HTN
A disease of elevated blood pressure, there are multiple stages.
Normal is 120/80
Elevated is 120-130 over 80
Stage 1 is 130-140/80-90
Stage 2 is above 140/90-100
HTN Crisis is 180 and or 120
What is Asthma
Chronic obstructive disease with bronchiolar inflammation that is reversible
Asthma staging is
Intermittent: Inhaler less than 2x week, FEV1 > 80%.
Mild Persistent: Inhaler not daily, , FEV1 > 80%.
Moderate Persistent: Inhaler Daily, FEV1>80-60%,
Severe Persistent: Inhaler multiple times a day, FEV1 > 60%
What is Diabetes
Metabolic disorder characterized by insulin resistance or lack of production of insulin resulting in hyperglycemia.
Diagnostic:
Fasting sugars over 126
BG over 200 2 hrs after a 75g bolus of glucose
Non fasting glucose over 200
HBA1c over 6.5
MRSA coverage
Vancomycin, bactrim, and clindamycin
Metronidazole
good against anaerobes, damages microbial DNA with free radicals
Vancomycin
inhibits bacterial wall synthesis binding to D ALA preventing cross linking, good against MRSA and gram positive
Ceftriaxone
inhibits penicillin binding proteins, effective in gram positive and gram negative bacteria.
Oculocardiac Reflex
Is a trigemino-vagal reflex slowing the heart (bradycardia) from eye manipulation, involving sensory signals via the trigeminal nerve (CN V) from eye stretch receptors to the brainstem, then motor signals via the vagus nerve (CN X) to the heart’s sinoatrial (SA) node
Submandibular Approach
- Mark 2cm below the inferior border of the mandible, inject local anesthetic
- Incise through the skin, subcutaneous tissue, undermine the skin flap and sharp dissection through the platysma
- Bluntly dissect to the inferior border of the mandible
Don’t forget Dingman and Grabb [8] study –
19% of the time, the marginal mandibular
nerve passed below the inferior border of
mandible until it crossed facial artery 1 cm
below the inferior border of the mandible
two branches
61% of the time and 21% it is a single branch
What is the Hayes Martin
Ligation of the facial vein with superior reflection to protect the facial nerve
Preauricular Approach to the Joint
- Incision along the pre auricular crease through the skin and subcutaneous with possible Al Kayat Extension
- Dissect through the temporalparietal fascia down to the Temporalis fascia, the nerve runs within this ~20 mm anterior to the EAC
- Dissect inferiorly and palpate zygomatic arch, dissect subperiosteally to the joint space, make an incision through the capsule.
Coronal Approach
incision made 5cm posterior to hair line from temporal line to opposing temporal line. Dissection through skin, subcutaneous tissue, and galea, dissect along this subgaleal plane. 2-3cm above the supraorbital rims the pericranium is incised and subpericranial dissection is continued. For additional exposure, the superficial temporalis fascia can be excised at the zygmoatic arch. Can reach subcondylar region by osteotoimzing the arch and detachment of the masseter
Asprin
permanently blocking COX-1 in platelets, aspirin prevents the production of thromboxane A2, a powerful promoter of platelet aggregation and blood clot formation
Pierre Robins
Small Lower Jaw (Micrognathia): The jaw doesn’t grow as much as it should.
Backward Tongue (Glossoptosis): The tongue sits far back, blocking the airway.
Airway Obstruction: The primary concern, causing breathing difficulty.
Cleft Palate: Often a U-shaped cleft palate forms because the tongue prevents the palate from closing
Down syndrome
trisomy 21 leading upward slanting eyes, and flattened face, short neck, small mouth
Macroglossia, short necks, VSD, atlantoaxial instability. thick necks.
Fetal Alcohol syndrome
prenatal alcohol exposure,
small eyes, thin upper lips, absent philtrum, can also have VSD
Antibiotic prophylaxis before a procedure
. Prosthetic cardiac valves and grafts
. History of infective endocarditis
. Cardiac transplant with valve regurgitation
. unrepaired cyanotic congenerical heart disease
. Any repaired congenital heart disease with residual shunts or regurgitation or at site of protethic patch
Long acting beta agonist for asthma
Leukotriene inhibitor
on moderate and severe, like salmetorol and formoterol
Singulair no for intermittent, yes for persisetnat
Heparin bridging
Short acting anticoagulant to use while the patient is not on warfarin (used for afib, heart attacks, dvts),
It boosts antithrombin 3, enoxaparin is smaller and is more potent against Xa than thrombin II
