Surgery C CBLs Flashcards
Common drug causing oral ulceration
Nicorandil
Red flags associated with head and neck malignancy
- unexplained ulceration in oral cavity > 3 weeks
- persistent and unexplained lump in neck
- lump on lip or in oral cavity
- Erythroplakia
- Erythroleukoplakia
Assessing a patient with burns
- ABCDE
- Primary survey, secondary survey assessing for further injuries
- Assess TBSA and depth with a Lund and Browder chart
- will help aid fluid resuscitation
What chart will you use to help assess TBSA?
Rule of 9s
- arm = 4.5%
- leg = 9%
- Torso = 18%
Signs of an inhalation injury
- tachypnoea
- hoarse voice
- facial hair loss
- swollen neck
- low sats on pulse oximetry
- high carbon monoxide levels
- alterations in voice
What is important to consider if you suspect an inhalation burn injury?
- early intubation
- call the anaesthetist to aid in early airway management
SUPERFICIAL BURN
- epidermis only
- like sunburn: red and painful
- no blister
- skin blanches
- does not scar
Superficial partial thickness
- epidermis and upper layer of dermis
- pink and painful
- blistering
- heals usually without scar
Deep partial thickness
- epidermis and lower layers of dermis
- red and fixed (does not blanch with pressure)
- may require surgical intervention
Full thickness burn
- all layers of skin, subcut and muscle
- LEATHERY SKIN
- does not blanch
- lack of cap refill
- needs surgical intervention
Formula used for resuscitation
PARKLAND FORMULA in burns
1/2 volume in first 8 hours
1/2 volume in next 16 hours
4mls x BODY WEIGHT x TBSA% = TOTAL FLUIDS FOR 24 HOURS
Procedures used to manage very severe burns
ESCHAROTOMY
- divide burned tissue to allow perfusion to be maintained in the limb
Why might limbs with circumferential full thickness burns swell?
- circumferential full thickness burn acts like a tourniquet
- limb swells due to injury
- perfusion pressure of limb can be overcome by tightness of burn
Concerns of an electrical burn
1. Electrical injuries —> can cause significant myocardial instability
- needs cardiac monitoring
- monitoring and adjustment of electrolytes as required
- beware AKI due to myoglobinuria
2. Upper limb
- Compartment syndrome
- due to superheating and necrosis of muscles
3. Patient intubated
- difficult to ascertain history
- medications and drug allergies
Fasciotomy vs Escharotomy
Escharotomy
- divides eschar (full thickness burn)
- performed on limbs and torso
- can be performed at bedside
- largely prophylactic
Fasciotomy
- divides deep fascia of limbs
- under GA
- prophylactic or therapeutic
- almost exclusively applies to high voltage electrical burns
When might an adenoidectomy be beneficial in children:
if child has glue ear and nasal obstruction due to adenoidal hypertrophy
What type of hearing loss is likely due to an acute infection with residual glue ear and tympanic membrane perforation
CONDUCTIVE HEARING LOSS
Management of acute mastoiditis
- discuss with neurosurgeons due to possible erosion into posterior cranial fossa
- start anticoag for possible VTE
Complications of mastoiditis
Intracranial
- abscesses
- empyema
- meningitis
- venous thrombosis
- otitic hydrocephalus
Extra-cranial
- abscess
- hearing loss
- facial nerve palsy
- labyrinthitis
Why might a cholesteatoma cause imbalance?
Cholesteatoma can erode through bone
- destroying ossicles and even causing erosion into the lateral semi-circular canal
- resulting in impaired vestibular function and possibly dead ear
What is a cholesteatoma?
- ingrowth of keratin in tympanic membrane retraction area
- it expands and erodes bone around it
- histologically benign but locally aggressive as it can erode bones
What might be seen in a patient with diabetic maculopathy?
- Microaneurysms
- Hard exudates
- Blot haemorrhages
- Cotton wool spots
- Neovascularisation
What is glaucoma?
Build up of aqueous humour due to blockage of trabecular meshwork.
Increased pressure of eye
Could cause damage to the optic nerve
What might be seen in central retinal vein occlusion?
- tortuous retinal veins
- diffuse intraretinal haemorrhages in all four quadrants
- cotton wool spots
- swollen optic disc
- retinal oedema
STORMY SUNSET
What is used to dilate the eyes during ophthalmoscopy?
Tropicamide?
Cataracts surgery involves
- incision is made into eye
- emulsification: breaks up cloudy lens
- intraocular lens implanted
- incision heals on its own
measure outcomes in quality of life and PROMS
Management of GCA (temporal arteritis)
If no vision loss –> high dose prednisolone
Some visual changes –> high dose prednisolone
VISION LOSS –> IV methyl pred
remember ESR > 50
Key features of acute closed angle glaucoma
-
Presenting features:
- ACUTE
- severe unilateral eye pain
- nausea and vomiting
- haloes around bright lights
-
Epidemiology
- women 4x more
- common in Inuit, southeast Asian and Chinese populations
- 50+
-
Examination
- unilateral red eye
- cloud cornea
- oval non-reactive pupil
-
Management
- same day admission
- risk of permanent vision loss!
- same day admission
Otitis Externa common pathogens (3)
Pseudomonas Aeruginosa
Staph aureus
E Coli
Tx of Otitis Externa
- Topical acidifier
- Topical ABx
- ciprofloxacin
OR
- gentamicin and hydrocortisone - Oral ABx
- oral flucloxacillin
If concerns about anaerobic infection –> METRONIDAZOLE
Tx of chronic suppurative otitis media
- Topical Abx –> CIPROFLOXACIN
OR
- gent and hydrocortisone
Surgery –> Tympanoplasty
Summarise causes Dizziness
- Vestibular neuronitis
- BPPV
- Meniere’s disease
- Vestibular migraine
- Labyrinthitis
Benign positional paroxysmal vertigo could be confirmed and treated by what
Confirmed by History and Dix Hallpike manoeuvre
Treated with Epley
Meniere’s disease characterised by what symptoms
- Aural fullness
- Tinnitus
- Deafness
Management of Meniere’s disease
- Prochlorperazine: not long term!
- Trans tympanic steroids
- Chemical labyrinthectomy
- gentamicin ablation
Key features of labyrinthitis
- tinnitus
- vertigo
- viral URTI
- hearing loss
Ramsay hunt syndrome most commonly caused by
Herpes zoster oticus
Mx of Ramsay Hunt syndrome
- Prednisolone 1mg/kg OD 7 days then taper
- PPI
- Viscotears
- Antivirals -> valacyclovir
Most common causes of acute otitis media
H Influenza
S pneumoniae
M catarrhalis
What type of viruses cause croup
Parainfluenza
What type of viruses cause epiglottitis
H influenza
Features of retrobulbar haemorrhage
- pain behind eye
- sticky out eye
- opthalmoplegia
Treatment of retrobulbar haemorrhage
- IV steroids
- ACETALZOLAMIDE - to reduce IOP
- Mannitol - osmotic diuretic
Definitive management
- surgical decompression
- LATHERAL CANTHOTOMY
Management of diabetic eye
Mx: retinal laser photocoagulation
ANTI-VEG F –> ranibizumab
Key features of hypertensive retinopathy on fundoscopy
- haemorrhages
- exudates
- cotton wool spots
- macular star
Which virus is associated with posterior uveitis
TOXOPLASMOSIS –> black scar on fundscopy
Management of anterior uveitis
- Steroid drops
- Dilating
- cyclopentolate
- atropine - Peri-orbital steroid injection
- subconjunctival dexamethasone
Management of acute closure glaucoma
- LIE PATIENT DOWN
- PILOCARPINE
- to constrict pupil
- 2% for BLUE eyes
- 4% BROWN eyes - IV acetazolamide
- reduce aqueous humour - Timolol
- LASER IRIDIOTOMY
When is central vision affected in retinal detachment?
When macular detached
Management of retinal detachment
SURGERY
- laser scars to weld retina in place
Layers of epidermis
COME LETS GET SUN BURNT
Corneum
Lucidum
Granulosum (3-5)
Spinosum (8-10)
Basal
Dermis
Jackson’s Burn zones
Zone of coagulation –> irreversible
Zone of Stasis –> decreased tissue perfusion
Zone of hyperaemia –> increased tissue perfusion, tissue usually recovers
Vestibular rehabilitation exercises
COOKSEY-CAWTHORNE exercises
Grading for facial palsy
HOUSE BRACKMANN GRADING (1-6)
