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13.01.21 Ward notes

ASA Grade: Physical Status Classification
  • I: Healthy patient
  • II: Systemic disease without functional limitation
  • III: Severe systemic disease with definite functional limitation
  • IV: Patient with severe systemic disease that is a constant threat to life
  • V: Moribund patient unlikely to survive 24 hours with or without an operation

Causes of renal failure post-surgery - Crying man
  • Reduced perfusion
  • Gentamycin
  • Cholangitis
  • CT contrast

Spigelian hernia
  • Hernia through the spigelian fascia
    • Aponeurotic layer between the rectus abdominis muscle medially, and the semilunar line laterally
    • Most occur on the right side
  • Generally interparietal hernias
    • Do not lie below the subcutaneous fat but penetrate between the muscles of the abdominal wall
    • Therefore there is often no notable swelling.
  • Usually small and therefore risk of strangulation is high
  • Commonest in 4th–7th decades of life
  • Compared to other types of hernias they are rare
  • Presentation:
    • Either an intermittent mass, localized pain, or signs of bowel obstruction
  • Treatment
    • These hernias should be repaired because of the high risk of strangulation
    • Surgery is straightforward, with only larger defects requiring a mesh prosthesis

  • Biological
    • Don't get infected
    • Dissolve
  • Synthetic
    • Strong
    • Cheap

Alvarado score
  • Scoring system for appendicitis
  • Scored out of 10 (2 points for RIF pain and leukocytosis)
  • Mnemonic:
    • M: Migration to the right iliac fossa
    • A: Anorexia / Ketonuria
    • N: Nausea/Vomiting
    • T: Tenderness in the right iliac fossa - 2 points
    • R: Rebound pain
    • E: Elevated temperature (fever)
    • L: Leukocytosis - 2 points
    • S: Shift of leukocytes to the left (neutrophilia)
  • Interpretation:
    • 5 or 6 : Compatible with the diagnosis of acute appendicitis
    • 7 or 8 : Probable appendicitis
    • 9 or 10 : Very probable acute appendicitis


  • Replace magnesium before trying to correct potassium
  • Apex beat moves if the mediastinum shifts