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LVL7 revision > Complications > Flashcards

Complications Flashcards

1
Q

High risk areas for vascular occlusion

A

Glabella
Forehead
Nose
Periocular
Perinasal
Temple

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2
Q

Vasovagal physiology

A

bradycardia
hypotension
arterial vasodilation

autonomic neural response

hypothalamic activation from stress or pain

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3
Q

Anaphylaxis adrenaline dose

A

500mcg of 1:100 (1mg/ml) IM

can be repeated after 5 minutes up to 3 times

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4
Q

Bruising risk factors (5)

A

antiplatelet
anticoagulant
NSAIDs
Vitamine E
High doses of garlic

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5
Q

Botox complication (non-cosmetic)

A

headache
Flu like symptoms

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6
Q

Cause of diploplia

A

lateral rectus palsy

lateral canthal injection diffusion

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7
Q

Cause of blurred vision

A

lower eyelid laxity stopping draining of tears

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8
Q

Cause of dry eyes

A

diffusion of toxin into lacrimal gland from deep periorbital injection

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9
Q

Causes of lower eye lid ectropiom

A

infraoribtital toxin causing lack of tone in palpebral portion

urgent opthalmology referral required to prevet corneal damage

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10
Q

Symptoms of systemic toxin overdose

A

dysphagia
slurred speech
muscle weakness

resp muscle paresis

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11
Q

Causes of toxin treatment faulure

A

Inproper product storage

true patient resistance

Inappropriate use - static lines

Calcium channel antagonist

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12
Q

Correcting medial brow ptosis

A

assess if there is still medial corrugator activity

if yes treat between 2-4 weeks to counterbalance medial frontalis fibre treatment

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13
Q

Managing adverse outcome

A

Document - identify reason for outcome

Liase with GP in needed

Refer to specialist services if needed

Make plan for continued care/ further review

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14
Q

Description of common side effect

A

Mild
Transient - resolve within 10 days
Does not require further intervention

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15
Q

Contents of emergency kit

A

Adrenaline 1:1000 x 4
Hyaluronidase 1500 units x 10
Associated consumables
Bacteriostatic saline 30mls x 2

Aspirin 75mg
Glucose gel/tablets
Loratidine 10mg

Warm Pack
BP monitor
Saturation probe

guaze
syringes
needles - 30G

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16
Q

Which governing body to report complications to?

A

MHRA (medicines and healthcare products regulatory agency)

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17
Q

Description of adverse events

A

Common reactions that have persisted
Rare
Moderate to severe effects

Anaphylaxis, necrosis, vascular compromise, scarring

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18
Q

Complication severity

A

Low - unlikely to result in complication, internvention unlikely

Moderate - may have complication, monitor

Major - immediate intervention essential

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19
Q

Examples of delayed filler complication (5)

A

Product migration
inflammatory nodules/granulomas
Oedema
Hypersensitivity related swelling
Chronic Infection
HSV activation

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20
Q

Examples of Early filler complications (5)

A

Infection
Swelling
Nerve damage
Tyndall effect
Muscle/expression change
HSV activation

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21
Q

Examples of immediate Filler complications (5)

A

Vascular event
Anaphylaxis
Bleeding
Vasovagal episode
Skin changes

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22
Q

Factors for nodule formation

A

Disease that creates immune mediated response

e.g Influenza

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23
Q

Anterograde embolism vs retrograde

A

Distally to terminal arteries

vs

Moves in opposition to blood flow

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24
Q

Venous complications

A

Congestion and compartment syndrome

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25
Q

Where are the labial arteries most at risk

A

In the midline - higher risk of subctaneous arteries

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26
Q

Factors affecting needle aspiration (6)

A

Primed needle
Product viscosity
Length of time
Needle length
Steadiness of hands
Amount of negative pressure

27
Q

Conservative management of VO

A

Firm massage for 5 mintuutes

Warm compress for vasodilaton

Firm tapping over occluded area may dislodge emboli

28
Q

Skin changes with filler

A

Neovascularisation from trauma/tissue expansion - treat with laser if resistant

Hyperpigmentation - Fitz IV-VI

Rosacea flare

Scarring from other complication (ifection/VO)

29
Q

Filler biofilm

A

Aggregation of microorganisms on implanted filler

formed by extracellilar matrix of polymeric fibrinogen and fibronectin

resitant to abx penetration

30
Q

First line abx for infection

A

Flucloxacillin 500mg QDS PO

or

Clarithromycin 500mg BD PO

31
Q

Malar oedema

A

May resolve over 2-3 weeks

Encourage lymphatic drainage and cold compress several times a day

Avoid steroids

32
Q

Type IV hypersensitivity

A

Delayed reaction mediated by cellular response

T-lymphocites

Inflammatory nodules

DO NOT RESPOND TO ANTIHISTAMINES, can be treated with oral steroids, tapering dose

33
Q

What to do if unsure of hypersensitivity vs infection

A

Treat with abx first

Then weaning steriod course

May need to dissolve to remove underlying trigger

34
Q

Type I hypersensitivity

A

IgE mediated - mast cell activation - fast onset

atopy, anaphylaxis, allergy, angioedema

Responds to antihistamines

35
Q

Nerve damage

A

rare

trauma through laceration, compression, occluding exiting foramen

36
Q

Bells palsy management

A

Artificial tears

sterpods

Eye patch

37
Q

Nodule management

A

Firm massage if occur immediately

Aspiration if delayed

38
Q

Cause of inflammatory module

A

Biofilm infection of filler

39
Q

Management of inflammatory nodule

A

Two weeks of abx, up to 4 weeks

Macrolide - clari 500mg BD

Tetracycline - minocycline 100mg BD - anti inflammatory properties

40
Q

Dual antibiotic therapy

A

add doxycycline 100mg BD or ciprofloxacin 500mg BD

41
Q

If infection of filler not improving

A

Punch biopsy and culture

Surgical excision

Intralesional antibiotics

Hyaluronidase dissolving

42
Q

Granuloma character

A

Red firm papules or nodules

Subdermal

Appear within 6 months of treatment

Usually non-biodegradeable products, not HA

43
Q

Hyaluronidase intradermal patch test

A

Should not be used to delay treatment in vascular compromise

30 units (0.2mls) in the forearm and compare with a saline control

observe for 30 minutes

Photographs pre and post test

44
Q

Positive reaction in Hyaluronidase patch test

A

Wheal and flare

increase in size by 50%

Wheal increase by over 8mm

45
Q

Hyaluronidase dose

A

Large volume protocol

1500 units in 10ml dilution

46
Q

What to do in context of positive hyaluronidase patch test

A

If treatment still needed - referred to a specialist for further consideration of treatment

with resuscitation facilities

47
Q

How many units in a vial of hyaluronidase

A

1500 unit

48
Q

Origin of UK hyaluronidase

A

ovine (sheep)

49
Q

Storage of hyaluronidase

A

2-8C improves quality and longevity

Room temperature stability is guaranteed for 12 months

Once opened use immediately

50
Q

Large volume, low concentration reconstitution

A

1500 units in 10mls of saline

non-emergency scenarios

51
Q

Small volume, high concentration

A

1500 units in 1-2mls of saline

Emergency vascular occlusion

52
Q

When would higher doses of hyaluronidase be needed

A

Highly cross linked HA

Higher doses of HA

Multiple prodcts

Nodules

Product injected over 6 months ago

53
Q

Reconstitution of hyaluronidase

A

Water or saline

Add 1ml to ampoule to dissolve powder - draw and expel syringe.

Add 1ml of reconstituted product to remaining dilutent and mix

54
Q

Hyaluronidase injection technique in VO

A

cannula or serial needle punctures along the course of vessel

Cannula use can prevent bruising which would mask visual feedback

Massage to disperse product

55
Q

How often can Hyaluronidase be repeated

A

hourly until clinical resolution

56
Q

Hyaluronidase after care

A

Observe patient for 30-60 minutes after treatment

Arrange F2F appointment 24-48 hours

if signficant skin changes prescribe abx prophylactics

Follow-up with patient every few hours that same day

57
Q

Where to report complications

A

MHRA Yellow card scheme
Manufacturere

58
Q

Signs of VO

A

Skin changes

Strong pulse upstream to affected area

59
Q

Most common cause for non-inflammatory nodule

A

Product misplacement

60
Q

Nodule excision - when & how

A

Recently placed

Superficial placement

Large bore needle 21G

Small incision and squeeze

61
Q

Delayed onset inflammatory nodule signs and causes

A

Tenderness
Erythema
Warmth
Discrete border

Low grade biofilm - can lead to chronic inflammation and granuloma formation

62
Q

Retinal artert occlusion immediate management

A

Stop treatment, supine position

Occular massage

Rebreathe in paper bag - increase CO2 and vasodilaton

Sublingual GTN

Emergency eye casualty referral

63
Q

Time to cause permanent visual loss in rentainal occlusion

A

12-15 minutes

64
Q

Retinal artery occlusion treatment

A

Specialist eye unit

Retrobulbar injections by specialist

injection of hyalase into supratrochlear or supraorbital arteries

LVL7 revision (18 decks)

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