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