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LVL7 revision > Complications > Flashcards

Complications Flashcards

(64 cards)

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1
Q

High risk areas for vascular occlusion

A

Glabella
Forehead
Nose
Periocular
Perinasal
Temple

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2
Q

Vasovagal physiology

A

bradycardia
hypotension
arterial vasodilation

autonomic neural response

hypothalamic activation from stress or pain

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3
Q

Anaphylaxis adrenaline dose

A

500mcg of 1:100 (1mg/ml) IM

can be repeated after 5 minutes up to 3 times

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4
Q

Bruising risk factors (5)

A

antiplatelet
anticoagulant
NSAIDs
Vitamine E
High doses of garlic

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5
Q

Botox complication (non-cosmetic)

A

headache
Flu like symptoms

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6
Q

Cause of diploplia

A

lateral rectus palsy

lateral canthal injection diffusion

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7
Q

Cause of blurred vision

A

lower eyelid laxity stopping draining of tears

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8
Q

Cause of dry eyes

A

diffusion of toxin into lacrimal gland from deep periorbital injection

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9
Q

Causes of lower eye lid ectropiom

A

infraoribtital toxin causing lack of tone in palpebral portion

urgent opthalmology referral required to prevet corneal damage

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10
Q

Symptoms of systemic toxin overdose

A

dysphagia
slurred speech
muscle weakness

resp muscle paresis

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11
Q

Causes of toxin treatment faulure

A

Inproper product storage

true patient resistance

Inappropriate use - static lines

Calcium channel antagonist

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12
Q

Correcting medial brow ptosis

A

assess if there is still medial corrugator activity

if yes treat between 2-4 weeks to counterbalance medial frontalis fibre treatment

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13
Q

Managing adverse outcome

A

Document - identify reason for outcome

Liase with GP in needed

Refer to specialist services if needed

Make plan for continued care/ further review

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14
Q

Description of common side effect

A

Mild
Transient - resolve within 10 days
Does not require further intervention

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15
Q

Contents of emergency kit

A

Adrenaline 1:1000 x 4
Hyaluronidase 1500 units x 10
Associated consumables
Bacteriostatic saline 30mls x 2

Aspirin 75mg
Glucose gel/tablets
Loratidine 10mg

Warm Pack
BP monitor
Saturation probe

guaze
syringes
needles - 30G

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16
Q

Which governing body to report complications to?

A

MHRA (medicines and healthcare products regulatory agency)

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17
Q

Description of adverse events

A

Common reactions that have persisted
Rare
Moderate to severe effects

Anaphylaxis, necrosis, vascular compromise, scarring

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18
Q

Complication severity

A

Low - unlikely to result in complication, internvention unlikely

Moderate - may have complication, monitor

Major - immediate intervention essential

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19
Q

Examples of delayed filler complication (5)

A

Product migration
inflammatory nodules/granulomas
Oedema
Hypersensitivity related swelling
Chronic Infection
HSV activation

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20
Q

Examples of Early filler complications (5)

A

Infection
Swelling
Nerve damage
Tyndall effect
Muscle/expression change
HSV activation

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21
Q

Examples of immediate Filler complications (5)

A

Vascular event
Anaphylaxis
Bleeding
Vasovagal episode
Skin changes

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22
Q

Factors for nodule formation

A

Disease that creates immune mediated response

e.g Influenza

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23
Q

Anterograde embolism vs retrograde

A

Distally to terminal arteries

vs

Moves in opposition to blood flow

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24
Q

Venous complications

A

Congestion and compartment syndrome

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25
Where are the labial arteries most at risk
In the midline - higher risk of subctaneous arteries
26
Factors affecting needle aspiration (6)
Primed needle Product viscosity Length of time Needle length Steadiness of hands Amount of negative pressure
27
Conservative management of VO
Firm massage for 5 mintuutes Warm compress for vasodilaton Firm tapping over occluded area may dislodge emboli
28
Skin changes with filler
Neovascularisation from trauma/tissue expansion - treat with laser if resistant Hyperpigmentation - Fitz IV-VI Rosacea flare Scarring from other complication (ifection/VO)
29
Filler biofilm
Aggregation of microorganisms on implanted filler formed by extracellilar matrix of polymeric fibrinogen and fibronectin resitant to abx penetration
30
First line abx for infection
Flucloxacillin 500mg QDS PO or Clarithromycin 500mg BD PO
31
Malar oedema
May resolve over 2-3 weeks Encourage lymphatic drainage and cold compress several times a day Avoid steroids
32
Type IV hypersensitivity
Delayed reaction mediated by cellular response T-lymphocites Inflammatory nodules DO NOT RESPOND TO ANTIHISTAMINES, can be treated with oral steroids, tapering dose
33
What to do if unsure of hypersensitivity vs infection
Treat with abx first Then weaning steriod course May need to dissolve to remove underlying trigger
34
Type I hypersensitivity
IgE mediated - mast cell activation - fast onset atopy, anaphylaxis, allergy, angioedema Responds to antihistamines
35
Nerve damage
rare trauma through laceration, compression, occluding exiting foramen
36
Bells palsy management
Artificial tears steroids Eye patch
37
Nodule management
Firm massage if occur immediately Aspiration if delayed
38
Cause of inflammatory module
Biofilm infection of filler
39
Management of inflammatory nodule
Two weeks of abx, up to 4 weeks Macrolide - clari 500mg BD Tetracycline - minocycline 100mg BD - anti inflammatory properties
40
Dual antibiotic therapy
add doxycycline 100mg BD or ciprofloxacin 500mg BD
41
If infection of filler not improving
Punch biopsy and culture Surgical excision Intralesional antibiotics Hyaluronidase dissolving
42
Granuloma character
Red firm papules or nodules Subdermal Appear within 6 months of treatment Usually non-biodegradeable products, not HA
43
Hyaluronidase intradermal patch test
Should not be used to delay treatment in vascular compromise 30 units (0.2mls) in the forearm and compare with a saline control observe for 30 minutes Photographs pre and post test
44
Positive reaction in Hyaluronidase patch test
Wheal and flare increase in size by 50% Wheal increase by over 8mm
45
Hyaluronidase dose
Large volume protocol 1500 units in 10ml dilution
46
What to do in context of positive hyaluronidase patch test
If treatment still needed - referred to a specialist for further consideration of treatment with resuscitation facilities
47
How many units in a vial of hyaluronidase
1500 unit
48
Origin of UK hyaluronidase
ovine (sheep)
49
Storage of hyaluronidase
2-8C improves quality and longevity Room temperature stability is guaranteed for 12 months Once opened use immediately
50
Large volume, low concentration reconstitution
1500 units in 10mls of saline non-emergency scenarios
51
Small volume, high concentration
1500 units in 1-2mls of saline Emergency vascular occlusion
52
When would higher doses of hyaluronidase be needed
Highly cross linked HA Higher doses of HA Multiple prodcts Nodules Product injected over 6 months ago
53
Reconstitution of hyaluronidase
Water or saline Add 1ml to ampoule to dissolve powder - draw and expel syringe. Add 1ml of reconstituted product to remaining dilutent and mix
54
Hyaluronidase injection technique in VO
cannula or serial needle punctures along the course of vessel Cannula use can prevent bruising which would mask visual feedback Massage to disperse product
55
How often can Hyaluronidase be repeated
hourly until clinical resolution
56
Hyaluronidase after care
Observe patient for 30-60 minutes after treatment Arrange F2F appointment 24-48 hours if signficant skin changes prescribe abx prophylactics Follow-up with patient every few hours that same day
57
Where to report complications
MHRA Yellow card scheme Manufacturer
58
Signs of VO
Skin changes Strong pulse upstream to affected area
59
Most common cause for non-inflammatory nodule
Product misplacement
60
Nodule excision - when & how
Recently placed Superficial placement Large bore needle 21G Small incision and squeeze
61
Delayed onset inflammatory nodule signs and causes
Tenderness Erythema Warmth Discrete border Low grade biofilm - can lead to chronic inflammation and granuloma formation
62
Retinal artert occlusion immediate management
Stop treatment, supine position Occular massage Rebreathe in paper bag - increase CO2 and vasodilaton Sublingual GTN Emergency eye casualty referral
63
Time to cause permanent visual loss in rentainal occlusion
12-15 minutes
64
Retinal artery occlusion treatment
Specialist eye unit Retrobulbar injections by specialist injection of hyalase into supratrochlear or supraorbital arteries

LVL7 revision (18 decks)

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