Perioperative Medicine for the Junior Clinician E-Book

Joel Symons

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 769

Veröffentlichungsjahr: 2015

Beschreibung

Perioperative Medicine for the Junior Clinician is the first easy-to-read resource, featuring a digital component, on how to manage a diverse range of patients in the perioperative period, providing up-to-date practical knowledge and advice from a broad range of medical specialists caring for surgical patients. Perioperative Medicine for the Junior Clinician provides a guide to perioperative care, covering principles and practices of care; risk assessment; laboratory investigations; medication management; specific medical conditions and complications; postoperative care and pain management. It also features bite-size videos explaining the key concepts, as well as case studies, investigations and quizzes. Ideal for final year medical students and junior clinicians, this digital and print resource will be an invaluable tool when working in this multidisciplinary, team-based specialty. Perioperative Medicine for the Junior Clinician: * Is based on a sell-out course run at the Alfred Hospital and Monash University in Melbourne, Australia * Is a practical resource available in a flexible and portable content * Features bite-size videos which further explain concepts in the written text, and clinically relevant case studies, all found on the companion website * Is structured around guidelines and protocols The video materials, case studies, self-assessment quizzes and fully explained answers can be viewed on the companion website at www.wiley.com/go/perioperativemed

Leseprobe

CONTENTS

Cover

Title page

Foreword

Preface

Acknowledgements

About the companion website

Part I: Introduction

1 The role of the perioperative medicine physician

The scope of perioperative medicine

Clinical data

The future

References

2 The role of the preadmission clinic

Patient assessment

Risk factor identification and management, and patient optimisation

Improve safety and quality of patient care

Improve hospital efficiency

Patient support, education and awareness

Record keeping and research

References

3 Consent

Ethical and legal basis of consent

Elements of a valid consent

Consent by junior doctors

Documenting consent

Special circumstances

References

4 The early postoperative round

Establish rapport

Scan the record

Take a history

Examine the patient

Troubleshoot the basics

Manage pain effectively

Detecting deterioration

Communicate with other staff and formulate an early postoperative plan

References

5 Quality improvement and patient safety

Introduction

The individual and the system

Safety of the perioperative patient

Quality improvement

Individual factors

Team training

Organisational and regulatory factors

References

6 Intraoperative and postoperative monitoring

Cardiovascular system

Respiratory system

Cerebral monitoring

Major organ function

References

7 Drugs used for anaesthesia and sedation

Definitions

Mechanism of action of anaesthetic and sedative drugs

Basic pharmacological concepts

Medications used as sole anaesthetic agents

Sedative agents

References

8 The recovery room

What is the recovery room?

Design of the recovery room [1]

Monitoring, equipment and drugs

Recovery room staff

Handover of care to the recovery room staff

Management of patients in the recovery room

Common management issues in the recovery room

Discharge of patients from the recovery room

References

9 Perioperative genomics

Perioperative genomic investigations

Pharmacogenomics and altered drug response (clopidogrel)

Epigenomics and chronic pain

Perioperative biobanks

References

Part II: Preoperative risk assessment

10 Perioperative medication management

Cardiovascular medications

Aspirin and other antiplatelet drugs

Warfarin and other anticoagulants

Corticosteroids

Antidepressants

Antiepileptics

Antiparkinson medications

Chronic opioid therapy

Herbal medications

References

11 The cardiac patient fornon-cardiac surgery

Preoperative assessment

Intraoperative management

Postoperative care

References

12 Cardiovascular risk assessment in cardiac surgery

Scoring systems

Practical application

Conclusion

References

13 Preoperative cardiac testing

Which patients require preoperative cardiac testing?

Functional capacity

Assessment of cardiac structure and function

Assessment of coronary artery disease and myocardial ischaemia

References

14 Airway assessment and planning

Physical assessment

References

15 Pulmonary risk assessment

Clinical features associated with PPC

Patient-related factors

Surgery-related factors

Scoring systems to predict PPC

Conclusion

References

16 Preoperative cardiopulmonary exercise testing

History

Preoperative rationale

Physiological background

Conduct of the CPET test

References

17 Anaemia

Patient blood management

Preoperative optimisation of anaemia

Intraoperative management of anaemia

Postoperative optimisation of anaemia

References

18 Central nervous system risk assessment

Parkinson’s disease

Multiple sclerosis

Headache

References

19 Risk assessment for perioperative renal dysfunction

Aetiology

Epidemiology

Risk factors for perioperative AKI

Diagnostic challenges

Prevention and treatment

Management of perioperative AKI

References

20 Medical futility and end-of-life care

Definitions

Medical futility

Misconceptions

Obligations of the treating doctor

Conclusion

References

21 The surgical safety checklist

Development of a surgical safety checklist

The WHO checklist

References

Part III: Perioperative investigations

22 Preoperative investigations (non-cardiac surgery)

Common preoperative investigations

Specific tests

References

23 Postoperative investigations

Bedside tests

Blood tests

Transthoracic echocardiogram (TTE)

Computed tomography (CT scan)

Conclusion

Further reading

Part IV: Specific medication management and prophylaxis

24 Thromboprophylaxis

Background risk of venous thromboembolism perioperatively

Estimating individual patient risk

Thromboprophylaxis options

Surgery in the setting of acute VTE

Thromboprophylaxis for those on long-term anticoagulation – role of ‘bridging therapy'

Management of patients on novel oral anticoagulants

References

25 Anticoagulants and antiplatelet agents

Patients on warfarin

Patients on direct-acting oral anticoagulants

Managing epidural catheters in the setting of postoperative thrombosis prophylaxis

Antiplatelet therapy

References

26 Diabetes medication

Key considerations for perioperative management

Type of diabetes

Type of medication

Type of surgery

Medication management

Type 2 diabetes

Type 1 diabetes

Insulin pumps (CSII) (Video 26.1)

Dexamethasone

Reference

Further reading

27 Steroid medication

Normal stress response

Perioperative cortisol responses

Management of steroid medication

Patients treated with long-term steroids

Hypopituitarism

References

28 Opioids and opioid addiction

Preoperative assessment

Perioperative management of opioid analgesics

Perioperative management of non-opioid analgesics

The patient on buprenorphine

Discharge planning

References

29 Antibiotic prophylaxis

Evidence supporting efficacy of prophylaxis

Antibiotic choice

Timing and repeat dosing

Special situations

Systems to ensure appropriate use

Areas of uncertainty

References

30 Antibiotic prophylaxis for endocarditis

Pathogenesis

Strategies for the prevention of perioperative endocarditis

Antibiotic prophylaxis

Antibiotic regimen scenarios

References

Part V: Perioperative management of organ dysfunction and specific population groups

31 Coronary artery disease and coronary stents

Perioperative myocardial ischaemia/infarction

Key features of perioperative myocardial ischaemia/infarction [2,3]

Diagnosis and management of perioperative myocardial infarction

Prevention of perioperative myocardial ischaemia/infarction

Management of patients with coronary stents requiring non-cardiac surgery (Videos 31.1 and 31.2)

References

32 Hypertension

Definition and pathophysiology

Epidemiology

Aetiology

Complications of perioperative hypertension

Management

Patient assessment

Postoperative treatment

References

33 Arrhythmias

Preoperative assessment

Specific arrhythmias

References

34 Pacemakers and implanted defibrillators

Management of pacemakers

Implanted cardioverter-defibrillators

Emergency management of an unknown device

References

35 Heart failure

Definition and diagnosis

Epidemiology and aetiology

Clinical evaluation

Investigations to consider in the preoperative evaluation of suspected heart failure

Risk assessment

Treatment and perioperative care of heart failure patients

References

36 Aortic stenosis

Pathophysiology of AS

Measures of severity

Symptoms and signs of aortic stenosis (Box 36.1)

Aetiology of aortic stenosis

Classification of disease severity

Treatment of aortic stenosis

Implications of aortic stenosis for the perioperative patient

Perioperative management of the patient with aortic stenosis

References

37 Pulmonary hypertension

Definition and aetiology

Diagnosis

Pharmacological management

Perioperative management

Reference

Further reading

38 Endocarditis, myocarditis and cardiomyopathy

Endocarditis

Myocarditis and cardiomyopathy

Myocarditis

Cardiomyopathy

References

39 Acute lung injury

Pathophysiology

Aetiology

Management

Ventilator-induced lung injury

Oxygen toxicity

Protective mechanical ventilation strategies

Fluid management

Rescue therapies

References

40 Obstructive sleep apnoea

Introduction and definitions

Epidemiology

Pathophysiology

Preoperative management of OSA

Elective surgery

Emergency surgery

Postoperative management of OSA

References

41 Asthma