Things I’ve Learnt This Week

I’m now into my fourth week of my sign-off placement on the gynae ward. As this is my first surgical ward placement, so I’ve got a ton of things to learn, and thought to myself: why don’t I share all the weird and wonderful things I’ve come across so far? Some are gynae related, some aren’t.

ITP

Immune thrombocytopenic purpura is a rare autoimmune disease where platelets are destroyed, causing thrombocytopenia (low platelets) along with bruising and bleeding. The origin is often unknown and it can have both acute and chronic forms. Only around 3-4000 people in the UK suffer from this condition at any time, and treatment can vary depending on its severity, but mostly revolves around increasing platelet numbers and reducing incidence of bleeding.

Salpingo-oophrectomy

This is where one or both ovaries and fallopian tubes are removed during a surgical procedure.

Salpingectomy

This procedure just involves removal of fallopian tubes, leaving the ovaries intact.

All about the wees

Following any gynae (or urology) procedure, nurses and doctors get super excited about their patients passing urine, especially if they’ve had a catheter. This just shows that there’s no issues with the urinary system that need to be addressed and that they haven’t gone into urinary retention.

Defunctioning stoma

These are temporary stomas normally used to protect other surgical anastomosis (bridges made between other tissues, such as blood vessels or bowel).

Pabrinex 

A funky yellow medicine cocktail including a range of vitamins ((thiamine, riboflavin, pyridoxine, nicotinamide and ascorbic acid) normally used to treat those dependent on alcohol, have certain infections or following surgery and haemodialysis. The only thing I’ve actually seen it used for so far is in alcohol dependence, where it can help prevent development of Wernicke’s encephalopathy, a neurological condition caused by vitamin B deficiency, leading to lesions in areas of the brain such as brain stem, periventricular region, diencephalon, the midbrain, hypothalamus, and cerebellar vermis. 

ACS Protocol

The ACS (acute coronary syndrome) protocol is used to treat STEMI, NSTEMI and unstable angina. This involves the patient taking a selection of medications to help treat and prevent further cardiac ischaemia; this includes a nitrate (typically glycerol trinitrate), aspirin, a low weight molecular heparin (dalteparin is the most common) or fondeparinex, ticagrelor or clopidogrel and a beta-blocker.

Importance of GTN

Make sure your patient has access to their GTN spray at all times in case they get ischaemic pain, and remind them to take it if they need it. I think of this one in the same boat at salbutamol inhalers: keep them within reach.

References

ITP – https://www.itpsupport.org.uk/index.php/en/itp-in-adults 

Stomas – https://www.fastbleep.com/wiki/article/276

Pabrinex – http://www.uhs.nhs.uk/Media/Controlleddocuments/Patientinformation/Medicinestherapiesandanaesthetics/Pabrinex-patient-information.pdf

ACS – https://bnf.nice.org.uk/treatment-summary/acute-coronary-syndromes.html

 

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