Introduction

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Introduction

  1. 1. Vascular Surgery for Final Medical Vascular Surgery UnitVascular Surgery Unit AMNCHAMNCH www.perfuse.net Introduction
  2. 2. Scope Occlusive Vascular disease Aortic aneurysm Carotid disease Varicose veins Occlusive venous disease Lymphoedema Visceral arterial occlusion Peripheral aneurysms Arterial Trauma Diabetic Foot Hyperhidrosis Venous access
  3. 3. Topics Occlusive Vascular disease Aortic aneurysm Carotid disease Varicose veins Occlusive venous disease Lymphoedema Visceral arterial occlusion Peripheral aneurysms Arterial Trauma Diabetic Foot Hyperhidrosis Venous access
  4. 4. Lecture topics • Introduction – History – Physical examination – Differential diagnosis – Presentation • Leg Ulcers – clinical description – clinical reasoning – differential diagnosis – Bayesian approach to diagnosis • Peripheral arterial occlusive disease – systemic disease – differing end organ manifestation – holistic approach to therapy – Indications for surgery • Aortic aneurysms – preparing patients for complex surgery – clinical decision making
  5. 5. Lecture topics • Carotid disease – evidence based medicine – randomised trials in surgery – choosing therapy • Varicose veins – relationship between symptoms & conditions – Risk/benefits in surgery – Informed consent • Diabetic foot – systemic disease – Warning signs – Interventions – Preventing amputations
  6. 6. Perfuse.net
  7. 7. Perfuse.net
  8. 8. Elements • Theoretical knowledge – anatomy – physiology – pathology – pharmacology – medicine – surgery etc. Normal & disease
  9. 9. Clinical skills • History • Physical examination • Diagnosis • Investigation • Treatment Patients present with symptoms and signs rather than disease Patients present with symptoms and signs rather than disease
  10. 10. History • Presenting problem • Context – personal • age • sex • occupation – social • domestic arrangements • lifestyle – medical • chronic illness • medications • previous surgery Process of communicationProcess of communication
  11. 11. History - II • Obtain information from the patient – listen – identify precise symptoms – avoid leading questions initially – ask questions to fill in the gaps • Collateral history – trauma, confused, paediatric etc All the information that cannot be obtained by examining the patient All the information that cannot be obtained by examining the patient
  12. 12. Art of History Taking Translate
  13. 13. Common language • Standard formula • Common among clinicians • Precise terminology vs – “haemorrhoids” – “can’t breathe” – “trouble passing water”
  14. 14. Physical examination
  15. 15. Differential diagnosis • Consider all the possibilities • Weight them Diagnosis • Test the hypothesis • Re prioritise Diagnosis • Treat • Evaluate response

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