surgery week 9 Flashcards
What s the aneurysm screening program
US from65 years
When do you need to operate on a patient with abdominal aortic aneurysm
5.5 cm
what is the risk of rupture for an aneurysm below 5cm
1%
What is the risk of rupture of an aneurysm that is above 5cm
20-30%
What is the national average risk for surgery on an abdominal aortic aneurysm
below 5%nationally and0.5 at st. mary’s
Is a stent or a surgical graft (open repair) better for abdominal aortic aneurysm
EVAR and a surgical graft
short term EVAR
At 8 years there is a higher rate of endoleak
tachycardic
hypotension
clamy and sweaty
back pain
abdominal aortic anyrism
Patient is hypotensive what do you do immidiatly
shocked- O- blood, colloid (don’tgive dextrose)
if speaking leave him alone
Why do you not give fluid to someone who has a ruptured aortic aneurysm
permissive hypotension
they have a clot stoping to much blood leaving ifyou increase the pressure
bring straight to theatre, or CT to theatre
What would have presented with retroperotonnal pain
acute pancreatitis- amylase
perforated viscus- erect chest X ray
MI- troponin
cross match blood
catherise
analgesia
ABG- see a high lactate, low FBC, acidosis
do a CT on the to theatre to determine the extent, if it is ok for endovascular repair
What symptoms of acute limb ischaemia
- Pain
- pulseless
- paresthesia
- paralyisis
- pale
- cold
What happens when people are revascualrised and the tissue has been dead for a while?
MI due to high potassium
also get lactate
how do manage patients with acute limb ischaemia
IV heparin - prevent propagation
thrombectomy OR do thrombolysis (patient wwith previous by pass surgery)
What are the 2 p that mean that you can’t revive the foot
rf of varicose veins
tumours (especially left- )
preganncy
family history
long standing job
how do you heal venous ulcer
compression bandaging techniche
Venous ulcers
phelbitis
skin changes
bleeding
what are the gold standard for venous incompetence
venous duplex
How yo
radiofrequency ablation
or glue
when do you make
without compression- symptoms, skin changes
