Problems Relating to Certain Systemic Conditions Flashcards
What are the components of the surgical sieve?
VITAMIN DIC V - vascular I - inflammatory T - traumatic A - autoimmune M - metabolic I - infection N - neoplastic D - degenerative I - idiopathic C - congenital
Is LA safe to use in pregnancy?
Yes.
The hormonal mechanism shields the uterus from smooth muscle activators.
What is the biggest danger to a foetus in GA?
Anoxia (total depletion of oxygen levels).
Most likely to occur in 3rd trimester as vital capacity of mother’s lungs is decreased and oxygen supply to foetus decreases.
When is the optimum time for a GA in pregnancy
2nd trimester
When is the most common time for spontaneous abortion to occur?
1st trimester
Increased risk of teratogenic drug effects also.
How would you manage a patient with hyperthyroidism?
- OS or use of LA with adrenaline may precipitate thyroid crisis
- Delay surgery until GP gives go ahead.
- GA may be preferable to LA as less upsetting
- Sedation is contraindicated
What are the causes of adrenal insufficiency?
Primary: Addison's - autoimmune breakdown of adrenal glands Secondary: Long term corticosteroids OR Tumour of pituitary - reduces ACTH
What drugs are prescribed for cortisol and aldosterone replacement?
Hydrocortisone
Fludrocortisone
What are the symptoms of adrenal crisis?
Postural hypotension Weakness Vomiting Nausea Fatigue Hypoglycaemia Tachycardia Weak pulse LoC
What are the guidelines for steroid cover with regard to adrenal insufficiency?
NICE Guidelines:
Pts taking 10mg/day prednisolone (or have done in the last 6 months) should be considered.
- Minor dental procedures: no cover
- Medium procedures under LA e.g. RCT: double hydrocortisone dose (up to 20mg) 1 hour before and for 24 hours after
- Major procedures under LA/GA e.g. XTN: 100mg hydrocortisone IM just before surgery, double dose for 24 hours after
How is the immediate management in adrenal crisis?
Crisis = BP below 25% of diastolic
100mg hydrocortisone (IV or IM) alongside saline drip
Adult: 100mg
Child 6+: 50-100mg
Child 1-5: 50mg
Child <1 year: 25mg
Name 3 complications of diabetes mellitus.
- Diabetic ketoacidosis (Type 1): high blood sugar (really dehydrated) so cell sugar is low and body breaks down ketone bodies instead
- Hyperosmolar hyperglycaemic state (Type 2): not as severe as pts have more insulin. Ketone bodies are not broken down
Tx for above: hospital for IV fluids and electrolytes
- Hyperglycaemia (both types): symptoms - tremor, anxiety, dry mouth, sweating, hunger, confusion, slurring words, convulsion, LoC
Tx: sugar drink/gel
If LoC: 1mg glucagon IM
How would you manage a patient with diabetes?
- LA with adrenaline is SAFE to use
- Offer AM appt if possible, ensuring they’ve had breakfast
- Severe diabetics having longer procedures require GKI (glucose, potassium and insulin infusion)
What are the two types of angioedema?
- Hereditary - exaggerated response to minor trauma shared by family members
- due to lack of C1 esterase inhibitor; no complement cascade initiation
- administration of fresh frozen plasma provides this inhibitor
- spontaneous angioedematous attacks treated with steroids - Non-hereditary - allergic response to food, drugs, emotional responses
- if acute reaction occurs treat for anaphylaxis
What is angina?
Occurs when partial occlusion of vessels due to atherosclerosis
What are the symptoms of angina?
Central, crushing chest pain
Radiates to mandible/arm
How is angina treated?
- Place pt upright
- GTN spray under tongue; 2 sprays every 3 mins
- Only repeat once, then begin Tx for MI
- Deliver oxygen 15 l/min CD cylinder
How should you manage a pt clinically who suffers from angina?
- Take a full history
- Use LA without adrenaline if unstable: prilocaine
- Max 2 cartridges of LA w/adrenaline if stable
- Ensure they have GTN with them
- Ensure GTN is in emergency drugs box
- Consider sedation
What is a myocardial infarction?
Complete occlusion of coronary arteries by thrombosis, causing ischaemia of the heart muscle
What are the symptoms of MI?
Same as angina
Plus - nausea and vomiting
How would you manage a pt experiencing MI?
- Make pt comfortable
- 300mg aspirin to chew
- Oxygen administered 15 l/min
- Ring 999
What is infective endocartitis?
Infection of the mural endocardium on the heart valves as a result of bacteraemia
What are the risk factors for IE?
- Congenital heart disease
- Prosthetic heart valve
- Tetralogy of fallot
- Previous IE
- Rheumatic heart disease
- Huntington’s chorea
Would you provide antibiotic cover in a pt with IE?
Not routinely given
Liase with specialist
Weigh up risk vs benefit
Stress GOOD OH! Warn of symptoms: - Malaise and fever - Flu symptoms - SoB - Chest pain when breathing
What is leukaemia?
Increased numbers of abnormal or immature leukocytes
How should you manage a pt with leukaemia?
ALL forms of leukaemia are a contraindication to ANY form of OS
- Always liase with haematologist
- Require FBC before XTN
- Adopt a conservative approach to Tx until in remission
- Higher susceptibility to infection
What are the 3 stages of clot formation?
- Contraction of blood vessel walls
- Plugging of small deficiencies by platelets
- Clotting of the blood
What can cause prolonged bleeding time?
- Vascular damage prevents the arrest by contraction of cut vessel walls
- Platelet abnormalities where there is ineffective plugging of small deficiencies
What are the 2 kinds of platelet abnormalities?
- Thrombocytopaenic purpura - low platelt count e.g. leukaemia
<100 x 10 9/L - use local haemostatic measures
<50 x 10 9/L - do not treat
- Thrombocythaemic purpura - platelet count is raised (related to polycythaemia - raised RBC count)
What factor is insufficient in Haemophilia A?
Factor VIII - males only
What coagulation disorder is also known as Xmas disease?
Haemophilia B - Factor IX insufficiency
Males only
What should you check in patients treated with anticoagulant drugs?
INR - should be less than 4
Clot may be stabilised with Surgicel (oxidise cellulose)
What are some oral presentations of HIV/AIDS?
- Oral candidosis
- Oral hairy leukoplakia
- Kaposi’s sarcoma
What classification is used to assess the fitness of patients before surgery under RA/GA?
ASA Classification
I - normal, healthy individual
II - mild systemic disease that doesn’t limit activity
III - severe systemic disease that isn’t incapacitating
IV - Incapacitating systemic disease; life-threatening
V - Moribund
