OCSE Flashcards
What you can’t forget when asking about diabetes? History of micro/macrovascular complicatoons
Micro/Macro vascular complications
When it was diagnosed
Hba1c levels
What have been sugars
Treatment Regimes
If Hba1c% is greater than 8% it is worth to liase with doctors
What are the micro vascular complications?
Nephropathy
Retinopathy
Neuropathy
-peripheral neuropathy
-autonomic neuropathy
Macrovascular complications:
- IHD, CVD: hypertension, hyperlipidarmia, nephropathy
Ophthalmologic surgery
- Opthalamic surgery: previous surgery or retinal detachment is contradicted
2.
What questions you should ask if someone had Mi?
Stents
What are the pertinent questions to ask when patient present for knee/hip/orthopaedic surgery?
Ask about previous general/regional anaesthesia and patient experience of them!
What questions to ask to patient who is hypertensive?
Any ankle sweeping
Orthopnea
Chest pain
SOB
What is a poor predictor of outcome in COPD?
FEV less than 1 is poor prognostic sign in terms of respiratory secretions and increased likehood of requiring respiratory support post operatively?
What are the side effects of blood patch
Seizure
Infections
Another rural puncture
Arrhythmia
Nerve pain (radiculaitis)
What is the lesson learned from analgesia for ex-intravenous drug user?
Patients might not want to have morphine because of the risk of addiction coming back.
Offer epidural/spinal analgesia and that you will discuss with consultant team and other members of the team
What do you offer to patients who’s operation has already been cancelled once?
That they operation would be prioritised as it has already been cancelled once.
If angry patient wants to talk to surgeon what would you say?
- say you have discussed
- say that someone from surgical team will come over and discuss it with her
- offer to have a senior colleague talking to her
What are the indications for awake fibre optic?
- anticipated or difficult airway
-difficult face mask ventilation - to reduce risk of aspiration
-to prevent cardiovascular collapse - minimise mobilisation of the c-spine
What are the absolute contradictions?
Patient refusal/coagulopathy/obstructed airway/allergy to local anaesththethiscs
What are the merications?
Nebulisers
Pastes
Sprays
Superior Laryngeal Nerve Block
Anti-sligagoguse such as glyopyrollate
What are the complications?
TCI propofol and fentanyl
Failure
Bleeding
Harmatoma
Laryngospasm
Local Anaesthethic toxicity
What are the complications?
Failure
Bleeding
Haematoma
Local Anaesthethic Toxicity
What is important to ask when asking about emergence?
-induction
-intraoperative
- emergence
-feeling pain
- any discussion with anaesthetists
What would you explain to patient presenting with awareness?
That this is:
- emergency situation]-obstetric anaesthesia
-difficult airway
What is the difference between EXPLICIT vs IMPLICIT
EXPLICIT - recollection of events
IMPLICIT - poor sleep
Child Refusing Surgery points to remember
- offer anxiolytics
- surgery in the morning
- if child is uncooperative postpone the surgery
- restraining might be traumatic for the child and scar them long-term
Can child refuse surgery?
A child can consent to surgery if having a full capacity that is in his best interest. A child can’t refuse surgery that is in person best interest.
What to do if patient refuses needles?
- canula is not a needle
- for big operations we would need to be checking blood groups
Jehowa’s witness blood products?
Clarify: - fractions, plasma, red blood cells, platelets
ask if factor VII would be ok?it is used for treatment of haemophilia
cell salvage
what you need to clarify with Jehowa witness?
Would day in life/death situation would they rather die than accept blood products
Do they have advance directive?
How would you pre-optimise patient who is Jehowa’s witness and anemic?
the need to treat anemia prior to operation
oral iron if ineffective
EPO should be considered
What are the strategises for minimising blood loss?
- hypotensive anaesthesia
- acute hypervolemic haemodilution
- regional anaesthesia
