1.

Haematomas

Subdural Epidural
CT scan findings Follows brain contour Lens shaped
Doesn’t cross midline as its limited
by Falx cerebri
Crescent shaped
Acute Enhancing lesion – bright white
Chronic (>2weeks) Dark
Pathos Bridging veins torn Middle meningeal artery rupture

Presentation Brief LOC

Lucid interval (recovery)
Then rapid deterioration within 6hrs
2. Thyroid gland
 Pre-surgical procedures:
o Normalise thyroid levels (TSH) before surgery to avoid a thyroid storm - arrhythmias an
hyperthermia, exaggerated catecholamine response
o Direct laryngoscopy
 To view vocal cords
 Bilateral damage of both recurrent laryngeal nerves – stridor (both adducted)
 Unilateral damage – hoarseness, mid abducted position
 Steroids
o MOA
 Anti- inflammatory agents
 Prednisolone is a synthetic glucocorticoid and derivative of cortisol. It is the
active form of prednisone and used in patients with renal failure
 Irreversibly bind with glucocorticoid receptors and modify gene transcriptions at
a nuclear level for inflammatory mediators including COX 2, cytokines
 Regulation of gene suppression leads to systemic suppression of inflammation
and immune response.
o S.E.
 Osteoporosis – can be irreversible
 Immune system – suppression
 Upper GI bleed
 Cushings Syndrome – moon face (fluid retention in face), acne, constipation,
purple striae
 Thinning of skin
 Gluconeogenesis
 Proteolysis
 Lipolysis
 Hypothalamic Pituitary Adrenal axis suppression
 Sudden withdrawal causes Addison’s disease
 Papillary – mostly <30years old; one O (Orphan Annie) and 2Ps (Psammoma bodies)
 Scars – collar incision – previous thyroid surgeries
 Posterior triangle – lymphadenopathy
 Haematoma
o I believe patient should have the haematoma evacuated in theatre but
 Calcium on ECG – hypo and hyper
 Patient assessment post op
o Dyspnoea
o Get laryngoscope ready
o Intubation tray ready
o Call for help
o Assess airway – look listen feel
 o Check evidence or signs of cyanosis
o Stridor
o Air entry
 Complications
o Bilateral recurrent laryngeal nerve injury causing stridor – occurs only with total
thyroidectomy
o Haematoma – reactionary haemorrhage within 24hrs of operation
 Remove all sutures: Layers to go through:
 Skin
 Subcutaneous tissue
 Platsyma
 Deep cervical fascia
o Hypocalcemia due to damage to parathyroid glands
 Chovstek’s
 Trousseau
o Tracheomalacia – tracheal rings collapse
 Post-op management
o Radioiodine therapy
o Thyroxine – if total thyroidectomy was done
 Multi-nodular goitre
o Signs of hyperthyroidism and hypothyroidism
o Investigations
o Diagnosis