looks like my idea hasn't really taken off but I'll just start this weeks anyway...
Pat
Thursday 26 July 2007
Sunday 22 July 2007
meetings in 2042 / week 1 cushing's
hey guys
we were talking about meeting this sem or at least posting our stuff here 2. just want to get the ball rolling and see if anyone is still interested. The best option might be to post our stuff and ask each other questions on the blog. we could have a facilitator for each week who might ask most of the questions and then write a condensed report. It's then possible for everyone to read the blog at any time and actually see the questions being asked and answered, and this will go on for some time for each topic so it's like a continual revision cycle thing-o. I'll volunteer for first and second week if anyone else wants to hop on the bandwagon.
Cheers
Pat
we were talking about meeting this sem or at least posting our stuff here 2. just want to get the ball rolling and see if anyone is still interested. The best option might be to post our stuff and ask each other questions on the blog. we could have a facilitator for each week who might ask most of the questions and then write a condensed report. It's then possible for everyone to read the blog at any time and actually see the questions being asked and answered, and this will go on for some time for each topic so it's like a continual revision cycle thing-o. I'll volunteer for first and second week if anyone else wants to hop on the bandwagon.
Cheers
Pat
Friday 1 June 2007
Week 13 & 14: The Ballet Dancer (PCL 11)
Angela Says:
SURGICAL MANAGEMENT:
DVT:
Surgical treatment tends to be used when medical management, i.e. fibrinolysis or anticoagulation is inadequate to dissolve the clot or when it is contraindicated due to recent surgery, trauma to the CNS etc.
Venous thrombectomy is used to extract the clot and maintain venous patency.
· Firstly the location and extent of the clot is worked out using ultrasound or venography
· The patient is placed on heparin (if not already done so)
· An incision is made to expose the femoral vein and a “Fogarty” catheter is inserted until it squeezes past the clot
· The balloon on the catheter is inflated and the catheter is pulled out slowly, dragging the clot with it
· There is a risk that the clot may become dislodged or break into smaller pieces during the procedure which could lead to PE
· Venous valves may sometimes prevent the passage of a catheter in a retrograde direction down the leg. In this case, the leg may be wrapped tightly with an Esmarch bandage in an attempt to force clot extrusion.
· Heparin is given for 6-12 months after surgery and leg compression devices may also be used.
· If thrombosis is associated with an underlying defect, it must be identified and corrected after the resolution of the DVT, or the thrombosis will recur.
Other procedures:
New percutaneous mechanical techniques have been developed, such as angioscopic thromboembolectomy (same procedure without making an incision in the vein, rather a scope is inserted), mechanical disruption thrombectomy (a laser or other device is used the shake up the clot without invasive surgery) and aspiration thromboembolectomy (aspirates the clot through a needle).
Some of the mechanical devices available today combine clot maceration with suction removal (eg, AngioJet, Hydrolyser, Oasis), while others (eg, the Amplatz device) use clot maceration alone. Maceration at the catheter tip can be achieved by use of physical cutting blades, by vortex, by high- or low-pressure saline jets, by suction alone, or by ultrasonic liquefaction.
After the thrombus has been removed, construction of a small arteriovenous fistula may assist in maintaining patency by increasing the flow velocity through a thrombogenic venous segment.
Source: emedicine: DVT
PULMONARY EMBOLISM (PE):
Treatment usually focuses on oxygen therapy and blood-thinners, drugs to raise blood pressure may also be given.
Again, a catheter technique can be used, the most common being suction thrombectomy. The catheter shoots a salt solution into the blocked vessel, which by increasing the blood osmolarity, pulls water out of the cells and into the vessel which helps break up the clot. Mechanical devices as mentioned above may also be used.
Rarely, physicians recommend open surgery for a pulmonary embolism as mortality can be as high as 25%. The procedure is called pulmonary embolectomy and can involve inserting a catheter via the femoral or internal jugular vein and using fluoroscopic guidance to navigate into the pulmonary artery. Emboli are then extracted from the pulmonary bed using a cup device and syringe suction. Alternatively open surgery may be required but this is extremely rare. Cardiopulmonary bypass (heart-lung machines) may be used to stabilise the patient before the surgery.
Indications for surgical intervention include:
-massive pulmonary embolism
-patient is very ill with no response to anticoagulation or thrombolysis, or thrombolysis is contraindicated because of:
--Recent surgery - within 5 days of operation (10 days of hip operation
--Active bleeding from the bowel or urinary tract etc.
A metal filter, inserted via a catheter, may be placed into the superior and/or inferior vena cava to prevent recurrence
Sources:
-VascularWeb: Pulmonary Embolism, available at: http://www.vascularweb.org/_CONTRIBUTION_PAGES/Patient_Information/NorthPoint/Pulmonary_Embolism.html
-GP notebook: Pulmonary embolectomy, available at:
http://www.gpnotebook.co.uk/cache/-1590362084.htm
-ABC7chicago.com: Pulmonary Embolism, available at:
http://ww2.abc7chicago.com/global/story.asp?s=1230257
SURGICAL MANAGEMENT:
DVT:
Surgical treatment tends to be used when medical management, i.e. fibrinolysis or anticoagulation is inadequate to dissolve the clot or when it is contraindicated due to recent surgery, trauma to the CNS etc.
Venous thrombectomy is used to extract the clot and maintain venous patency.
· Firstly the location and extent of the clot is worked out using ultrasound or venography
· The patient is placed on heparin (if not already done so)
· An incision is made to expose the femoral vein and a “Fogarty” catheter is inserted until it squeezes past the clot
· The balloon on the catheter is inflated and the catheter is pulled out slowly, dragging the clot with it
· There is a risk that the clot may become dislodged or break into smaller pieces during the procedure which could lead to PE
· Venous valves may sometimes prevent the passage of a catheter in a retrograde direction down the leg. In this case, the leg may be wrapped tightly with an Esmarch bandage in an attempt to force clot extrusion.
· Heparin is given for 6-12 months after surgery and leg compression devices may also be used.
· If thrombosis is associated with an underlying defect, it must be identified and corrected after the resolution of the DVT, or the thrombosis will recur.
Other procedures:
New percutaneous mechanical techniques have been developed, such as angioscopic thromboembolectomy (same procedure without making an incision in the vein, rather a scope is inserted), mechanical disruption thrombectomy (a laser or other device is used the shake up the clot without invasive surgery) and aspiration thromboembolectomy (aspirates the clot through a needle).
Some of the mechanical devices available today combine clot maceration with suction removal (eg, AngioJet, Hydrolyser, Oasis), while others (eg, the Amplatz device) use clot maceration alone. Maceration at the catheter tip can be achieved by use of physical cutting blades, by vortex, by high- or low-pressure saline jets, by suction alone, or by ultrasonic liquefaction.
After the thrombus has been removed, construction of a small arteriovenous fistula may assist in maintaining patency by increasing the flow velocity through a thrombogenic venous segment.
Source: emedicine: DVT
PULMONARY EMBOLISM (PE):
Treatment usually focuses on oxygen therapy and blood-thinners, drugs to raise blood pressure may also be given.
Again, a catheter technique can be used, the most common being suction thrombectomy. The catheter shoots a salt solution into the blocked vessel, which by increasing the blood osmolarity, pulls water out of the cells and into the vessel which helps break up the clot. Mechanical devices as mentioned above may also be used.
Rarely, physicians recommend open surgery for a pulmonary embolism as mortality can be as high as 25%. The procedure is called pulmonary embolectomy and can involve inserting a catheter via the femoral or internal jugular vein and using fluoroscopic guidance to navigate into the pulmonary artery. Emboli are then extracted from the pulmonary bed using a cup device and syringe suction. Alternatively open surgery may be required but this is extremely rare. Cardiopulmonary bypass (heart-lung machines) may be used to stabilise the patient before the surgery.
Indications for surgical intervention include:
-massive pulmonary embolism
-patient is very ill with no response to anticoagulation or thrombolysis, or thrombolysis is contraindicated because of:
--Recent surgery - within 5 days of operation (10 days of hip operation
--Active bleeding from the bowel or urinary tract etc.
A metal filter, inserted via a catheter, may be placed into the superior and/or inferior vena cava to prevent recurrence
Sources:
-VascularWeb: Pulmonary Embolism, available at: http://www.vascularweb.org/_CONTRIBUTION_PAGES/Patient_Information/NorthPoint/Pulmonary_Embolism.html
-GP notebook: Pulmonary embolectomy, available at:
http://www.gpnotebook.co.uk/cache/-1590362084.htm
-ABC7chicago.com: Pulmonary Embolism, available at:
http://ww2.abc7chicago.com/global/story.asp?s=1230257
Monday 21 May 2007
Week 12 (PCL 10) Hoping For The Best
Definition:
Hyponaturemia
Hyponatremia is defined as a serum level of less than 135 mmol/L and is considered severe when the serum level is below 125 mEq/L. (The normal serum sodium level is 135-145 mmol/L)
From emedicine (Hyponatremia, Author: Eric E Simon, MD)
Hyponaturemia
Hyponatremia is defined as a serum level of less than 135 mmol/L and is considered severe when the serum level is below 125 mEq/L. (The normal serum sodium level is 135-145 mmol/L)
From emedicine (Hyponatremia, Author: Eric E Simon, MD)
Tuesday 15 May 2007
Week 11 (PCL 9) - Complications (Nephrotic Syndrome)
Definition:
Nephrotic syndrome (NS) is a condition caused by any of a group of diseases that damage the glomerular leading to increased permeability. It is defined by heavy proteinuira (usually >3g/day), hypoalbuminaemia, hyperlipidemia and oedema.
Nephrotic syndrome (NS) is a condition caused by any of a group of diseases that damage the glomerular leading to increased permeability. It is defined by heavy proteinuira (usually >3g/day), hypoalbuminaemia, hyperlipidemia and oedema.
References: Textbook of Medicine – Souhami and Moxham 2002
Elliot
Monday 23 April 2007
Week 8: A Hot Summer's Night - Acute Renal Failure
Definition:
Renal failure is failure of renal excretory function due to decreased glomerular filtration rate and may be accompanied by failure of:
· EPO production
· Vitamin D hydroxylation
· Regulation of acid-base
· Regulation of salt-water balance and blood pressure
Acute renal failure is abrupt deterioration of this function and may be reversible.
It leads to uraemia and/or oliguria and is life-threatening due to the subsequent biochemical malfunctions.
Sources: Kumar and Clarke
From Angela
Renal failure is failure of renal excretory function due to decreased glomerular filtration rate and may be accompanied by failure of:
· EPO production
· Vitamin D hydroxylation
· Regulation of acid-base
· Regulation of salt-water balance and blood pressure
Acute renal failure is abrupt deterioration of this function and may be reversible.
It leads to uraemia and/or oliguria and is life-threatening due to the subsequent biochemical malfunctions.
Sources: Kumar and Clarke
From Angela
Monday 16 April 2007
Thursday 12 April 2007
Katie Says:
Causes of sleep apnoea:
During sleep the activity of the respiratory muscles is reduced, especially during REM* sleep. During this time the diaphragm can be the only muscle to maintain respiration. Particularly because of reduced muscle tone during sleep, obstructive sleep apnoea occurs because the airway at the back of the throat is sucked closed more easily, creating narrowing of the airway that can result in snoring. Usually people with obstructive sleep apnoea have an airway that is more narrow than normal.
*REM stands for 'rapid eye movement'. It is a stage of sleep that is characterized by rapid movements of the eye and low muscle tone. It occupies around 25% of sleep and we might have 4 or 5 periods of REM during one night.
Particular parts of the throat can cause trouble and increase risk:
Enlarged tonsils- eg tonsillitis
pharangeal soft tissue changes in **acromegaly or hypothyroidism
nasal obstruction- nasal deformities, rhinitis, polyps, adenoids
large tongue
normally narrow airway- eg obesity
certain shapes of palate and jaw
large neck
**Acromegaly is a hormonal disorder when the pituitary gland produces excess growth hormone
Lifestyle factors that make obstructive sleep apnoea worse:
overweight with lack of exercise contributing to this
COPD , for example as a consequence of smoking or occupational dust
sleeping on one's side instead of the back can make obstructive sleep apnoea worse in some people
Consumption of alcohol and sedatives before bedtime can reduce muscle tone due to a 'dampening effect' in the Central Nervous System, particularly within the respiratory centre in the Medulla
References:
Medline Plus Encyclopedia, "sleep apnoea"
http://www.nlm.nih.gov/medlineplus/ency/article/000811.htm
http://www.entcolumbia.org/osa.htm
Kumar and Clark, "obstructive sleep apnoea"
Talley and O'conner, "apnoea"
Causes of sleep apnoea:
During sleep the activity of the respiratory muscles is reduced, especially during REM* sleep. During this time the diaphragm can be the only muscle to maintain respiration. Particularly because of reduced muscle tone during sleep, obstructive sleep apnoea occurs because the airway at the back of the throat is sucked closed more easily, creating narrowing of the airway that can result in snoring. Usually people with obstructive sleep apnoea have an airway that is more narrow than normal.
*REM stands for 'rapid eye movement'. It is a stage of sleep that is characterized by rapid movements of the eye and low muscle tone. It occupies around 25% of sleep and we might have 4 or 5 periods of REM during one night.
Particular parts of the throat can cause trouble and increase risk:
Enlarged tonsils- eg tonsillitis
pharangeal soft tissue changes in **acromegaly or hypothyroidism
nasal obstruction- nasal deformities, rhinitis, polyps, adenoids
large tongue
normally narrow airway- eg obesity
certain shapes of palate and jaw
large neck
**Acromegaly is a hormonal disorder when the pituitary gland produces excess growth hormone
Lifestyle factors that make obstructive sleep apnoea worse:
overweight with lack of exercise contributing to this
COPD , for example as a consequence of smoking or occupational dust
sleeping on one's side instead of the back can make obstructive sleep apnoea worse in some people
Consumption of alcohol and sedatives before bedtime can reduce muscle tone due to a 'dampening effect' in the Central Nervous System, particularly within the respiratory centre in the Medulla
References:
Medline Plus Encyclopedia, "sleep apnoea"
http://www.nlm.nih.gov/medlineplus/ency/article/000811.htm
http://www.entcolumbia.org/osa.htm
Kumar and Clark, "obstructive sleep apnoea"
Talley and O'conner, "apnoea"
Monday 9 April 2007
Week 6-Wake up, Dad!
hey everyone, sorry to whoever is chair, but I created a new post cuz I'm keen to post my stuff ( seriously putting off sudying for exam)
ang.
ang.
Monday 26 March 2007
Week 5 - Anna's out of Breath
Hey Guys,
Hope you all have a great week. This thing took me so long to figure out..jeez..ah well..Happy posting!!
Hope you all have a great week. This thing took me so long to figure out..jeez..ah well..Happy posting!!
Monday 19 March 2007
Monday 12 March 2007
Wednesday 7 March 2007
Monday 26 February 2007
Week 1 - Hans at the Football
Hey guys, welcome to the new blog! Hope you all figure it out ok...
To post all your information, just reply to this post as a comment, that way it's all under the week 1 heading. Whoever is chairing next week just create a new post by signing in...
Good luck!
Shane
Unconsciousness:
"A dramatic alteration of mental state that involves complete or near-complete lack of responsiveness to people and other environmental stimuli"
eg. a coma
Unconsciousness is not an altered state of consciousness (eg. delerium), normal sleep, or hypnosis, as response to stimuli is shown.
Unconsciousness should not be confused with the psycoanalytical unconscious (cognitive processes)
Causes include traumatic brain injury, brain hypoxia, poisoning with CNS depressants, and severe fatigue.
Syncope:
The medical term for fainting.
"Syncope is a sudden (and generally momentary) loss of consciousness, or blacking out due to the Central Ischaemic Response, [due] to a lack of sufficient... oxygen reaching the brain"
Symptoms immediatly before fainting include:
- dizziness
- dimming of vision
- tinnitus
- hot flush
Causes:
- dehydration
- hypotension
- hypoglycaemia
- lack of sleep
- excessive physical exertion
- arrythmia
- other cardiovascular conditions (eg. subclavian steal syndrome, aortic stenosis)
All quoted or paraphrased from Wikipedia (keywords "unconsciousness" and "fainting")
To post all your information, just reply to this post as a comment, that way it's all under the week 1 heading. Whoever is chairing next week just create a new post by signing in...
Good luck!
Shane
Unconsciousness:
"A dramatic alteration of mental state that involves complete or near-complete lack of responsiveness to people and other environmental stimuli"
eg. a coma
Unconsciousness is not an altered state of consciousness (eg. delerium), normal sleep, or hypnosis, as response to stimuli is shown.
Unconsciousness should not be confused with the psycoanalytical unconscious (cognitive processes)
Causes include traumatic brain injury, brain hypoxia, poisoning with CNS depressants, and severe fatigue.
Syncope:
The medical term for fainting.
"Syncope is a sudden (and generally momentary) loss of consciousness, or blacking out due to the Central Ischaemic Response, [due] to a lack of sufficient... oxygen reaching the brain"
Symptoms immediatly before fainting include:
- dizziness
- dimming of vision
- tinnitus
- hot flush
Causes:
- dehydration
- hypotension
- hypoglycaemia
- lack of sleep
- excessive physical exertion
- arrythmia
- other cardiovascular conditions (eg. subclavian steal syndrome, aortic stenosis)
All quoted or paraphrased from Wikipedia (keywords "unconsciousness" and "fainting")
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