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
Meshes- Biological
- Don't get infected
- Dissolve
- Synthetic
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
Notes
- Replace magnesium before trying to correct potassium
- Apex beat moves if the mediastinum shifts
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