Beruflich Dokumente
Kultur Dokumente
Contents
Foreword Glossary 1 Anaesthetics and ITU 2 General Surgery and Urology 3 Orthopaedics and Neurology 4 Cardiovascular 5 Endocrine and Breast 6 Plastics and ENT 7 Your Lists Bibliography Index page vii ix 1 19 43 57 67 77 85 91 93
4 ES SE NT IAL L IS TS
(Baseline peri-operative MI rate is 0.2% of which half are silent and most are on the third post-operative day)
AN AE ST HE TIC S A ND IT U 5
Aldosterone (adrenal cortex): ADH (posterior pituitary): GH (anterior pituitary): Glucagon (pancreatic G cells):
COMPLICATIONS OF VENTILATION
Barotrauma (pneumomediastinum/thorax, subcutaneous emphysema) Volutrauma Air embolism Cardiac output Nosocomial pneumonia Parenchymal lung damage
6 ES SE NT IAL L IS TS
COMPLICATIONS OF INTUBATION
Trauma to teeth or upper airway Procedural hypoxia Aspiration Haemorrhage Blockage Misplacement Cuff puncture/displacement
AN AE ST HE TIC S A ND IT U 7
RESPIRATORY FAILURE
Type I: paO2: 8 kPa and paCO2 : 6.7 kPa) Acute asthma ARDS COPD/emphysema PE Pneumonia Pulmonary brosis Atelectasis Haemo/pneumothorax Type II: paO2: 8 kPa and paCO2 : 6.7 kPa) Severe asthma Spinal injury Severe COPD/emphysema Head injury Bronchiectasis ! ICP Kyphoscoliosis Coma Chest wall trauma Opioids Abdominal distension Muscular dystrophy Phrenic nerve injury Myasthenia gravis Sleep apnoea GuillianBarre syndrome
Metabolic acidosis Metabolic alkalosis: Ketoacidosis Vomiting Acute renal failure Chronic renal failure Lactic acidosis (see below) Hyperaldosteronism Methanol/ethanol Iatrogenic, eg diuretics Fistulae/diarrhoea Alkali abuse TPN Salicylate (late in poisoning)
AN A E ST HE TIC S A ND IT U
8 ES SE NT IAL L IS TS
POST OP HYPOXIA
Pneumonia Atelectasis Bronchospasm Pneumothorax Diaphragmatic splinting Poor analgesia Opioids ARDS/ALI PE Pulmonary oedema Tracheal compression
IV FLUIDS
Crystalloids: Na+ Cl mmol/l mmol/l 154 154 0 0 30 30 131 111 147 156 Dextrose g/l 0 50 40 0 0 K+ Osmolality mmol/l mosm/l 0 308 0 252 0 286 5 279 4 273
Normal saline Dextrose 1/5 Normal saline Hartmanns Ringers lactate Colloids: Albumin Gelofusine Dextrans (40,70) Penta/Hetastarch
AN AE ST HE TIC S A ND IT U 9
TYPES OF SHOCK
Hypovolaemic Septic Cardiogenic Anaphylactic Neurogenic Temp. / !/ / !/ CVP BP TPR ! !
CLASSES OF SHOCK
AN A E ST HE TIC S A ND IT U
Class Vol loss Pulse rate BP Pulse pressure Urine output Resp rate Consciousness Fluid Skin Class Vol loss Pulse rate BP Pulse pressure Urine output Resp rate Consciousness Fluid Skin
I 1015% (0.75 L) :100 930 :20 Restless Crystalloid Normal III 3040% (:2 L) 120
II 3040% (1.5 L) 9100 920 :30 Anxious Cry/colloid Clammy IV 940% (92 L) 9140
10 ES SE NT IAL L IS TS
AN AE ST HE TIC S A ND IT U 11
++ ++ +++
+ ++ ++
++ + +++ + +++
D1 +++
D2 ++
RENAL FAILURE
Pre-renal: Hypovolaemic shock Septic shock Cardiogenic shock Anaphylactic shock ATN Hypertension Diabetic disease Glomerulonephritis Infection/pyelonephritis Renal artery trauma/embolus Renal artery stenosis Compartment/crush syndrome Vasculitis Interstitial nephritis Goodpastures syndrome Renal vein thrombosis/embolism
Renal:
Post-renal: Bladder outlet obstruction Stricture Stones Retroperitoneal brosis Blocked catheter Neoplasm Infection
12 ES SE NT IAL L IS TS
(Original classication used nutrition but later modied to prothrombin time increase)
FEED TYPES
Enteral (EN): Oral NG PEG NJ Jejunostomy Peripheral line PICC Central line
Parenteral (TPN):
AN AE ST HE TIC S A ND IT U 13
Vitamin A epithelial cell proliferation and differentiation Vitamin B6 collagen cross-linkage Vitamin C collagen cross-linkage and transport Vitamin D calcium and phosphate metabolism Carbohydrate prevents ketosis during a stress response Proteins extracellular matrix Zinc RNA/DNA synthesis, metalloproteases, antibacterial Copper collagen and elastin cross-linkage Selenium anti-oxidant
COMPLICATIONS OF EN
Tube related: Feed related: Misplacement Displacement Diarrhoea Bloating/colic Refeeding syndrome Leakage Blockage Nausea/vomiting Drug interactions
AN A E ST HE TIC S A ND IT U
14 ES SE NT IAL L IS TS
COMPLICATIONS OF TPN
Line related: Sepsis/infective endocarditis Thrombophlebitis Pneumothorax Haemothorax Nerve injury Vascular injury/haematoma Feed related: ! Glucose, Na+, K+, H+ ! Ca++, CL Folate, Zn, PO4, Mg++ Fluid overload Thoracic duct injury Chylothorax Embolism Lost guide wire Arrhythmia Perforated right atrium Fatty liver Abnormal LFTs Gall bladder stasis Refeeding syndrome
STEROID EQUIVALENCE
Hydrocortisone Prednisolone Methylprednisolone 20 mg 5 mg 4 mg Triamcinalone 4 mg Betamethasone 0.75 mg Dexamethasone 0.75 mg
TRANSPLANT REJECTIONS
Hyperacute preformed antibody (hours) Accelerated acute secondary antibody response (days) Acute cytotoxic T-cell mediated (weeks) Chronic antibody-mediated vascular damage (months controversial)
AUTOIMMUNE DISEASE
Hashimotos thyroiditis Thyroglobulin + microsome Graves disease TSH receptor Atrophic gastritis Parietal cells Pernicious anaemia Intrinsic factor Goodpastures syndrome Basement membrane Myasthenia Gravis Acetylcholine receptor Systemic Lupus erythematosis DNA smooth muscle Rheumatoid Arthritis IgM Scleroderma Centromere
AN AE ST HE TIC S A ND IT U 15
Primary biliary cirrhosis Mitochondria Insulin-dependent DM Pancreatic islet cells GuillianBarre syndrome Peripheral nerve myelin
CAUSES OF IMMUNOSUPPRESSION
Congenital: Agammaglobulinaemia Hypogammaglobulinaemia IgA deciency Common variable immunodeciency Selective antibody deciency Acquired: Infectious HIV, systemic infection Iatrogenic Splenectomy, transfusion, radiotherapy, chemotherapy, steroids Neoplastic Leukaemia, lymphoma, myeloproliferative diseases, advanced solid tumours Other Hypoxia, DM, alcoholism, poor nutrition, trauma/surgery
AN A E ST HE TIC S A ND IT U
16 ES SE NT IAL L IS TS
Immunosuppression (see above) Cardiac failure Renal failure Hepatic failure Respiratory failure
ANTIBIOTICS
Bacteriocidal: -lactams Aminoglycosides Vancomycin Chloramphenicol Tetracycline Erythromycin Clindamycin
Bacteriostatic:
AN AE ST HE TIC S A ND IT U 17
Upper GIT staph, strep, Neisseria, Haemophilus, corynebacteria, clostridium, yeasts Lower GIT Enterobacteriaceae, enterococci, bacteroides, clostridium, yeasts GU Enterobacteriaceae, enterococci, bacteroides, clostridium, yeasts, staph, strep, lactobacilli, corynebacteria
CLASSIFICATION OF WOUND
uninammed tissue with no GU/GI tract entry (:2% infection rate) Clean-contaminated entry to hollow viscus other than colon with minimal contamination. (810% infection rate) Contaminated spillage from hollow viscus, eg colon, open fractures or bites (1220% infection rate) Dirty frank pus, perforated viscus, traumatic wound (925% infection rate) Clean
TUMOURS IN HIV
Lymphoma non-Hodgkins lymphoma Squamous cell carcinoma skin, cervix, larynx Kaposis sarcoma Squamous cell papilloma
AN A E ST HE TIC S A ND IT U
18 ES SE NT IAL L IS TS
TOXINS
Bacteria Source Structure Effect Vaccine Heat stable Exotoxin Gram +ve and ve Intracellular Polypeptide Variable Yes No Endotoxin Gram ve Cell wall Lipopolysaccharide Septic shock No Yes