Surgery drugs/management Flashcards
How would you manage a stroke acutely?
Depends on the cause
Ischaemic stroke- is present within 4.5 hours and meet inclusion criteria then IV alteplase
Aspirin 300mg
Haemorrhagic stroke- correction of any coagulopathy and referall to neurosurgery (for potential clot evacuation)
Thrombectomy is indicated in confirmed acute ischaemic stroke and confirmed occlusion of the proximal anterior circulation on angiography, intravenous thrombolysis is also considered.
What is the management of an abdominal aortic aneurysm which is less than 5.5cm?
Depends on the size
3-4.5 12 monthly US scan
4.6-5.4 3 monthly US scan
Patient with small AAA cardiovascular risks should be reduced as appropriate
- smoking cessation
- improve blood pressure control
- commence statin and aspirin therapy
- weight loss and increased exercise
What is the management of an AAA which is >5.5cm
There are 3 indications of surgery with AAA: >5.5cm in diameter, AAA expanding at >1cm per year, symptomatic AAA in a patient in someone who is fit
2 options- endovascular repair (complication- endovascular leak)
Or open repair
How do you manage a ruptured AAA?
A to E
If unstable then immediate transfer to theatre for open repair
If stable then CT angiogram to determine if the aneurysm is suitable for endovascular repair
How do you treat acute limb ischaemia?
Start the patient on high flow oxygen and ensure adequate IV access
Therapeutic dose of heparin then heparin infusion
If being treated conservatively (Rutherford type 1 and type 2a) give a prolonged course of heparin, they will need regular APTT monitoring
If being treated surgically- embolectomy/ bypass for an embolic cause or angioplasty/byPass for thrombotic disease
How do you treat chronic limb ischaemia?
Lifestyle advice, statin (atorvastatin 80mg OD), clopidogrel 75mg OD, optimise diabetic control, enrollment in local supervised exercise programme to improve walking distance and claudication distance
How do you treat critical limb ischaemia
Surgery- angioplasty or bypass grafting
Amputations are considered for any patients who are unsuitable for revascularisation with ischaemia causing incurable symptoms of gangrene leading to sepsis
How should you treat a thoracic aneurysm?
Increased risk of CVD therefore should be started on medical management- statin and anti platelet therapy to decrease the risk of an MI
Blood pressure should be controlled and smoking cessation is imperative
How do you manage chronic mesenteric ischaemia?
Modify risk factors- smoking cessation and commending anti platelet and statin therapy to minimise the disease progression
Surgical intervention in severe disease-endovascular and open procedures.
How do you treat an arterial ulcer?
Treat by conservative- lifestyle changes/ smoking cessation/ weight loss and increased exercise
Medical- statin, anti platelet, optimisation of glucose and blood pressure
Surgical- angioplasty or bypass grafting
How do you treat a neuropathic ulcer?
Diabetic control optimised, improved diet, exercise regular chiropodist and good foot hygiene and footwear provided
Any signs of infection will warrant swabs taken and antibiotics
Ischaemic or necrotic tissue may require surgical debridement
Amputation if severe
How would you treat haematemesis caused by peptic ulcer disease
A to E
Fluid resuscitation and cross match blood
Adrenaline and high dose PPI therapy (IV 40mg omeprazole) to reduce acid secretion +/- H pylori eradication if necessary
How do you treat haematemesis caused by oesophageal varices?
Endoscopic banding is the most definitive method of manage,ent Somatostatin analogues (ocreotide) or vasopressors (terlipressin) should be started Repeated banding and long term beta blockers should be used
What are 5 alpha reductase inhibitors and alpha 1 antagonists?
Alpha 1 antagonists (just help with symptoms)
5 alpha reductase inhibitors (actually reduce prostate volume)
What is an example of5 alpha reductase inhibitors
Finasteride
