Conditions Flashcards
Cardiovascular drugs pre-op
Beta-blockers / alpha 2 agonists - continue
ACEI/ARB/diuretics; w/h morning dose
Statins; continue
Blood thinners pre-op
Warfarin; w/h 5 days
Xarelto; 48hrs
Apixaban; 48hrs
Aspirin; most continued, but if need - stop 5-7/7 prior
Clopidogrel; w/h 5-7/7
NSAIDS; 7-10/7 prior
Pre-op warfarin mx
Check INR 5-7/7 prior to surgery
INR 1.5-1.9; stop 3-4 days prior
INR 2-3; stop 5 days prior
INR >3; stop at least 5 days
Bridge; clexane 1.5mg/kg subcut (1mg/kg if CrCL <30)
Imaging of breast mass
<35yo; USS
- do mammogram if suspicious clinical findings, USS indeterminant/suspicious, or if USS not consistent with clinical exam findings
>=35yo; USS + mammogram
Bariatric surgery post-op checklist
Monitor weight and complications at each visit
Adherence to diet/exercise
Medication; avoid NSAID, adjust antiHTN/diabetic meds
Supplement
- Iron, folic acid, thiamine, B12
- Citrated calcium - elemental Ca 1200mg/day
Bloods
- FBC, U+E, LFT, uric acid, glucose, lipids every 6/12
- VD, PTH, Ca, albumin, PHo, B12, folate, iron annually
Carotid artery stenosis mx
Antiplatelet
Statin
Smoking cessation
BP control
screen DM
>80% stenosis -> non urgent vascular surgery review
<80%: medical mx + annual USS
Risk factors AAA
> 65yo
Peripheral atherosclerotic disease
Smoking
COPD
Marfan
Ehler’s-Danlos syndrome
HTN
FDR
Cholesterol
Indication to screen for AAA
Male >65yo and smoking
>65yo and FDR
Known popliteal/thoracic aortic aneurysm
Venous leg ulcer features
Haemosiderin
Lower third of leg
Shallow poorly defined edges
Granulating/sloughy base
Venous leg ulcer mx
Cleaning/debridement
Compression 30-40mmHg
Nutrition; omega 3 fatty acids, vitamin C, zinc
Leg elevation
Exercise
Weight loss
Skin care for dermatitis; paraffin emollient , steroid
Early referral to vascular surgeon
Superficial thrombophlebitis mx
If IVC complication; topical or oral NSAID
Consider anticoagulation if involves thigh veins
- Clexane 40mg 6/52
Elevation
Compression
Warm
Review in 7-10 days to ensure resolution
Mx of DVT
Exercise
Compression
Cease OCP
Anticoagulation
- Xarelto 15mg BD 3/52 -> 20mg daily
- Apixaban 10mg BD 1/52 -> 5mg BD
- Clexane 1.5mg/kg subcut
PICC related VTE; elevation, NSAID, anticoag 3/12, remove PICC if non-functional
USS surveillance as alternative if high bleeding risk
- 2-3 x USS over 2 weeks to assess progression
Duration of anticoagulation DVT
Distal DVT
- Provoked; 6/52
- Unprovoked; 3/12
Proximal
- Provoked; 3/12
- Unprovoked; 6/12
Examination of foot with ulcer
Assess for infection; discharge, smell
Hair loss / skin trophic changes
Peripheral pulses
ABPI (<0.9 abnormal)
Sensation
Reflex
Joint deformity
Gait
Footwear
Wound dressings
Hydrogel (Aquaclear); dry wounds with necrotic tissue
Hydrocolloid (Duoderm): chronic wounds with mild-moderate exudate
Foam (Allevyn): granulating wounds, mild-moderate exudate, non-infective
Cadexomer iodine (Iodosorb): wounds with malodorous exudate
Alginate (Algisite): heavy exudate
