MNEMONICS AND TACTICS IN SURGERY AND MEDICINE Get a printable copy (PDF file) of the complete article (K), or click on a page image below to. Print Friendly, PDF & Email. General Surgery Mnemonics. The best gen surgery mnemonics for medical student finals, OSCEs and MRCP. 7. ENDOCRINOLOGY. 8. ETHICS. 9. GASTROENTEROLOGY. GENERAL SURGERY. GYNECOLOGY. HEMEATOLOGY.

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Surgery Mnemonics Pdf

Memory and Medical Mnemonics Rise and Fall of Mnemonics . Surgery. Malignancy. Autoimmune. Scorpion sting. Hypercalcemia. ERCP. Rapid Series Mnemonic in list 1. The surgical procedures follow the six subheadings in list 2. We hope that this textbook will consolidate your personal and. Name, Posted by, Posted on, Rating, Views. treatment in soft-tissue injuries, avijit69, Feb, , "TESTIS", DEEPAKMB, Sep, ,

However, it is often a perplexing problem especially during the early stages of the disease that in some cases could delay the diagnosis and could contribute to the persistent rate of morbidity and mortality. Therefore, the clinician has to improve his diagnostic acumen by looking carefully for those signs and symptoms. Clinical method Here I am presenting my own method for the early diagnosis of acute appendicitis [ 5 ] which has been proved to be helpful in many studies around the world. The method relies on a combination of factors derived from physical signs, symptoms, and laboratory tests. This mnemonics makes the method even easier to follow: First you check for the three main symptoms: Migration, Anorexia, and Nausea or vomiting; then you follow with the signs which are: Tenderness in the right lower quadrant, Rebound pain Blumberg sign and Elevation of the temperature oral temperature of Another indirect sign that can replace the rebound pain is tenderness by gentle direct percussion with the fist, as a mallet, on the right lumbar area in cases of a retrocecal acute appendicitis. In order of decreasing importance the eight best predicting factors proved to be: Localized tenderness on the right lower quadrant, leukocytosis, migration of pain, shift to the left, temperature elevation, nausea and vomiting, anorexia or acetone in the urine and direct rebound pain. I assigned a value of 2 to each of the two of the more important factors tenderness and leukocytosis , and a value of 1 to each one of the others, for a possible total score of A score of 5 or 6 is compatible with the diagnosis of acute appendicitis, a score of 7 or 8 indicates a probable appendicitis, and a score of 9 or 10 indicates a very probable appendicitis. To this score the clinician could subtract 2 points if the patient complains of headache because this symptom is very rare in cases of acute appendicitis. In this particular situation the patient may need further investigation to rule out a different disorder. When the score is three or four, the clinician has two options: This could represent a very early stage of an acute appendicitis so the clinician could keep the patient under observation and repeat the tests, or even more, order additional tests such as an US or CT scan if they are available in that particular setting.

Add to Cart. Add to Wishlist Add to Compare. PDF version print quality. Patients who underwent CT evaluation were included in the final analysis.

Surgery Mnemonics

In fact, a common surgical treatment for ptosis involves shortening the levator tendon to open up the eye. Ill be using this mnemonicmetaphore many times throughout this book to. Publishing Year, This book some key features are: i Molecular basis of common hematological disorders. Acute appendicitis is one of the most common causes of acute abdominal pain. The overall median age of the patients was 33 years range 15 to 82 years: Please dont create mnemonics which will not come handy at need.

Hey jobin. Pls tell me how to utilise my internship and final year for preparation. May 14, They ossify, in order of increasing year:Elbow: 16 yearsPelvis, Ankle: 17 yearsS houlder.

Note: di- means two, so diverticulum is the thing with all the. Jul 1, Apr 27, I know him through a common friend since a couple of months.

This subcutaneous ring of local anesthetic can also be performed distal to the malleoli for a midtarsal block. Deep Peroneal Nerve Block For the perimalleolar approach, the patient is asked to extend the great toe, which will tense and identify the extensor hallucis tendon see Figure 7.

The needle is then withdrawn a few millimeters, and after negative aspiration, 5 mL of local anesthetic is injected. For the midtarsal approach, the extensor hallucis tendon is identified as mentioned above, but more distally, and the pulse of the dorsalis pedis artery is identified on the top of the foot as well.

Posterior Tibial Nerve Block For the perimalleolar approach, a 1.

The needle is directed toward the tibia at a degree angle to contact bone. For the midtarsal approach, there are two approaches.

Ankle Block – Landmarks and Nerve Stimulator Technique

Either the posterior tibial artery is identified below and distal to the medial malleolus on the calcaneus, or the sustentaculum tali is identified. The needle is directed toward the calcaneus, slightly under the bony shelf of the sustentaculum tali, or on either side of the tibial artery. After contact with bone, the needle is withdrawn 2 mm, and 5 mL of local anesthetic is injected.

NYSORA Tips Because the posterior tibial artery is not palpable in all individuals, the sustentaculum tali is a more consistent, easily palpable landmark for posterior tibial nerve block. MAYO BLOCK Clinical Anatomy The Mayo block is a combination of the nerve block and a field block that involves the infiltration of local anesthesia through the tissues proximal to a surgical site in a ring shape around the first metatarsal most commonly or a lesser metatarsal base.

The first and second branches of the common plantar digital nerves, which are superficial branches of the medial plantar nerve, provide sensation to the plantar aspect of the first metatarsal. Indications The Mayo block is commonly used in podiatric office surgery to anesthetize the area before performing bunion or hallux surgery.

The injection can be used with or without epinephrine. Technique The Mayo block consists of three or four separate injections. The block is performed by raising a wheal of local anesthetic proximally and dorsally in the first intermetatarsal space and advancing the needle in the plantar direction while injecting 3—5 mL of local anesthetic Figure The needle is then withdrawn partially and redirected medially, raising a subcutaneous wheal along its course 3—5 mL Figure The needle is then removed and reentered and directed laterally to raise a subcutaneous wheal along the course 3—5 mL Figure Finally, the needle is removed and directed plantar-medially to the metatarsal and injected from medial to lateral underneath the metatarsal bone 3—5 mL Figure The block encircles the entire metatarsal bone.

Mayo block, step 2. After a wheal of local anesthesia is raised at the level of the first intermetatarsal space, the needle is advanced in the plantar direction and 3—5 mL of local anesthetic is injected. Arrow, First metatarsal bone; X, first metatarsal space. Mayo block, step 1. The needle is entered subcutaneously dorsomedially raising a wheal along the course. Arrow, First metatarsal bone; X, first metarsal space. Mayo block, step 3.

The needle is directed medial to lateral subcutaneously and 3—5 mL is injected. Mayo block, step 4. The needle is directed medial to lateral and plantar underneath the metatarsal bone while injecting 3—5 mL of local anesthetic. Choice of Local Anesthetic The decision regarding which local anesthetic solution to use depends on the anticipated duration of surgery and the degree of postoperative pain.

Surgery Mnemonics

Blood levels of plain local anesthetic are well below toxic levels, even when large amounts are used. Bilateral midtarsal blocks performed with up to 30 mL of plain 0. No adverse local anesthetic effects were reported in a series of 66 patients receiving bilateral ankle blocks with mixtures of plain lidocaine and ropivacaine 0.

The addition of epinephrine with ankle block remains controversial. The preponderance of the literature suggests that epinephrine should not be used in distal extremity local anesthesia. However, low concentrations of epinephrine in local anesthetic solutions have been used with remarkable safety.

The overall incidence of severe vascular complications after injection of epinephrine-containing local anesthetics has been estimated to be 1 per , injections. Note that the use of , solutions of epinephrine has a 2. Regardless, epinephrine is probably best avoided altogether in patients with peripheral vascular disease or compromised circulation.

The high-efficacy, prolonged postoperative analgesia and safety of plain bupivacaine and ropivacaine suggest that these drugs should be the choice for surgery in which postoperative pain is expected. However, blocks should be performed 30 minutes before surgery minimum of 20 minutes when using bupivacaine or ropivacaine to maximize success rate. In a prospective analysis of patients, the failure rate was significantly lower after waiting 20 minutes after the injection, with the lowest failure rates occurring after 50 minutes.

NYSORA Tips When using ropivacaine or bupivacaine, perform the block at least 30 minutes before surgery to allow adequate time for block onset. In addition to gentle, slow injection, patients usually benefit from anxiolysis and analgesia with midazolam 1—4 mg and fentanyl 25— mcg.

Before starting surgery, the block should be checked in all five nerve distributions, and supplemental local anesthetic can be injected if necessary.

Tourniquets should have a soft lining or padding and should be placed just above the malleoli. Supplementation by the surgeon intraoperatively may rescue an incomplete block.

Postoperatively, acetaminophen and a nonsteroidal anti-inflammatory drug NSAID can be continued routinely. Depending on the extent and type of surgery, small doses of a long-acting opioid such as controlled-release oxycodone may provide a smooth transition from block to postoperative analgesia and may facilitate rehabilitation.


Ambulation with crutches is possible right after surgery. Elevation of the leg, when not ambulating, may further decrease postoperative pain.

In a retrospective study of patients with pneumatic ankle tourniquet at relatively high pressures of mmHg, there were three cases 0. Ankle tourniquets have been used routinely with as little as mmHg pressure, although a bloodless surgical field may require Thus, no more than mm Hg pressure is necessary, and more pressure may be harmful. The incidence of complications after ankle block is low and is usually in the form of transient paresthesias, which almost always resolve.

Complications may occur from injection or from application of the tourniquet. In a prospective survey of patients with posterior tibial, sural, and saphenous blocks at the ankle and common peroneal block at the knee, no patient developed postanesthetic neuralgia or other complications.

In three other studies with a total of patients who received ankle blocks, no patients developed complications. After midtarsal ankle block in 71 of patients available for follow-up, 1 patient developed transient posterior tibial paresthesias, which resolved in 4 weeks. In another study of 40 patients, 1 developed paresthesias lasting 6 weeks, which resolved.

In a retrospective study of patients who received ankle block followed by a posterior tibial nerve catheter for postoperative analgesia, 5 patients had transient paresthesias, with 1 patient developing neurolysis probably related to the catheter insertion but with complete recovery. In a prospective randomized trial of 32 patients 40 total feet undergoing forefoot surgery under ankle tourniquet inflation pressure mmHg over systolic under complete or selective ankle block of which 26 patients 33 total feet were available for follow-up to injection or tourniquet, 1 had ankle pain, and 1 had cold toes.

Local anesthetic systemic toxicity would be expected to be rare, given the low blood levels after injection.

In another series of patients who received standard and modified ankle blocks as well as digital nerve blocks, 3 patients had vasovagal reactions and 1 had an episode of hypotension and supraventricular tachycardia, thought by the investigators to be from lidocaine toxicity. No other complications were seen in this series.

Both of these patients had altered anatomy, which may have predisposed them to the complication. Avoid injection of large volumes; most ankle blocks can be performed with less than 30 mL of local anesthetic. There should be no resistance to injection at any time. If there is, stop the injection and reposition the needle.

Anesthesiology ;— Wassef MR: Posterior tibial nerve block. A new approach using the bony landmark of the sustentaculum tali. Anaesthesia ;— Br J Anaesthesia ;— Foot Ankle ;— ANZ Surg ;—

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