introduction

Vascular Surgery for Final Medical

Vascular Surgery UnitVascular Surgery Unit

AMNCHAMNCHwww.perfuse.net

Introduction

Scope

Occlusive Vascular disease

Aortic aneurysm

Carotid disease

Varicose veins

Occlusive venousdisease

Lymphoedema

Visceral arterial occlusion

Peripheral aneurysms

Arterial Trauma

Diabetic FootHyperhidrosis

Venous access

Topics

Occlusive Vascular disease

Aortic aneurysm

Carotid disease

Varicose veins

Occlusive venousdisease

Lymphoedema

Visceral arterial occlusion

Peripheral aneurysms

Arterial Trauma

Diabetic FootHyperhidrosis

Venous access

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

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

Perfuse.net

Perfuse.net

Elements

• Theoretical knowledge– anatomy– physiology– pathology– pharmacology

– medicine– surgery etc.

Normal & disease

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

History

• Presenting problem

• Context– personal

• age

• sex

• occupation

– social• domestic

arrangements

• lifestyle

– medical• chronic

illness

• medications

• previous surgery

Process of communicationProcess of communication

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

Art of History Taking

Translate

Common language

• Standard formula

• Common among clinicians

• Precise terminology vs– “haemorrhoids”– “can’t breathe”– “trouble passing water”

Physical examination

Differential diagnosis

• Consider all the possibilities• Weight them

Diagnosis• Test the hypothesis• Re prioritise

Diagnosis• Treat• Evaluate response