Miscellaneous Flashcards
What is Poland syndrome?
Poland syndrome is a birth defect characterized by an underdeveloped chest muscle and short webbed fingers on one side of the body.
There may also be short ribs, less fat, and breast and nipple abnormalities on the same side of the body. Typically, the right side is involved. Those affected generally have normal movement and health.
How do you classify infected sternotomy wounds?
Classification Postoperative phase on which the infection occurs
Type I In the first week after sternotomy – serosanguinous discharge without evidence of cellulitis, costochondritis or osteomyelitis
Type II Between 2 to 6 weeks after sternotomy – osteomyelitis and or costochondritis on background of purulent mediastinitis
Type III After 6 weeks to years – fistulas or sinuses and chronic osteomyelitis, chondritis and foreign body
What are the treatment options for sternal wound dehiscence?
Negative wound therapy – this will reduce bacterial load, increase blood flow, promote granulation tissue formation and improve respiration function
Surgery
Once there is satisfactory debridement of infected/necrotic tissue, removal of foreign bodies (including wires)
Aim is to fill dead space
Pectoralis major flap either a turnover or rotation advancement
Rectus abdominis flap – can be muscle only or with skin as myocutaneous flap (VRAM)
Omental flap
Describe the Pannus grading
I - apron covers pubic hairline
II - apron covers gentials
III - apron covers upper thigh
IV - apron covers mid thigh
V - apron covers knees
Describe the types of abdominoplasty
- Standard abdominoplasty
- Fleur-de-lys abdominoplasty
This is different to a standard abdominoplasty because it involves a vertical incision from the costal margin down to the pubis, which allows excess skin and tissue to be removed from the sides of the abdomen, not just below
- Lipoabdominoplasty
A combination of liposuction followed by abdominoplasty
- Panniculectomy
Functional excision of large apron to improve patient’s ADLs without undermining or plication of the rectus sheath
What are the different levels of evidence?
1a: Systematic reviews of randomized controlled trials
1b: Individual randomized controlled trials
2a: Systematic reviews of cohort studies
2b: Individual cohort study or low quality randomized controlled trials
3a: Systematic review of case-control studies
3b: Individual case-control study
4: Case series (and poor quality cohort and case-control studies)
5: Expert opinion
Source: Oxford centre for Evidence Based Medicine
What is NCEPOD?
National confidential enquiry into patient outcomes and death
How is NCEPOD categorised?
- Immediate – minutes
- Urgent – hours
- Expedited – days
- Elective – planned
Explain some key NCEPOD findings
NCEPOD 1997 – made suggestions to improve surgical safety, particularly during emergency surgery.
Suggested that operations should not take place out of hours if they can be avoided – this changed practice in the UK and introduced an assessment system of how urgent a case was.
What are the components of the LRINEC score?
CRP (mg/L) ≥150: 4 points
WBC count (×103/mm3) <15: 0 points; 15–25: 1 point; >25: 2 points
Haemoglobin (g/dL) >13.5: 0 points; 11–13.5: 1 point; <11: 2 points
Sodium (mmol/L) <135: 2 points
Creatinine (umol/L) >141: 2 points
Glucose (mmol/L)>10: 1 point
A score >6 has a positive predictive value of 92% of having necrotizing fasciitis
How can extravasation agents be classified?
Vesicants (can be DNA or non DNA binding)
Irritants
Non vesicants
How do you treat extravasation injury?
Updated guidelines in 2017, SACT
DNA binding: localise and neutralise
Non DNA binding: disperse and dilute
Non vesicant: local dry cold compresses
Name some neutralising agents for extravasation injury
Topical DMSA
Dexrazoxane
Hyaluronidase
How do local anaesthetics work?
Local anaesthetic blocks voltage-gated sodium channels to prevent the conduction and propagation of nerve impulses. This occurs quicker when the pKa is similar to the of human tissue and less effective in the presence of an infection.
Describe some pharmacokinetic points regarding local anaesthetics
Local anaesthetics work when in an ionised state
Act faster if acid dissociation constant (pKa) is similar to human tissue (pH 7.4)
Act faster if high diffusion rather than through non-neural tissue
Less effective in infections due to local hypoxia causing a raised tissue pH
More effective when administered in an alkaline state (combined with sodium bicarbonate)
Longer duration of action if more lipid-soluble (high affinity for axons)
What are the types of LA agents?
Esters: a type of para-aminobenzoic acid (PABA)–based anaesthesia
Amide: a type of non-para-aminobenzoic acid (nPABA)–based anaesthesia
What is the difference between amides and esthers?
Esters: metabolised in plasma by pseudocholinesterase to PABA (anaphylaxis)
Amide: metabolised in the liver, less allergy risk.
Name some signs and symptoms of LA toxicity
Head and Neck: Dizziness, Disorientation, Tinnitus, Perioral paresthesia
Heart: Sinus bradycardia leading to sinus arrest, v. fib with bupivacaine.
CNS: Seizures, Coma
How do you treat LA toxicity?
Local anaesthetic toxicity should be treated with immediate first aid, consultation with senior colleagues and anaesthetics, and a lipid rescue protocol.
Intralipid 20% bolus 1.5mL/kg
Infusion at 0.25mL/kg/min.
What is the MOA of botox?
BoNT-A cleaves SNARE proteins at the neuromuscular junction, blocking acetylcholine release, causing reversible muscle paralysis typically lasting 3–6 months.
