Round

Round
Aug 18, 6:19 PM
Amputation stump - downstream pulse, warmth, infection

Acute thrombosis->antiplatelet therapy
Risk factor: smoking, DM, homocystinemia
5-10 min rest cure claudication walk 100 m; location of claudication -
Lerisch syndrome; sleep pain sit relieve
Subside slowly - venous claudication
Neuropathic most common in diabetes; calluses cause ischemia
Gangrene dry: bypass->amputation; wet: amputate->bypass
Skin and subcutaneous atrophy; Buerger test,angle = vascular angle;
drop->reactive hyperemia
Clinical diagnosis
Medial calcification
Velocity wave form
PVR 60 mmHg; TBI<0.7
Exercise therapy in claudication 30-60 min 3/wk 3 mo: better tolerance
CT angiography for revascularization
Anticoagulant->prevent obstruction, repeated surgery

<1cm telangiectasia (spider vein)
1-3 reticular vein
>3 varicose vein
Fix with aethoxysklerol not >5cm
Dilatation, tortuous, deformity
Sclerotherapy
Tight venous pain, chronic venous insufficiency

Fluid resuscitation for surgery: isotonic; urine SpG <1.02
Antibiotic prophylaxis: clean contaminated wound needs one.; vs
antibiotic therapeutic
Anaerobe: Bacteroides MTX
Set OR, define the skin to operate
Bowel preparation: exacerbate peritonitis, perforation; not in appendicitis
Post-op fluid NSS/2 for how long? + 5% dextrose just to maintain catabolic state
Morphine/pethidine for analgesia, naloxone antidote/on respirator; MO
0.05-0.1 mg/kg

Endothelial injury, stasis, hypercoagulable state; SCD sequential
compressive device; lifestyle; lupus, antiphospholipid syndrome; CA
lung; smoking; protein C,S deficiency; always check pulse
Acute compartment syndrome: sensory loss 1st dorsal web space
Sure DVT -> D-dimer, not sure -> Doppler, duplex, ascending
venography, CTA; Doppler normally like respiration, variable:
respiratory variation, augmentation; heparin keep APTT/PT loading 80
MT 18 cc/kg stimulate ATIII switch warfarin, pressurize leg; warfarin
cause prothrombotic state so start heparin first. Primary DVT 3-6 mo +
FU, secondary treat cause first or lifelong; late complication
alba->cerulea need surgery drip heparin + consult surgery

Patarapol Withayasakpunt
5101006 SIMD/B

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