The document discusses various complications that can occur after thyroid surgery. Some immediate complications include hemorrhage, infection, recurrent laryngeal nerve palsy, thyroid crisis or storm, and respiratory obstruction. Late complications include thyroid insufficiency, recurrent thyrotoxicosis, progressive exophthalmos, and hypertrophic scarring. The recurrent laryngeal nerve is at risk and its anatomy is discussed. Injury can cause temporary or permanent vocal cord paralysis. Management depends on whether paralysis is unilateral or bilateral.
The document discusses various complications that can occur after thyroid surgery. Some key complications include recurrent laryngeal nerve injury, which can cause temporary or permanent hoarseness and has an incidence of 1-5%; hematoma formation; wound infections; seromas; respiratory obstruction; and hypoparathyroidism. Preventing complications involves careful identification and protection of structures like the recurrent laryngeal nerve and parathyroid glands during surgery. Management depends on the specific complication but may include drainage, antibiotics, voice therapy, or calcium/vitamin supplementation.
Postoperative Thyroid Surgery ComplicationsHossam atef
The document discusses the anatomy and physiology of the trachea. It notes that the trachea lies in the midline of the neck, has 20 C-shaped cartilage rings, and becomes intrathoracic at the 6th ring. During respiration, the trachea and bronchi change in length and diameter due to their elastic structure. The document then discusses various complications that can arise from thyroid surgery, including hemorrhage, infection, recurrent laryngeal nerve injury, respiratory obstruction, and parathyroid issues. It provides details on preventing, diagnosing, and managing each complication.
The document discusses thyroidectomy, including:
- Types of thyroidectomy such as hemithyroidectomy, subtotal thyroidectomy, and total thyroidectomy.
- Surgical anatomy of the thyroid gland and related structures like the recurrent laryngeal nerve.
- Preoperative preparation, the surgical procedure, and postoperative management of complications like hemorrhage and recurrent laryngeal nerve injury.
This document provides information about tracheostomies including the procedure, indications, complications, and post-operative care. A tracheostomy is a surgical opening created in the windpipe to allow for breathing when the mouth or nose are unable to be used. It involves making an incision below the larynx and inserting a tube. Tracheostomies are used when the airway is obstructed or for long-term ventilation. Potential complications include bleeding, infection, and tracheal stenosis. Ongoing care involves suctioning, humidification, and assessing for decannulation.
SURGICAL MANAGEMENT OF THYROID SWELLING AND COMPLICATION OF (5).pptxAshwathkumar40
This document discusses surgical management and postoperative complications of thyroid surgery. It describes various types of thyroid surgeries including hemithyroidectomy, subtotal thyroidctomy, total thyroidctomy, and more. Critical steps of the surgical procedure are outlined including positioning, incision, identification and preservation of recurrent laryngeal nerve, and hemostasis. Potential complications such as hemorrhage, nerve injury, hypocalcemia, and vocal cord paralysis are reviewed. Management of thyroid cancers and long term follow up with radioactive iodine are also summarized.
A tracheostomy is a surgically created opening in the trachea to allow for breathing when the mouth or nose cannot be used. It involves making an incision through the neck and inserting a tracheostomy tube. The procedure has a long history dating back to ancient Egypt and India. Modern tracheostomies can be performed as emergencies or electively, and tubes can be temporary or permanent depending on the condition. Complications include bleeding, infection, and damage to nearby structures like blood vessels or the esophagus. Ongoing care is required to clean and change tubes as needed.
TRACHEOSTOMY is a surgical procedure to maintain a patent airway to the person who is in airway distress or electively in certain surgical procedures like oncological resections to maintain an adequate oxygenation to the patient by creating a stoma on the trachea
This document discusses the management of coarctation of the aorta. It provides indications for intervention based on gradient measurements and presence of complications. It describes the critical management of neonatal coarctation including stabilization measures. The timing of intervention depends on factors like age, blood pressure, and heart failure status. Surgical techniques discussed include resection with end-to-end anastomosis, extended end-to-end anastomosis for hypoplastic arch, and left subclavian patch aortoplasty to avoid a circumferential suture line. Complications addressed include spinal cord ischemia and managing the physiology of aortic clamping and declamping.
The document discusses various complications that can occur after thyroid surgery. Some key complications include recurrent laryngeal nerve injury, which can cause temporary or permanent hoarseness and has an incidence of 1-5%; hematoma formation; wound infections; seromas; respiratory obstruction; and hypoparathyroidism. Preventing complications involves careful identification and protection of structures like the recurrent laryngeal nerve and parathyroid glands during surgery. Management depends on the specific complication but may include drainage, antibiotics, voice therapy, or calcium/vitamin supplementation.
Postoperative Thyroid Surgery ComplicationsHossam atef
The document discusses the anatomy and physiology of the trachea. It notes that the trachea lies in the midline of the neck, has 20 C-shaped cartilage rings, and becomes intrathoracic at the 6th ring. During respiration, the trachea and bronchi change in length and diameter due to their elastic structure. The document then discusses various complications that can arise from thyroid surgery, including hemorrhage, infection, recurrent laryngeal nerve injury, respiratory obstruction, and parathyroid issues. It provides details on preventing, diagnosing, and managing each complication.
The document discusses thyroidectomy, including:
- Types of thyroidectomy such as hemithyroidectomy, subtotal thyroidectomy, and total thyroidectomy.
- Surgical anatomy of the thyroid gland and related structures like the recurrent laryngeal nerve.
- Preoperative preparation, the surgical procedure, and postoperative management of complications like hemorrhage and recurrent laryngeal nerve injury.
This document provides information about tracheostomies including the procedure, indications, complications, and post-operative care. A tracheostomy is a surgical opening created in the windpipe to allow for breathing when the mouth or nose are unable to be used. It involves making an incision below the larynx and inserting a tube. Tracheostomies are used when the airway is obstructed or for long-term ventilation. Potential complications include bleeding, infection, and tracheal stenosis. Ongoing care involves suctioning, humidification, and assessing for decannulation.
SURGICAL MANAGEMENT OF THYROID SWELLING AND COMPLICATION OF (5).pptxAshwathkumar40
This document discusses surgical management and postoperative complications of thyroid surgery. It describes various types of thyroid surgeries including hemithyroidectomy, subtotal thyroidctomy, total thyroidctomy, and more. Critical steps of the surgical procedure are outlined including positioning, incision, identification and preservation of recurrent laryngeal nerve, and hemostasis. Potential complications such as hemorrhage, nerve injury, hypocalcemia, and vocal cord paralysis are reviewed. Management of thyroid cancers and long term follow up with radioactive iodine are also summarized.
A tracheostomy is a surgically created opening in the trachea to allow for breathing when the mouth or nose cannot be used. It involves making an incision through the neck and inserting a tracheostomy tube. The procedure has a long history dating back to ancient Egypt and India. Modern tracheostomies can be performed as emergencies or electively, and tubes can be temporary or permanent depending on the condition. Complications include bleeding, infection, and damage to nearby structures like blood vessels or the esophagus. Ongoing care is required to clean and change tubes as needed.
TRACHEOSTOMY is a surgical procedure to maintain a patent airway to the person who is in airway distress or electively in certain surgical procedures like oncological resections to maintain an adequate oxygenation to the patient by creating a stoma on the trachea
This document discusses the management of coarctation of the aorta. It provides indications for intervention based on gradient measurements and presence of complications. It describes the critical management of neonatal coarctation including stabilization measures. The timing of intervention depends on factors like age, blood pressure, and heart failure status. Surgical techniques discussed include resection with end-to-end anastomosis, extended end-to-end anastomosis for hypoplastic arch, and left subclavian patch aortoplasty to avoid a circumferential suture line. Complications addressed include spinal cord ischemia and managing the physiology of aortic clamping and declamping.
The document discusses laryngeal trauma. It begins by describing the anatomy and functions of the larynx. It then covers the causes, symptoms, diagnosis, and management of laryngeal injuries. Common causes include blunt injuries from accidents, strangulation, or penetrating injuries. Diagnosis involves examination, imaging like CT scans, and direct laryngoscopy. Injuries are classified into four groups based on severity. Minor injuries may be observed while more severe injuries involving exposed cartilage or vocal cord immobility require surgical exploration and repair to restore the laryngeal framework and phonation.
The thyroid and parathyroid glands are crucial components of the endocrine system, and surgical interventions are often necessary to address various conditions affecting these glands. Understanding the surgical importance and anatomy of the thyroid and parathyroid glands is essential for endocrine surgeons, otolaryngologists, and healthcare professionals involved in the management of thyroid and parathyroid disorders. Surgical interventions aim to restore hormonal balance, treat underlying conditions, and optimize patient outcomes.
The document discusses various vascular emergencies that can be diagnosed using ultrasound. It outlines tools like ultrasound, CT, MR and DSA that can be used and highlights advantages of ultrasound like being readily available, portable, and having good temporal resolution. It describes acute conditions like ruptured aortic aneurysm, acute carotid thrombosis, carotid and vertebral dissections, pseudoaneurysms, acute limb ischemia and graft failure. For each condition, it provides ultrasound findings, diagnostic criteria and treatment options. It emphasizes the importance of prompt diagnosis, accurate assessment and timely intervention in managing vascular emergencies.
The document discusses splenic injuries, providing details on the surgical anatomy, blood supply, assessment, investigations including FAST scan and CT scan, grading of injuries, and management approaches including conservative management, splenorrhaphy, splenectomy, embolization, and complications like overwhelming post-splenectomy infection. Splenic injuries are most commonly caused by blunt trauma to the abdomen and can range from minor injuries to severe lacerations requiring surgical intervention.
Tracheostomy is a surgical procedure that creates an opening in the trachea through the neck. It is commonly performed to bypass upper airway obstructions or to facilitate prolonged mechanical ventilation. Potential indications for tracheostomy include prolonged intubation, neurological impairment putting one at risk for aspiration, and obstructive sleep apnea. Complications can include bleeding, infection, tube dislodgement, and tracheal stenosis. Care of the tracheostomy involves tube changes, suctioning, humidification, and assessing readiness for decannulation.
TURP is a common procedure to relieve BPH symptoms by resecting prostate tissue. Key considerations for anesthesia include assessing cardiac, respiratory and renal function due to the elderly patient population. Regional anesthesia is preferred to allow early detection of complications like TURP syndrome. Potential intraoperative complications are hypotension, hemorrhage, bladder/capsule perforation, hypothermia, and infection. Careful fluid management and warming are important due to large irrigation fluid volumes.
Aortic dissection, pathophysiology, risk, incidence, types and treatment, Moh...Moh'd sharshir
This document presents a case of a 55-year-old man with a history of diabetes, hypertension, and prior stroke who was transferred for endovascular aortic repair after a motor vehicle accident caused multiple injuries including head trauma, chest trauma, cardiac contusion, aortic injury, and bone fractures. On examination, he was intubated and sedated. Imaging showed aortic pseudoaneurysm, lung effusions, and subcutaneous emphysema. The document then reviews aortic dissection including types, risk factors, clinical manifestations, diagnosis, and involvement of the ascending versus descending aorta.
1) The document discusses guidelines for the resuscitation and transportation of trauma patients, emphasizing the importance of the "Golden Hour" where 80% of trauma deaths occur in the first hour after injury.
2) It outlines the systematic approach of the primary survey (ABCDE) to identify and treat life-threatening injuries, secondary survey, and transfer criteria.
3) Key priorities of the primary survey include airway management, breathing and ventilation assessment, circulation assessment and hemorrhage control, disability assessment, and full body exposure while preventing hypothermia.
This document discusses epistaxis (nosebleeds), including its causes, sites of bleeding, classification, and management approaches. The main points covered are:
- Epistaxis is caused by bleeding from inside the nose, with common causes being local trauma, infections, or general medical conditions like hypertension.
- The most common site of bleeding is an area of the nasal septum called Little's area, where several arteries converge.
- Epistaxis can be anterior (from the nasal cavity) or posterior (from the nasopharynx). Anterior bleeding is more common and usually mild.
- First approaches to manage epistaxis include applying pressure, cauterization of bleeding vessels, or anterior nasal packing
This document discusses acute limb ischemia, which refers to the sudden decrease in blood flow to the limbs that threatens tissue viability. It is most commonly caused by arterial embolism or thrombosis. The lower limbs are more affected than the upper limbs. Diagnostic evaluations include Doppler ultrasound, angiography and echocardiography. Treatment depends on the severity and cause of ischemia but may include embolectomy, thrombectomy, thrombolysis, or amputation in severe cases. The prognosis is generally good if emergency treatment is provided but mortality can be up to 20% for high-risk patients.
In this playlist I have discussed some important Venous diseases like Varicose veins, deep vein thrombosis and Pulmonary embolism. If you watch all these videos together, you will become confident in managing these venous pathologies.
1. Common procedures for treating nephrolithiasis include cystoscopic procedures like ureteroscopy with stone extraction and lithotripsy, as well as extracorporeal shock wave lithotripsy (ESWL) and percutaneous or laparoscopic nephrolithotomy.
2. ESWL uses focused acoustic shockwaves to fragment stones within the kidney without invasive surgery. It is commonly used for stones 4-20mm in size.
3. Radical prostatectomy and cystectomy are major surgeries for urological cancers that require extensive dissection and carry risks of significant blood loss. Robotic assistance and laparoscopic approaches are now commonly used.
1. The renal transplant surgical technique involves removing a kidney from the donor and surgically implanting it into the recipient's iliac fossa. An end-to-side anastomosis is preferred between the renal artery and external iliac artery to reduce the risk of stenosis.
2. A renal nurse provides emotional support and education to patients with renal failure on diet, lifestyle modifications, and what foods to avoid in order to stay alive while waiting for a transplant or on dialysis.
3. Coronary heart disease is the leading cause of death in developed countries. It occurs when fatty deposits build up in the arteries and restrict blood flow to the heart, which can cause angina, heart attack, or
This document provides guidance on the evaluation and management of head injuries. It discusses examining the scalp, eyes, ears and skull for fractures. It recommends CT scans for significant closed or penetrating head injuries to identify hemorrhages, contusions or fractures. It provides criteria for operative intervention in head injuries based on factors like intracranial pressure, Glasgow Coma Scale score and size of hematomas. It also outlines general management principles like maintaining blood pressure, oxygen levels and ICP. The document provides a thorough overview of evaluating and treating various types and severities of head injuries.
This document discusses laryngeal paralysis, including the nerve supply and causes of paralysis of the larynx. It describes recurrent laryngeal nerve paralysis and superior laryngeal nerve paralysis, including their clinical features and treatments. Bilateral paralysis and combined (complete) paralysis are also covered. Congenital vocal cord paralysis and various phonosurgery procedures are summarized.
This document provides an overview of benign thyroid swellings and conditions. It begins with the anatomy and physiology of the thyroid gland and its blood supply. Various classifications of thyroid goiters are then outlined, including toxic diffuse goiter (Graves' disease), multinodular goiter, and inflammatory conditions. Specific conditions such as thyroglossal cyst, retrosternal goiter, solitary thyroid nodule, Graves' disease, Hashimoto's thyroiditis, and acute suppurative thyroiditis are then described in more detail. Diagnostic tools and treatments for these conditions are also mentioned.
This document discusses epistaxis (nosebleeds), including its definition, causes, pathophysiology, and management. It notes that nosebleeds can be anterior or posterior based on the source of bleeding within the nasal cavities and outlines the various blood vessels involved. Common causes include trauma, inflammation/infection, tumors, hypertension, and medications. Management involves first aid, cauterization, nasal packing, and potentially surgical intervention. Prevention focuses on controlling risk factors and avoiding behaviors that could cause trauma to nasal tissues.
The document discusses various complications that can occur following head and neck surgery like neck dissection. It classifies complications as major/minor, early/late, local/systemic. It describes in detail immediate local complications like bleeding, shock, airway obstruction, increased intracranial pressure, and nerve injury and their management. Intermediate complications discussed include chylous fistula, seroma, wound infection, and flap failure. Late complications mentioned are recurrence, parotid gland hypertrophy, lymphedema, and hypertrophic scars. Prevention and management strategies are provided for many of the complications.
Transurethral resection of the prostate (TURP) is a common surgery performed to relieve urinary symptoms caused by an enlarged prostate. Regional anesthesia such as spinal anesthesia is generally preferred over general anesthesia for TURP. Key complications during the procedure include hypotension from sympathetic blockade, hemorrhage, perforation of the bladder or prostate capsule, hypothermia from cold irrigation fluids, and potential for developing TURP syndrome from fluid absorption. Careful patient assessment, fluid management, and monitoring are important to help prevent complications during this common urological procedure.
This document discusses airway management, including:
1) The differences between pediatric and adult airway anatomy such as the more rostral larynx and relatively larger tongue in pediatric patients.
2) Evaluation of the airway through history, physical exam, and special investigations to assess airway difficulty.
3) Clinical management of the airway including techniques for opening the airway with or without equipment, mask ventilation, endotracheal intubation, and managing a difficult airway. Complications of airway management are also reviewed.
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The document discusses laryngeal trauma. It begins by describing the anatomy and functions of the larynx. It then covers the causes, symptoms, diagnosis, and management of laryngeal injuries. Common causes include blunt injuries from accidents, strangulation, or penetrating injuries. Diagnosis involves examination, imaging like CT scans, and direct laryngoscopy. Injuries are classified into four groups based on severity. Minor injuries may be observed while more severe injuries involving exposed cartilage or vocal cord immobility require surgical exploration and repair to restore the laryngeal framework and phonation.
The thyroid and parathyroid glands are crucial components of the endocrine system, and surgical interventions are often necessary to address various conditions affecting these glands. Understanding the surgical importance and anatomy of the thyroid and parathyroid glands is essential for endocrine surgeons, otolaryngologists, and healthcare professionals involved in the management of thyroid and parathyroid disorders. Surgical interventions aim to restore hormonal balance, treat underlying conditions, and optimize patient outcomes.
The document discusses various vascular emergencies that can be diagnosed using ultrasound. It outlines tools like ultrasound, CT, MR and DSA that can be used and highlights advantages of ultrasound like being readily available, portable, and having good temporal resolution. It describes acute conditions like ruptured aortic aneurysm, acute carotid thrombosis, carotid and vertebral dissections, pseudoaneurysms, acute limb ischemia and graft failure. For each condition, it provides ultrasound findings, diagnostic criteria and treatment options. It emphasizes the importance of prompt diagnosis, accurate assessment and timely intervention in managing vascular emergencies.
The document discusses splenic injuries, providing details on the surgical anatomy, blood supply, assessment, investigations including FAST scan and CT scan, grading of injuries, and management approaches including conservative management, splenorrhaphy, splenectomy, embolization, and complications like overwhelming post-splenectomy infection. Splenic injuries are most commonly caused by blunt trauma to the abdomen and can range from minor injuries to severe lacerations requiring surgical intervention.
Tracheostomy is a surgical procedure that creates an opening in the trachea through the neck. It is commonly performed to bypass upper airway obstructions or to facilitate prolonged mechanical ventilation. Potential indications for tracheostomy include prolonged intubation, neurological impairment putting one at risk for aspiration, and obstructive sleep apnea. Complications can include bleeding, infection, tube dislodgement, and tracheal stenosis. Care of the tracheostomy involves tube changes, suctioning, humidification, and assessing readiness for decannulation.
TURP is a common procedure to relieve BPH symptoms by resecting prostate tissue. Key considerations for anesthesia include assessing cardiac, respiratory and renal function due to the elderly patient population. Regional anesthesia is preferred to allow early detection of complications like TURP syndrome. Potential intraoperative complications are hypotension, hemorrhage, bladder/capsule perforation, hypothermia, and infection. Careful fluid management and warming are important due to large irrigation fluid volumes.
Aortic dissection, pathophysiology, risk, incidence, types and treatment, Moh...Moh'd sharshir
This document presents a case of a 55-year-old man with a history of diabetes, hypertension, and prior stroke who was transferred for endovascular aortic repair after a motor vehicle accident caused multiple injuries including head trauma, chest trauma, cardiac contusion, aortic injury, and bone fractures. On examination, he was intubated and sedated. Imaging showed aortic pseudoaneurysm, lung effusions, and subcutaneous emphysema. The document then reviews aortic dissection including types, risk factors, clinical manifestations, diagnosis, and involvement of the ascending versus descending aorta.
1) The document discusses guidelines for the resuscitation and transportation of trauma patients, emphasizing the importance of the "Golden Hour" where 80% of trauma deaths occur in the first hour after injury.
2) It outlines the systematic approach of the primary survey (ABCDE) to identify and treat life-threatening injuries, secondary survey, and transfer criteria.
3) Key priorities of the primary survey include airway management, breathing and ventilation assessment, circulation assessment and hemorrhage control, disability assessment, and full body exposure while preventing hypothermia.
This document discusses epistaxis (nosebleeds), including its causes, sites of bleeding, classification, and management approaches. The main points covered are:
- Epistaxis is caused by bleeding from inside the nose, with common causes being local trauma, infections, or general medical conditions like hypertension.
- The most common site of bleeding is an area of the nasal septum called Little's area, where several arteries converge.
- Epistaxis can be anterior (from the nasal cavity) or posterior (from the nasopharynx). Anterior bleeding is more common and usually mild.
- First approaches to manage epistaxis include applying pressure, cauterization of bleeding vessels, or anterior nasal packing
This document discusses acute limb ischemia, which refers to the sudden decrease in blood flow to the limbs that threatens tissue viability. It is most commonly caused by arterial embolism or thrombosis. The lower limbs are more affected than the upper limbs. Diagnostic evaluations include Doppler ultrasound, angiography and echocardiography. Treatment depends on the severity and cause of ischemia but may include embolectomy, thrombectomy, thrombolysis, or amputation in severe cases. The prognosis is generally good if emergency treatment is provided but mortality can be up to 20% for high-risk patients.
In this playlist I have discussed some important Venous diseases like Varicose veins, deep vein thrombosis and Pulmonary embolism. If you watch all these videos together, you will become confident in managing these venous pathologies.
1. Common procedures for treating nephrolithiasis include cystoscopic procedures like ureteroscopy with stone extraction and lithotripsy, as well as extracorporeal shock wave lithotripsy (ESWL) and percutaneous or laparoscopic nephrolithotomy.
2. ESWL uses focused acoustic shockwaves to fragment stones within the kidney without invasive surgery. It is commonly used for stones 4-20mm in size.
3. Radical prostatectomy and cystectomy are major surgeries for urological cancers that require extensive dissection and carry risks of significant blood loss. Robotic assistance and laparoscopic approaches are now commonly used.
1. The renal transplant surgical technique involves removing a kidney from the donor and surgically implanting it into the recipient's iliac fossa. An end-to-side anastomosis is preferred between the renal artery and external iliac artery to reduce the risk of stenosis.
2. A renal nurse provides emotional support and education to patients with renal failure on diet, lifestyle modifications, and what foods to avoid in order to stay alive while waiting for a transplant or on dialysis.
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This document provides an overview of benign thyroid swellings and conditions. It begins with the anatomy and physiology of the thyroid gland and its blood supply. Various classifications of thyroid goiters are then outlined, including toxic diffuse goiter (Graves' disease), multinodular goiter, and inflammatory conditions. Specific conditions such as thyroglossal cyst, retrosternal goiter, solitary thyroid nodule, Graves' disease, Hashimoto's thyroiditis, and acute suppurative thyroiditis are then described in more detail. Diagnostic tools and treatments for these conditions are also mentioned.
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The document discusses various complications that can occur following head and neck surgery like neck dissection. It classifies complications as major/minor, early/late, local/systemic. It describes in detail immediate local complications like bleeding, shock, airway obstruction, increased intracranial pressure, and nerve injury and their management. Intermediate complications discussed include chylous fistula, seroma, wound infection, and flap failure. Late complications mentioned are recurrence, parotid gland hypertrophy, lymphedema, and hypertrophic scars. Prevention and management strategies are provided for many of the complications.
Transurethral resection of the prostate (TURP) is a common surgery performed to relieve urinary symptoms caused by an enlarged prostate. Regional anesthesia such as spinal anesthesia is generally preferred over general anesthesia for TURP. Key complications during the procedure include hypotension from sympathetic blockade, hemorrhage, perforation of the bladder or prostate capsule, hypothermia from cold irrigation fluids, and potential for developing TURP syndrome from fluid absorption. Careful patient assessment, fluid management, and monitoring are important to help prevent complications during this common urological procedure.
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2) Evaluation of the airway through history, physical exam, and special investigations to assess airway difficulty.
3) Clinical management of the airway including techniques for opening the airway with or without equipment, mask ventilation, endotracheal intubation, and managing a difficult airway. Complications of airway management are also reviewed.
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Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
Temple of Asclepius in Thrace. Excavation resultsKrassimira Luka
The temple and the sanctuary around were dedicated to Asklepios Zmidrenus. This name has been known since 1875 when an inscription dedicated to him was discovered in Rome. The inscription is dated in 227 AD and was left by soldiers originating from the city of Philippopolis (modern Plovdiv).
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
2. HISTORY
HISTORY
●
Term 'thyroid' was coined by Thomas Warton
in 17th century
●
Emil Theoder Kocher is considered as the
Father of Modern Thyroid surgery
●
First thyroidectomy is considered to be done
more than 1000 years ago by Abu-al-Qasim
●
The earliest account of thyroidectomy was
probably given by Roger Frugardi, 1170
4. THYROID GLAND
THYROID GLAND
(Anatomy)
(Anatomy)
- Shield shape gland with an isthmus and two lateral
lobes (near the third tracheal ring)
- Each lateral lobes have superior and inferior pole
and firmly attached to laryngotracheal skeleton
- Blood supply: superior and inferior thyroid
arteries
- Venous drainage: superior , middle , and inferior
thyroid veins
5. Thyroid Anatomy
Thyroid Anatomy
Locate deep to the sternohyoid muscle,
from level C5 to T1 vertebrae or
anterior to the 2nd
and 3rd
tracheal rings.
Thyroid gland is attached to the trachea
by the lateral suspensory (Berry)
ligaments.
RLN runs with inferior thyroid artery,
SLN with the superior thyroid artery
7. Anatomy
Anatomy
Blood supply: sup. & inf.
thyroid arteries
Anatomy variant: thyroid
ima artery, in 1.5% to
12%, in front of the
trachea.
Lymph vessels: drain to
prelaryngeal, pretracheal
and Para tracheal nodes.
Innervation: superior,
middle, and inferior
sympathetic ganglia.
13. COMPLICATIONS
COMPLICATIONS
Complications can typically be divided
into nonmetabolic and metabolic
complications.
Of particular concern are injuries to the
RLN and the parathyroid glands.
postoperative infections are very unusual
because of the abundant blood supply in
the thyroid bed
16. HEMATOMA
HEMATOMA
Hematoma can usually be differentiated
from seroma by the presence of skin
ecchymosis, firmness to palpation, or
clotted drain output
Prevention consists of preoperative
avoidance of anticoagulants and
antiplatelet agents and meticulous
intraoperative hemostasis
17. HEMORRHAGE
HEMORRHAGE
Two types -
◦ Deep to deep fascia
◦ Subcutaneous
May be primary or reactionary
A deep bleeding produces tension hematoma.
Usually due to slipping of the ligature of the
superior thyroid artery, though it can also be from
a thyroid remnant or a thyroid vein. This
compresses on the airway & potentially life
threatening unlike the subcutaneous bleeding.
18. HEMORRHAGE
HEMORRHAGE
GOOD INTRAOPERATIVE
HEMOSTASIS
Don’t traumatize the thyroid
Avoid too much neck dressings
Suction drain ??
Do not waste time on imaging
A tension hematoma requires opening of
the wound, evacuation of hematoma &
ligature of the bleeding vessels
A subcutaneous hematoma can be
aspirated.
19. INFECTION
INFECTION
Aerodigestive tract entry is the single
most important factor that contributes to
the risk of wound infection.
tyroidectomy without exposure to oral
flora is considered a clean procedure.
Administration of prophylactic
antibiotics for clean neck dissections is
reasonable
20. infection
infection
Factors associated with wound infection
include
the performance of bilateral neck
dissections and total laryngectomy,
advanced stage tumors, and in some studies,
a history of prior tracheotomy and
malnutrition.
Diabetes was not found to be associated
with a greater incidence of postoperative
infection.
21. INFECTION
INFECTION
Cellulitis – erythema, warmth & tenderness
around the wound
Abscess – superficial / deep
Deep abscess associated with fever, leucocytosis,
tachycardia
22. INFECTION
INFECTION
Pus for Gram’s stain & culture
CT for deep neck abscess
Can be prevented by proper hemostasis at the
time of surgery & using suction drain.
Peri-operative antibiotics not recommended.
Once established
◦ Antibiotics
◦ Drainage of abscess.
23. SEROMA
SEROMA
Division of lymphatic and adipose tissue
during neck dissection
especially after the removal of a large
goiter.
If a fluid collection is present, simple
needle aspiration should manage the
problem
25. Causes of seroma include incorrect drain
placement, drain failure, or early drain removal.
Prevention consists primarily of proper
management of closedsuction drains that are left
in place until the total output per drain falls
below 25 mL in a 24hour period
Rx
Fibrin glue
management of seroma includes needle
aspiration and, in select patients, drain
replacement. Pressure dressings do not appear to
prevent fluid reaccumulation.
26. Nerve supply:
◦ Superior laryngeal nerve
Internal branch (sensory) +superior
laryngeal artery .
External branch ►cricothyroid
muscle
◦ Recurrent laryngeal nerve
RT side: crosses the subclavian
artery
LT side: arises on the arch of the
aorta deep to ligamentum arteriosum
◦ it is divided behind the
cricothyroid joint
Motor all the intrinsic muscles
►
except ?
Sensory
33. RLN
RLN
The incidence of permanent RLN
paralysis is approximately 1% to 1.5% for
total thyroidectomy and less for near-
total procedures
Temporary dysfunction because of nerve
traction occurs in 2.5% to 5% of patients.
Incidence increases with second and
third procedures. RLN injury is also more
common in thyroidectomy with neck
dissection,
34. RLN
RLN
Disease-specific risk factors for
permanent nerve damage include :
recurrent thyroid carcinoma, substernal
goiter, and various thyroiditis conditions.
Vocal cord function should be evaluated
and documented by indirect
laryngoscopy, especially in patients who
have had previous surgery.
35. RECURRENT LARYNGEAL NERVE
RECURRENT LARYNGEAL NERVE
PARALYSIS
PARALYSIS
Unilateral –
◦ 1/3 rd are asymptomatic
◦ Change in voice
◦ Improves due to compensation by the healthy
cord.
Bilateral- dyspnea & biphasic stridor
36. RECURRENT LARYNGEAL NERVE
RECURRENT LARYNGEAL NERVE
PARALYSIS
PARALYSIS
Prevent injury to the nerve by
◦ Identify
◦ ITA ligated far from lobe
◦ Posterior layer of pretracheal fascia kept intact.
Laryngoscopy, laryngeal EMG
For bilateral paralysis
◦ Tracheostomy (with speaking valve.
◦ Lateralization of cord
Arytenoidectomy
Through endoscope
Thyroplasty type 2
Cordectomy
Nerve muscle implant
37.
38. RLN PARALYSIS
RLN PARALYSIS
Unilateral
◦ Vocal cord lies in cadaveric position
◦ Hoarseness of voice & aspiration of liquids.
◦ Ineffective cough
Bilateral
◦ Aspiration
◦ Ineffective cough
◦ Bronchopneumonia
◦ Concurrent injury of the SLN results in a more laterally positioned
vocal cord and worsens voice quality and glottic
competence.Occasionally, patients may have difficulty with aspiration
and pneumonia
39. RLN PARALYSIS
RLN PARALYSIS
Unilateral
Speech therapy
Medialise of cord
Teflon paste injection
Thyroplasty type 1
Muscle or cartilage implant
Arthrodesis of arytenoid joint
Bilateral
Tracheostomy
Epiglottopexy
Vocal cord plication
Total laryngectomy
SLN: speech therapy
40. RLN
RLN
The surgeon should also be aware of the
possibility of a nonrecurrent nerve, most
commonly on the right side.
If the nerve is transected during surgery,
microsurgical repair of the nerve is
recommended.
Although the repair is unlikely to restore
normal function, reanastomosis of the
RLN may decrease the extent of vocal
cord atrophy
41. RLN
RLN
Return of normal vocal cord function
occurs 6 to 12 months after temporary
RLN injury occurs,
and speech therapy can be valuable
In unilat. Par.treatment directed toward
vocal cord medialization may consist of
vocal cord injection, thyroplasty
In cases of bilateral RLN injury,
management is directed at improving the
airway
42.
43.
44. SLN
SLN
Often disturbance of SLN function is
temporary and unrecognized by the
patient and the surgeon
Injury to the SLN alters function of the
cricothyroid muscle.
Patients may have difficulty shouting, and
singers find difficulty with pitch variation,
especially in the higher frequencies.
45. SLN
SLN
The external branch of the SLN is not
often visualized and lies near the superior
pole vessels.
Adequate exposure of the superior
thyroid pole and close ligation of the
individual vessels on the thyroid capsule
may prevent SLN injury
46. THYROID CRISIS / STORM
THYROID CRISIS / STORM
Acute exacerbation of
hyperthyroidism as the patient has
not been brought to the euthyroid
state before operation.
Tachycardia, fever(>1050
C) ,
restlessness, delirium
Mortality is 10%
47. THYROID CRISIS / STORM
THYROID CRISIS / STORM
Ensure euthyroid state before operation
Sedation – morphine / pethidine
Hyperpyrexia – ice bags. Tepid sponging, hypothermic
blanket, rectal ice irrigation
Oxygen administration
IV glucose-saline for dehydration
Potassium for tachycardia
Cortisone – 100mg IV
Carbimazole – 10- 20 mg 6th hourly
Lugol’s iodine 10 drops 8th hourly by mouth or potassium
iodide 1g IV
Propranolol – 20-40mg 6th hourly
Digoxin for atrial fibrillation
Diuretics for cardiac failure
48. RESPIRATORY OBSTRUCTION
RESPIRATORY OBSTRUCTION
Laryngeal edema due to
◦ Tension hematoma
◦ Endotracheal intubation & surgical
handling
◦ More chance in vascular goiters.
Collapse / kinking of the trachea
Bilateral recurrent nerve paralysis
can aggravate obstruction if edema
is present.
49. RESPIRATORY OBSTRUCTION
RESPIRATORY OBSTRUCTION
Open the wound & release the
tension hematoma
Endotracheal tube if no
improvement. INTUBATION TO
BE DONE BY AN EXPERIENCED
ANESTHETIST as repeated
attempts cause more edema leading
to cerebral anoxia.
The tube is left in place for several
days & steroids
51. Dissection of ITA and removal of gland
Dissection of ITA and removal of gland
52. PARATHYROID GLANDS
PARATHYROID GLANDS
●
They are small semilunar shaped, ochre
(yellow-brown)coloured glands,situated in a
pad of fat generally outside surgical capsule
secreting PTH, which controls serum Ca
metabolism
●
Gland are usually 4 in numbers, two on each
side, occasionally 3-6.
●
Superior parathyroid glands -
●
Develops from 4th pharyngeal pouch and
descend only slightly during development and
their position remains constant in adult life
53. ●
Generally found at level of pharyngo-
oesophageal junction behind and seperate
from posterior border of thyroid gland
●
Supplied by branch from upper division of
inferior thyroid artery
●
Inferior parathyroid glands
●
Arise from 3rd pharyngeal pouch along with
thymus
●
Descend along with thymus and have a wide
range of distribution in adults
●
Usually located short distance from lower pole
of thyroid
●
Supplied by inferior terminal branch of inferior
thyroid artery
54.
55. Ca
Ca
Transient symptomatic hypocalcemia
after total thyroidectomy occurs in
approximately 7% to 25% of cases,
but permanent hypocalcemia is less
common (0.4% to 13.8%).
Changes in serum calcium levels are
often transient and may not always be
related to parathyroid gland trauma or
vascular compromise
56. Ca
Ca
Transient hypocalcemia is often related
to variations in serum protein binding
caused by
perioperative alterations in acid-base
status, hemodilution, and albumin
concentration.
These changes do not produce
hypocalcemic symptoms
57. Ca
Ca
Sudden changes in levels of ionized serum
calcium can result in perioral and distal
extremity paresthesias,
Lower ca: patients may experience
tetany, bronchospasm, mental status
changes, seizures, laryngospasm, and
cardiac arrhythmias.
Chvostek sign and Trousseau sign may
develop with increased neuromuscular
irritability as serum calcium levels
58. Ca
Ca
Findings that should be worrisome for
hypoparathyroidism include
hypocalcemia, hyperphosphatemia, and
metabolic alkalosis.
PTH levels may also be measured to
predict potential hypocalcemia.
59. PARATHYROID INSUFFICIENCY
PARATHYROID INSUFFICIENCY
Due to removal of parathyroids or the parathyroid end artery.
Incidence – 1-3%
Occurs 2 – 5% after operation. Can be delayed for 2-3 weeks or
hypocalcemia may be asymptomatic.
Classic triad –
◦ Carpopedal spasm
◦ Stridor
◦ Convulsions
Latent tetany
◦ Trousseau’s sign
◦ Chvostek’s sign
Persistent – grand mal epilepsy, cataracts, psychosis, calcification of basal
ganglia, papilledema.
60. PARATHYROID INSUFFICIENCY
PARATHYROID INSUFFICIENCY
Correct identification of the gland
Ligate vessels distal to the parathyroids.
Recognition of the parathyroid glands, which appear in a variety of
shapes and have a caramel-like color, is critical. When they lose their
blood supply, they turn black. The devascularized gland should be
removed, cut into 1 to 2mm pieces, and reimplanted in the
sternomastoid muscle or the forearm.
Monitor serum Ca for 72 hrs post-operatively
61. Ca
Ca
Parathyroid autotransplantation may be
considered when:
thyroid carcinoma that requires total
thyroidectomy with central neck
dissection,
en bloc resections that require removal
of the parathyroid glands, and
reoperation after previous thyroid or
parathyroid surgery
62. Ca
Ca
Treatment for hypocalcemia is typically
initiated if the patient is symptomatic or
serum calcium levels decrease to less
than 7 mg/dL.
In these patients, cardiac monitoring is
warranted.
Patients should receive 10 mL of 10%
calcium gluconate and 5% dextrose in
water intravenously,
63. Ca
Ca
Oral calcium supplementation should
begin with 2 to 3 g of calcium carbonate
per day.
Calcitriol (1,25-dihydroxycholecalciferol)
also should be initiated.
Adjustments in supplemental calcium and
vitamin D should be done in consultation
with an endocrinologis
64. THYROID INSUFFICIENCY
THYROID INSUFFICIENCY
INCIDENCE :20-25% of patients subjected to
subtotal thyroidectomy for diffuse toxic goiter &
toxic nodular goiters with internodular
hyperplasia
Time: <2 yrs. May be delayed >5yrs.
Transient hypothyroidism may occur within 6
months which is asymptomatic.
Due to change in nature of autoimmune
response.
More chance if less residual thyroid tissue
Cold intolerance, fatigue constipation, weight
gain, myxedema.
65. THYROID INSUFFICIENCY
THYROID INSUFFICIENCY
Thyroxine – start with 50 mcg/d, 100mcg/d after
3 weeks, and 150 mcg/d thereafter. Taken as a
single daily dose.
Monitoring –
◦ TSH in the lower end of reference range (0.15-3.5 mU /
l)
◦ T 4 normal or slightly raised. (10 – 27 pmol / l)
Manage ischemic heart disease with beta
blockers & vasodilators
Increase thyroxine during pregnancy. (50 mcg)
Myxedema coma: IV thyroxine 20mcg 8th
hourly followed by oral.
67. RECURRENT THYROTOXICOSIS
RECURRENT THYROTOXICOSIS
Less than 40 yrs – carbimazole
◦ 0-3wks 40-60mg/d
◦ 4-8wks 20-40mg/d
◦ 18-24 months 5-20mg/d
More than 40 yrs – radioiodine
◦ 5-10mCi oral; 75% respond in 4-12 weeks
◦ Repeated after 12-24 weeks if no
improvement.
◦ Beta blocker / carbimazole cover during lag
period.
◦ Long term follow-up for hypothyroidism.
68. PROGRESSIVE / MALIGNANT
PROGRESSIVE / MALIGNANT
EXOPHTHALMOS
EXOPHTHALMOS
Occurs even when thyrotoxic features
are regressing.
Steroids & radiotherapy.
69. SCAR
SCAR
The prevention of scar widening or
hypertrophy depends on proper
placement of the incision,
which can often be hidden within
existing skin creases;
to avoid the increased skin tension over
the sternal notch, the incision should not
be placed too low in the neck.
70. HYPERTROPHIC SCAR / KELOID
HYPERTROPHIC SCAR / KELOID
Platysma to be divided at a higher level
Occurs if scar overlies the sternum
Some persons are more susceptible.
May follow wound infection.
Intradermal steroids, repeated monthly.
73. RARE COMPLICATIONS
RARE COMPLICATIONS
Pneumothorax is very rare and is often
associated with extended procedures that
involve subclavicular dissection.
Chylous fistulas may occur more often
on the left side but are usually self-
limiting when wound drainage is
adequate.