Misc Teaching Flashcards
What are potential complications of surgery?
- Wrong patient
- Wrong site
- Wrong operation
- Lack of notification of allergy status
- Complications of anaesthetic
- Lack of airway control and breathing
- Circulatory complications
- Poor skin quality
- Infection
- Fractures
- Lesions of nerves and arteries
- Perforation of organs
- Abandoned swabs, instruments post surgery
What are the different types of anaesthetic?
- Local
- General
- Spinal
How does local anaesthetic work?
-Prevents the uptake of sodium ions into the nerve so an action potential is not generated
What happens if local anaesthetic is injected into the blood stream?
-Muscle paralysis = heart becomes paralysed –> death
What are some complications of general anaesthetic?
- Incorrect dose
- Unknown allergy to anaesthetic
- Ventialation problems
- Co-morbidities
What are some intubation complications that can result from surgery?
- Knock out the teeth
- Soft palate lesion
- Can intubate the stomach - stomach inflates with test breath, hypoxia
- Intubate into the pharyngeal pouches
- Lesion of vocal cords (affected by recurrent laryngeal nerve)
- Intubation size (too narrow or too wide)
- Intubate too far into one bronchus - (right as more lobes of the lung - more steep bronchus)
- Inflation breaths: incorrect rate, depth
- Pneumothorax
What are some complications of spinal anaesthetic?
- Poor skin quality at site (ie infection)
- Excess fat (high BMI)
- Lesion of muscles
- Wrong site of administration (should be L3/L4)
- Lesion of blood vessels supplying spinal cord
- Low pressure headaches (meningeal headache)
- Administration of drug into wrong space ie sub dural, subarachnoid, epidural
- Administration into intervertebral disc
What are the different types of shock?
- Hypovolaemic
- Cardiogenic
- Septic
- Anaphylatic
- Neuralgic
What is hypovolaemic shock?
-Loss of fluid volume in the blood vessels due to a lesion
What are some causes of hypovolaemic shock?
- Bleeding
- Burns
- Severe dehydration ie N+V, DKA, Diabetes insipidus
What is one of the first signs of hypovolaemic shock?
- Increased resp rate
- Increased heart rate
What is cardiogenic shock?
-Dysfunctional heart. Stops pumping blood effectively around the body
What are some causes of cardiogenic shock?
- Cardiac arrest
- MI
- Cardiomyopathy
- Arrhythmia
What is shock?
-Inadequate perfusion of the tissues and organs
What is septic shock?
-An inflammatory response to bacteraemia
What are signs of septic shock?
- Temperature
- Tachycardia
- Increased resp rate
What is the management for septic shock?
- Fluids
- Antibiotics
- Steroids
- Adrenaline
- Monitor urine output (fluid balance)
- Analgesia
- Find the source
What is anaphylactic shock?
-An exaggerated inflammatory response to a foreign body
What causes the inflammatory process?
- interleukins
- prostaglandins
- histamine
How do you manage anaphylactic shock?
- Adrenaline
- Noradrenaline
- Steroids
- removal of cause
- Fluids
What is neuralgic shock?
- Dysregulation of nerves controlling the blood vessels = vasodilation
- ->Hypovolaemia which doesn’t respond to fluids. Usually post surgery but returns to normal
What are examples of drugs that are p450 inducers?
- Antiepileptics: phenytoin, carbamazepine
- Barbiturates: phenobarbitone
- Rifampicin
- St John’s Wort
- Chronic alcohol intake
- Griseofulvin
- Smoking
What are examples of drugs that are p450 inhibitors?
- antibiotics: ciprofloxacin, erythromycin
- isoniazid
- cimetidine,omeprazole
- amiodarone
- allopurinol
- imidazoles: ketoconazole, fluconazole
- SSRIs: fluoxetine, sertraline
- ritonavir
- sodium valproate
- acute alcohol intake
- quinupristin
What is Phaeochromocytoma?
Phaeochromocytoma is a rare catecholamine secreting tumour. About 10% are familial and may be associated with MEN type II, neurofibromatosis and von Hippel-Lindau syndrome
What are the clinical features of phaeochromocytoma?
Features are typically episodic
- hypertension (around 90% of cases, may be sustained)
- headaches
- palpitations
- sweating
- anxiety
Investigations for phaeochromocytoma?
- 24 hr urinary collection of metanephrines
- CT if metanephrines are positive
What is the treatment for phaeochromocytoma?
-Surgery is the definitive management.
-The patient must first however be stabilized with medical management:
>alpha-blocker (e.g. phenoxybenzamine), given before a
>beta-blocker (e.g. propranolol)
What are some endocrine side effects of glucocorticoids?
- Impaired glucose secretion
- Increased appetite/weight gain, hirsutism, hyperlipidaemia
What are some of the Cushing’s syndrome features?
- Moon face
- Buffalo hump
- Striae
What are some msk side effects of glucocorticoids?
- Osteoporosis
- Proxiaml myopathy
- Avascular necrosis of the femoral head
What are some of the immunosuppression side effects of glucocorticoids
- increased susceptibility to severe infections
- reactivation of tb
What are some psychiatric side effects of glucocorticoids?
- Insomnia
- Mania
- Depression
- Psychosis
What are some GI side effects of glucocorticoids?
-Peptic ulcers adn acute pancreatitis
What are some ophthalmic side effects of glucocorticoids?
- glaucoma
- cataracts
How might steroids affect children adversely?
-Growth suppression
What are some mineralocorticoid side effects?
- Fluid retention
- Hypertension
Which drugs are known to cause impaired glucose intolerance?
- Thiazides
- Steroids
- Tacrolimus
- Ciclopsorins
- Interferon-alpha
- Nicotinic acid
- Antipsychotics
Which vaccines are live attenuated?
- BCG
- MMR
- oral polio
- yellow fever
- oral typhoid
What is Reynold’s pentad?
-Chacot’s triad plus hypotension and confusion
>ruq pain, fever/rigors, vomiting
