Medicine Notes General and Vascular Surgery Notes
Complete set of notes covering the most common general and vascular surgical conditions. Includes pathophysiology, presentation, investigation and management. Clinically orientated with examination tips and colour-coded by topic. A great overview - ideal for written and clinical finals....
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Vascular Emergencies
Trauma
Penetrating wounds
Blunt trauma
Invasive procedures (iatrogenic)
Hard signs (diagnostic)
External pulsatile bleeding
Palpable bruit/thrill
Expansive haematoma
Ischaemic limb
Fracture/dislocation
Soft signs (suggestive of vascular injury but not diagnostic)
History of blood loss at the scene
Proximity of injury to major vessel
Supracondylar and tibial fracture, posterior knee dislocation
Small non-pulsatile haematoma
Neurogenic deficit
Management
IV access (two large bore cannulae) (in contralateral limb – preserve cephalic and saphrenous veins)
Fluid resuscitation
Surgical exploration and repair
Prevent further haemorrhage + salvage ischaemic limb
Chest vascular trauma
Blunt trauma
Pneumothorax/tamponade
CT scan to assess
Most common injury = rupture of descending aorta
Treatment = stent graft
Retroperitoneal bleed
Pelvic fracture
Surgery in pelvis
Spontaneous (warfarin)
Following angiography
Acute Limb Ischaemia
Pain
Pallor
Perishing cold
Parasthesia
Paralysis
Pulseless
Acute ischaemia leads to tissue necrosis in 6 hours unless arterial function restored
Requires prompt assessment and management
Clinical features
Marble white limb progressing to mottled blue (venous filling)
If the mottled limb blanches it is salvageable
Aetiology
Embolism (due to AF etc)
Sudden onset ‘gun shot’ pain
Known embolic condition
Normal pulses in other leg
No previous claudication
Thrombosis
Others = trauma, external compression
Investigations
Baseline bloods
U+E, FBC, group and save
ECG
Seek senior advice regarding imaging
Management
Analgesia
IV morphine
Oxygen (increase perfusion)
IV heparin to prevent clot propagation
Correct hypotension (increase perfusion)
Medical management if patient shows sigs of improvement – may be treatable with IV heparin in addition to treatment of...
Buy the full version of these notes or essay plans and more in our General and Vascular Surgery Notes.
Complete set of notes covering the most common general and vascular surgical conditions. Includes pathophysiology, presentation, investigation and management. Clinically orientated with examination tips and colour-coded by topic. A great overview - ideal for written and clinical finals....
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