Ординатура / Офтальмология / Английские материалы / Moorfields Manual of Ophthalmology_Jackson_2007

Appendix 1

Cardiorespiratory Arrest

Act quickly – ‘time is (cardiac) muscle’.

Confirm diagnosis Unconscious patient, apnoeic, with absent carotid pulse.

Treatment Administer a precordial thump only if the arrest was witnessed or monitored and a defibrillator is not immediately available. Recheck the carotid/femoral pulse. If absent, perform Adult Basic Life Support (Fig. A1.1) while waiting for a defibrillator.

Send or go for help as soon as possible according to guidelines

Fig. A1.1: Adult basic life support (Courtesy of 684 Resuscitation Council, UK).

Appendix 2

Anaphylaxis

Signs Suspect anaphylaxis if, after exposure to a potential allergen, the patient develops: wheeze, breathlessness and cyanosis, tachycardia, hypotension, urticaria and erythema, angioedema or other soft tissue swelling (eyelids, lips).

Treatment

1.If possible, remove the cause.

2.Give epinephrine (adrenaline) 0.5 mg i.m. (equivalent to 0.5 mL of 1 : 1000 solution). If required, repeat every 10 minutes, until there are signs of clinical improvement.

3.Establish i.v. access. Give chlorpheniramine 10 mg i.v. over 1 minute.

4.Give hydrocortisone 100 mg i.v.

5.Administer 100% oxygen. Upper airway obstruction from laryngoedema may cause respiratory distress. Consult an anaesthetist, as patient may require endotracheal intubation or emergency tracheotomy.

6.If systolic BP <90 mmHg, administer 500 mL of i.v. colloid, over 15–30 minutes.

7.Attach an ECG monitor.

8.Nebulized salbutamol can also be given if there is bronchospasm.

9.Admit to ward for 24 hours, as relapses can occur.

10.Discuss with the duty physicians regarding further management, especially if the patient remains hypotensive or wheezy (admission to intensive care unit may become necessary).

If the anaphylactic reaction was caused by drug administration, this must be reported to the Committee on the Safety of Medicines (complete yellow cards at the back of the British National Formulary).

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Appendix 3

Visual Standards for Driving

Table A3.1: Guide to fitness to drive (United Kingdom)

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Appendix 4

Suture Material

Sutures

■Sutures can be divided into absorbable/nonabsorbable, and monofilament/multifilament (braided) (Table A4.1).

■Absorbable sutures are absorbed by proteolysis of natural material or hydrolysis of synthetic materials; hydrolysis causes less tissue reaction. Nonabsorbable sutures become encapsulated by fibrosis.

■Compared to multifilament sutures, monofilament sutures are more resistant to infection, have a lower coefficient of friction (easier to pass through tissue), lower tensile strength, lower flexibility, and are harder to tie.

■Sutures may be coated to reduce their coefficient of friction and dyed to increase their visibility.

Needle types

■The needle is divided into three parts: the point, the body, and the swage.

■The point extends from the tip to the maximum cross-section of the body. There are five types: spatulate, round bodied/ taper point, cutting point, reverse cutting point, and tapered spatulate (Fig. A4.1). The body incorporates the needle length, and is the grasping area that transmits the penetrating force to the point. The body can be oval, round, triangular, sideflattened rectangular, or trapezoidal. The longitudinal shape of the body can be straight, half-curved, curved, or compound curved. The suture attaches to the swage, creating a continuous unit.

■A needle has five measurements:

1.Chord length : linear distance from the point of a curved needle to the swage. This determines the width of the bite.

2.Needle length : distance measured along the needle from