14. Peri-Operative Care PART-A COURSE MRCS (UK) Lecture Note
MRCS (UK) PART-A COURSE 14. Peri-Operative Care New Edition: February, 2023 About The DrAcademy The Best Medical Academy for Postgraduate Medical Exams of The Royal Colleges of UK. The DrAcademy [Experienced 12+years] is led by a group of talented doctors from all over the world & managed by a very skillful administrative staff. Our mission is to provide the best quality medical education with a very convenient fees structure to all the doctors who are preparing for MRCP (UK) | MRCS (UK) | MRCOG (UK) | MRCPCH (UK) | FCPS | MD | MS | PLAB & OET. Published by The DrAcademy � 25/2, Level-3, Green Road, Dhanmondi, Dhaka- 1205, Bangladesh � Web: www.thedracademy.com � Facebook: www.facebook.com/thedracademy ✉ Email:
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TOPICS OVERVIEW TOPIC- 01 | WARFARIN ..................................................................................... 3 TOPIC- 02 | SPLENECTOMY ................................................................................. 4 TOPIC- 03 | WOUND HEALING ............................................................................ 5 TOPIC- 04 | PROBLEMS WITH SCARS..................................................................... 6 TOPIC- 05 | BLOOD PRODUCTS - CROSS MATCHING ................................................ 11 TOPIC- 06 | RESPONSE TO SURGERY ................................................................... 12 TOPIC- 07 | INTRAVENOUS ACCESS ..................................................................... 13 TOPIC- 08 | PREPARATION FOR SURGERY ............................................................. 16 TOPIC- 09 | AMERICAN SOCIETY OF ANESTHESIOLOGIST’S PHYSICAL STATUS SCORING SYSTEM (ASA) .............................................................................................. 19 TOPIC- 10 | SURGICAL SITE INFECTION................................................................. 20 TOPIC-11 | SURGICAL COMPLICATIONS ................................................................ 24 TOPIC-12 | BLOOD PRODUCTS .......................................................................... 28 TOPIC-13 | PREPARATION FOR SURGERY.............................................................. 35 TOPIC-14 | POST-OPERATIVE FLUID MANAGEMENT ................................................ 39 TOPIC-15 | PROACTIVE CARE OF OLDER PEOPLE UNDERGOING SURGERY...................... 40 TOPIC- 16 | ATROPINE .................................................................................... 43 TOPIC-17 | DISORDERS OF ACID - BASE BALANCE .................................................. 45 TOPIC-18 | PRE-OPERATIVE FLUID MANAGEMENT.................................................. 50 TOPIC-19 | PYREXIA- POST OPERATIVE................................................................ 59 TOPIC- 20 | PREPARATION FOR SURGERY ............................................................. 63 TOPIC- 21 | THYROID DISEASE........................................................................... 67 TOPIC-22 | ANTIBIOTICS: MECHANISM OF ACTION ................................................. 70 TOPIC-23 | POST PROSTATECTOMY SYNDROMES..................................................... 71
MRCS (UK) Part-A COURSE Peri-Operative Care Lecture Note The DrAcademy, 25/2 Green Road (Level-3), Dhanmondi, Dhaka-1205 Web: www.thedracademy.com | Office: +88-017 9905 0606 Helpline: +88-017 3355 2110 3 Topic- 01 | Warfarin Warfarin is an oral anticoagulant which inhibits the reduction of vitamin K to its active hydroquinone form, which in turn acts as a cofactor in the formation of clotting factor II, VII, IX and X (mnemonic = 1972) and protein C Factors that may potentiate warfarin Liver disease P450 enzyme inhibitors, e.g.: amiodarone, ciprofloxacin Cranberry juice Drugs which displace warfarin from plasma albumin, e.g. NSAIDs Inhibit platelet function: NSAIDs Side-effects Haemorrhage Teratogenic Skin necrosis: when warfarin is first started biosynthesis of protein C is reduced. This results in a temporary procoagulant state after initially starting warfarin, normally avoided by concurrent heparin administration. Thrombosis may occur in venules leading to skin necrosis. Question 1 Which of the following is not directly affected by warfarin? A. Protein C B. Factor II C. Factor VII D. Factor IX E. Factor VIII Correct answer: E. Factor VIII Warfarin affects synthesis of factors II, VII, IX, X and protein C. A reaction - (means cause Toxicity) , Metro , OHA ,empicillin , euthromycin, cimetidine Hyperthyroidism . Warfarin Toxicity : 2, 7, 9 , 10 su synthesis oThe Mx : Stop warfarin & Vitk (not 1/1-moscebIeed) Apce (reverse In I hour FFP (reverse in 4-6hrs) · Wartarin Anti prothrombin Heparin Anti thrombin Heparin : 2 , 9, 10 , 11 , 12 (Prevents activation) Warfarin : 2 , 7 . 9, 10
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