Systemic complications of aneurysmal subarachnoid hemorrhage

🔺Hypovolemia

🔺Hyponatremia

🔺Hypokalemia

🔺Hypocalcemia

🔺Electrocardiographic abnormalities

🔺Pulmonary edema

🔺Pneumonia

🔺Pulmonary embolus

🔺Hepatic dysfunction

🔺Renal dysfunction

🔺Thrombocytopenia

🔺Gastrointestinal bleeding

SURGICAL APPROACHES FOR VARIOUS ANEURYSMS

🌀FRONTO TEMPORAL (PTERIONAL ) CRANIOTOMY 

🔺Allows access to most aneurysms on lateral and anterior Circle of Willis vessels.

🔺Internal Carotid : Paraclinoid / Superior hypophyseal artery

🔺Internal Carotid : Ophthalmic artery

🔺Posterior Commununicating Artery

🔺Anterior Choroidal artery

🔺Internal Carotid Bifurcation 

🔺Middle Cerebral Artery

🔺Anterior Commununicating Artery

🌀PTERIONAL / SUBTEMPORAL APPROACH 

🔺Upper Basilar Artery

🔺Superior Cerebellar Artery

🌀SUBOCCIPITAL APPROACH 

🔺Vertebral Artery

🔺Posterior Inferior Cerebellar Artery

🌀COMBINED SUBTEMPORAL AND SUBOCCIPITAL APPROACH 

🔺Basilar trunk

🔺Vertebrobasilar Junction

NSAIDS-COMPARISON

ANTI INFLAMMATORY PROPERTIES 

〰〰〰〰〰〰〰〰〰〰〰〰〰

✨BETTER THAN NAPROXEN :

🔹Flurbiprofen

🔹Indomethacin

✨GOOD:

🔹Naproxen

🔹Fenoprofen

🔹Ketoprofen

🔹Tiaprofenic acid

🔹Diclofenac

🔹Aceclofenac

🔹Etodolac

🔹Nabumetone

🔹Piroxicam

🔹Tenoxicam

🔹Etoricoxib

✨WEAK:

🔹Ibuprofen

🔹Mefenamic acid

SIDE EFFECTS 

〰〰〰〰〰

✨FEWER SIDE EFFECTS 

🔹 Ibuprofen 

✨GREATER THAN IBUPROFEN

🔹 Naproxen

🔹 Fenoprofen(GI)

🔹 Flurbiprofen(GI)

🔹 Ketoprofen

🔹 Diclofenac

🔹 Aceclofenac

🔹 Sulindac

🔹 Tenoxicam

✨HIGH

🔹 Indomethacin

🔹 Piroxicam 

✨HIGH RISK OF RASH

🔹 Fenbufen

✨SEVERE CYSTITIS

🔹 Tiaprofenic Acid

✨DIARRHOEA & HEMOLYTIC ANEMIA

🔹 Mefenamic acid

✨LOW G.I.; BUT HIGH C.V. EFFECTS

🔹 Celecoxib

🔹 Etoricoxib

Reference: 

Medicines Optimisation Academy 

British National Formulary

MAKE OURSELVES AWARE OF THE DISINFECTANTS USED IN HOSPITALS: PLASMA STERILIZATION

✔️Plasma sterilization requires an array of equipments

🔹A chemical processor (to derive the plasma)

🔹A closed chamber and deep vacuum ( for the creation of low temperature plasma)

🔹A source of electromagnetic energy ( to create an electromagnetic field)

🔹Hydrogen peroxide or a mixture of Hydrogen peroxide + per acetic acide can be used as the chemical disinfectant

✔️The electromagnetic field interacts with the chemical disinfectant to induce the plasma

✔️The resulting UV radiation causes rapid destruction of vegetative organisms including spores

✔️Examples of commercial plasma sterilizers : Sterrad 100S , Plazlyte

✔️Useful for sterilization of surgical instruments having long and narrow lumens

( e.g. Those used in urologic, laparoscopic and arthroscopic surgeries )

Reference :

Hospital Associated Infections; Epidemiology, Prevention and Control , Nita Patwardhan