1. Criteria for starting tPA:
-Disease: diagnosis of ischemic stroke that began <4.5 hrs ago and is causing significant symptoms that are not resolving, no seizure with post-ictal
-Patient: patient does not have major deficits, understands risks.
-Brain: no signs of ICH, SAH, no recent history of head trauma or stroke, no history of ICH, CT does not show diffuse multiloblar infarction (hypodensity >1/3 cerebral hemisphere-- this can increase risk of bleed after tPA)
-Body: no recent GI/GU hemorrhage (21 days), no major surgery in last 14 days, no arterial puncture in non-compressible aa in last 7 days, no evidence of acute injury/active bleeding now.
-Coags: INR<=1.7, PTT normal, platelets > 100
-Other labs /vitals: BP <185/110, glucose >=50
2. Left MCA stroke:
-R facial/body weakness
-Receptive or productive aphasia
3. Right MCA parietal stroke:
-L facial and body weakness.
-Hemineglect of L side
-Visuospatial compromise (misjudge distances, hold books upside down)
-Denial of stroke symptoms.
4. Anticoagulation for prevention of future stroke: 
-Warfarin if high risk of stroke, past stroke (goal INR 2-3)
-Asprin if low risk, unable to tolerate anticoagulation
-Aspirin + Plavix = warfarin for bleed risk.
-CHADS2 score to predict risk of stroke in people with afib.
-Don't start anticoagulation for about 2 weeks after an ischemic stroke to lower risk of secondary hemorrhage.
5. About cochlear implants:
-In infants, you want to implant bilateral cochlear implants so they develop biauricular hearing and will be able to triangulate sounds later in life.
-If someone is born deaf, once they pass the critical period for brain development of auditory processing, don't give them a cochlear implant. They will not be able to interpret the sound. Few exceptions is if you just want to give someone "sound awareness" so they can hear alarms or such.
-In adults who have auditory processing capability (i.e. they were hearing as a child and lost it later in life), start with one cochlear implant. Some people will have complete restoration of hearing. Some people will have partial restoration. In this case, put in a second cochlear implant. If the first implant had zero benefit, don't put in a second.
-When operating on someone with one, don't use a bovie, it can mess up the electronics of the implant
-To put one in, cut behind the ear and drill through the mastoid air cells until you reach the bone that covers the facial nerve. Use it as a landmark to find the round window. Go through it to get to the cochlea. Insert the electrode into the cochlea. Make a pocket in the bone behind the ear to put in the rest of the implant. Suture it in.
-The battery is worn outside the ear, there is no internal battery.
-The device is activated 2-3 weeks after the surgery to give the electrodes a chance to heal in.
6. Why did sinuses evolve? Theories: 
-To lighten the head
-To allow for blowout fractures that protect the brain and eyes from facial trauma.
-To act as reservoirs for humidified air that will humidify air before it enters the lungs. The turbinates channel the flow of air in, most of it goes through the inferior part, some is channeled upwards and will pass by the meatus and via the bernoulli effect (air passing by holes for sinus outlets sucks in humidified air into the stream) the appropriate amount of humidity is passed into the air stream. People who have their turbinates removed have chronic problems with dryness.
-In our aquatic mammal common ancestors, it may be useful for buoyancy.
7. About maxillary sinuses: 
-The outlet is at the top of the sinus, into the space under the middle turbinate
-Coated with mucus that traps dust and bacteria
-Cilia push mucus up towards the top of the sinus
-The maxillary sinus mucosa should appear white. If it is red, full of blood vessels, inflamed appearing, something is wrong.
-In maxillary sinusitis, there is chronic inflammation of the mucosa of the sinuses, plugging of the ostia leads to entrapped mucus, bacterial overgrowth. Eventually the cilia are destroyed by the inflammation/infection, leading to worsening mucus trapping.
-To treat chronic maxillary sinusitis unresponsive to meds, drill open the natural ostia that drain the sinuses. If that fails, drill an additional ostium under the inferior turbinate into the sinus.
8. About sinus surgery:
-To control bleeding, before surgery soak cotton patties in a solution of cocaine, like 4% (max dose: 4mg/kg) and stuff them in the nose. Cocaine is more vasoconstrictive than other local anesthetics.
-In people who chronically abuse cocaine, this may trigger a vasoconstrictive crisis, so watch their vital signs.
-Speaking of people who chronically abuse cocaine, the vasoconstrictive effect is so intense that over time, the tissues of the nose and sinuses will be deprived of blood supply. This leads to death of the cartilage (septal perforation) and to severe destruction of the cilia in the sinuses, leading to a significant, unremitting chronic sinusitis.
-Also soak cotton in afrin solutions (a1/a2 agonist) to promote vasoconstriction
9. Local anesthesia max dose
-Lido without epi: 7mg/kg
-Lido with epi: 4-5mg/kg
-Marcaine: 2mg/kg
These are probably somewhat arbitrary. The data is of questionable quality and come from animal tests or extrapolations
10. About angioedema
-The inherited version is mediated by bradykinin and does not respond to steroids. Its associated with decreased levels of C1 inhibitor. Treat by giving purified C1 inhibitor protein, or bradykinin or kallikrein inhibitors.
-Acquired angioedema is mediated by histamine, and responds well to steroids.