have been acknowledged in this publication, we would be pleased to acknowledge in subsequent reprints or editions any omissions brought to our attention.

Registered names, trademarks, etc. used in this book, even when not marked as such, are not to be considered unprotected by law.

Cover design by AM Graphic Design Ltd
Cover wave image supplied by Dr Mark Salmon

Typeset by Evolution Design & Digital Ltd (Kent), UK
Printed in the UK
Last digit is the print number: 10 9 8 7 6 5 4 3 2 1

Contents

Foreword

Taking the first step towards preparing for the exam can be daunting and finding the right resources equally so. Those resources that ultimately become invaluable act not only as complete guides to the subject at hand, but as quick-fire aids as the exam draws closer.

The FRCA syllabus is comprehensively covered, and the relationship between physics and anaesthesia is consistently articulated throughout the book. Traditionally dense topics are presented with clarity, logic and care and, as a result, everything is not only easy to follow, but also easy to digest and understand. The use of real life examples adds extra meaning to the content and accelerates the process of learning. Each chapter is rounded off with a straightforward summary, and the web-based, exam-style, MCQ and SBA questions now include helpful pointers and references back to the text.

Each of these attributes is welcomed for anyone deep in the revision process. Combined, they are what continues to make this book an indispensable text for the primary FRCA examinations. Of course, there is work still to be done by the candidate, but in the midst of my own exam preparation, Im fortunate to have been exposed to this book to such a degree.

Dr Zara Al-Faham, MBChB BSc

Core Trainee 1

East of England School of Anaesthesia

Preface

Ten years ago, we were convinced there was a need for a book that really helped the clinician to reacquaint themselves with the basic principles of physics. Our challenge was to write a book that takes the reader from the level of dual science GCSE to success at FRCA exams. We did our level best to deliver such a book, and thankfully the feedback we received has been such that a second edition is now here. This time we have put a lot of effort into the SBAs and MCQs: they are separate to the book so you can look at the book whilst answering the questions. We have added pointers, clues and tips beneath the questions so as to maximise your learning whilst going through the questions. We really believe this has added extra breadth to the book.

As in the first edition, the topics have been carefully selected to ensure that they are all relevant for those tackling the FRCA if you go to www.scionpublishing.com/pia2 and click on Resources you will find:

the latest FRCA syllabus indexed against sections in the book

a copy of the contents list annotated to let you know which topics it is essential that you learn, and which are only for those looking to excel

These updates make for a comprehensive text suitable not only for doctors but also for nurses, operating department practitioners and students. Short, snappy chapters include worked examples to help understanding of tricky areas, along with clinical examples to highlight the relevance to anaesthetic practice. All the key terms are highlighted in bold at their first mention and defined. Links to self-assessment questions (MCQs and SBAs in an FRCA style) can be found at the end of each chapter a QR code will take you straight to them.

The result, we hope, is a book that brings an understanding of physics to those who have long since given up on it, with the minimum of pain and frustration.

Ben, Justin and Simon

Comments, errors and omissions

We welcome feedback and so if you have any questions or comments regarding the book or the SAQs, please email .

Errors in the SAQs will be corrected immediately on the website.

Errors in the book will be corrected at the next printing and an alert noted on the website.

Acknowledgements

This second edition was greatly helped by the energy and insight of Dr Zara Al-Faham. Her hard work has resulted in the SBAs and MCQs being greatly improved. She also meticulously went through every line, table and diagram in the first edition, and this has helped create a sharper second edition.

Rik Thomas helped us to write the first edition but was unable to assist with this new edition; we remain grateful for his contributions.

We also would like to thank Gary Corderey for his generous help with the Equipment management chapter. Thank you also to Dr Raghu Nalgirkar for his help and support with the improvements to the Ultrasound chapter.

We would like to thank our publisher, Jonathan Ray, for his patience in waiting for the planets to align in order for a second edition to be born. Our families have had to endure the peaks and troughs during this project, and we would like to dedicate this book to them: Elwira, Oliver & Jeremy; Deborah; Ese, Luke, Harry & Hannah.

About the authors

Dr Simon G Stacey (MBBS FRCA FFICM) is a Consultant Cardiothoracic Anaesthetist & Intensivist based at Barts Heart Centre, London.

Justin Phillips (BSc PhD MIPEM) is a Research Scientist at Google and a Research Fellow in Biomedical Engineering at City University of London. He studied physics at Durham University.

Ben Middleton (BSc SOPGBI RN) is Head of Clinical Perfusion Science at the Essex Cardiothoracic Centre, Basildon Hospital (MSE NHS Trust). He studied physics at Bristol University.

Abbreviations