QUT CSB539 Podiatric Anaesthesia and Surgery Lecture 2 PDF

Week 2 – Patient Assessment for Surgery (Lecture) CSB539 Podiatric Anaesthesia and Surgery Bachelor of Podiatry, School of Clinical Sciences, Faculty of Health TEQSA Provider ID PRV12079 Australian University | CRICO...

Week 2 – Patient Assessment for Surgery (Lecture) CSB539 Podiatric Anaesthesia and Surgery Bachelor of Podiatry, School of Clinical Sciences, Faculty of Health TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Week 2 - Patient Assessment for Surgery ULOs addressed: 1) Evaluate the findings from a clinical history and physical examination, exercise clinical decision making, and administer an anaesthetic in accordance with legal requirements and Podiatry Accreditation Committee standards; 2) Apply high level clinical judgement and technical skills in performing podiatric surgery; TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Importance of patient assessment https://www.accidentspecialistsolicitors.co.uk/removal-of- TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J toenail-death/ CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Nail Surgery by Podiatrists Generally very successful with high rates of patient satisfaction. In a retrospectives audit of 80 patients in a central London community podiatry setting (Krishan et al, 2016)… TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Pre-operative History and Physical Examination Process of surgery can be broken down into 3 areas: 1) Pre-operative 2) Intra-operative Peri-operative 3) Post-operative Positive outcome with surgery depends on effective assessment and management at each stage. TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Determine the need for surgery Surgery is indicated when either: 1) Conservative options have been attempted but have not been successful. 2) Conservative treatment is not indicated. NICE grading system for surgery Grade 1 (minor) e.g. nail surgery An operation causes physiological stress to Grade 2 (intermediate) e.g. knee arthroplasty the patient – increases with the invasiveness of Grade 3 (major) e.g. hysterectomy the procedure Grade 4 (major+) e.g. total hip replacement TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Indications for Nail Surgery Assessment Painful nail conditions (painful/hx of sepsis) include: 1) Onychocryptosis (often associated with bacterial infection) 2) Painful onychauxis/gryphosis 3) Painful onychomycosis 4) Painful involuted nails 5) Trauma (loose nail, potentially subungual haematoma/ulceration) TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Pre-operative History and Physical Examination Screening for underlying diseases, esp. vascular impairment of the lower limb Allows proactive identification of perioperative issues and potential modification, individualisation and optimisation of treatment approach. Inadequate assessment may have serious consequences… TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Assess the Suitability of Patient for Nail Surgery American Society of Anaesthesiologists (ASA) Physical Status Classification System – simple scale the describes pt’s fitness to undergo anaesthesia. Ensures a standardised classification system for pt risk status for pts needing nail surgery. ASA Meaning State 1 Normal healthy pt Pts for routine nail surgery usually expected to be ASA 1 2 Pt with mild systemic disease or 2. ASA 3, 4 and 5 pts 3 Pt with severe systemic disease ASA 3? Avoid if possible. should be managed in hospital setting 4 Pt with severe systemic disease that is constant threat to life ASA 4 or 5? Not suitable for routine nail surgery! 5 Moribund patient, not expected to survive 24 hours with/without surgery TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Pre-operative History and Physical Examination Comprehensive review of clinic history! Vascular and neurological status assessment of the lower limb and foot. Contraindications (relative or absolute) to LA use, torniquet and/or liquefied phenol? Ability of pt to provide informed consent (LA and nail surgery procedure) and aftercare regime. Essential! TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Pre-operative Hx for Nail Surgery Consider medical history Arrive at informed 1) Immune function (inc. autoimmune diseases) position regarding 2) Blood diseases medical appropriateness of 3) Cardiovascular disease (e.g. hypertension) planned procedure 4) Pregnancy 5) Endocrine/metabolic disorders 6) Neurological disorders (Depression? Anxiety?, Epilepsy? MS?) 7) Cancer/malignancy/tumour? 8) Current investigations? This is usually performed 9) Current consultant care? days in advance! TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Pre-operative Hx for Nail Surgery Consider surgical history 1) Major surgery 2) Minor surgery (inc. previous use of LA) 3) Insertion of pins, plates or prosthesis in region of LA TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Nail Surgery and Autoimmune Diseases (AD) Examples include RA, Crohn's, PsO, scleroderma…inflammatory connective tissue disorders Management includes DMARDs (biologics, non-biologics) with immunosuppression. Increased risk of post-operative infection and delayed healing time. ADs can be characterised by exacerbations and remissions. What if a pt is experiencing a disease flare up? Nail surgery is a physically traumatic procedure (torniquet, LA, phenol) increased risk of vasculitis and gangrene. ESR and CRP monitoring necessary before procedure? TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Nail Surgery and Autoimmune Diseases (AD) With ADs, it can be necessary to closely monitor disease activity prior to surgery, confirming no disease flare is present. DMARDs dosage regiment may need to be altered in consultation with pt’s specialist to minimise risk of adverse outcomes. CAREFUL CONSIDERATION! Raynaud’s phenomenon – never attempt nail surgery during vasospasm. Procedures best avoided in cold weather. Link TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Nail Surgery and Diabetes HbA1c should be below 9% (75mmol/mol) within past 12 months Where glycaemic control cannot be improved, risk/benefit decision needed. Nail avulsion without Risk Benefit phenolisation can be considered in Poor Acute inflammation (and infection) situations where there glycaemic associated with poor glycaemic In such cases, patient are concerns about has to understand and healing. control impairs control? agree to risks in wound healing. conjunction with Increased Potential for development of diabetologist. Clear Always be risk averse documentation needed. for you and your immunosuppre severe infection is worse than risk patient. Consider ssion and risk of procedure and prolonged referring to DM MDT for of infection healing time. management. TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Hepatic diseases Associated with immunosuppression Can cause impaired blood coagulation May need to consider in the same way as other coagulation disorders TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  HIV Immunosuppressed. CD4 count indicated how well the immune system is functioning. Where CD4 count is > 200 cells/mm3 with low viral load = similar range of post- op risks and complications as general population. CD4 count must be reviewed pre-operatively. TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Endocarditis Severe and often fatal condition characterised by inflammation and bacterial infection of heart lining and valves, resulting in congestive heart failure, myocardial abscesses, embolic stroke and brain abscesses. Can result where heart valves have been damaged – e.g. rheumatic fever. Condition is not a barrier to nail surgery and antibiotic no longer recommended. TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Angina Angina- Unstable or stable Stable – chronic ,predictable chest pain on exertion. If no hx of previous Ml or other risk factors are absent the risk of perioperative Ml is low. Provided pt is not exposed to excess stress! Pt's antianginal medications should be continued perioperatively TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Unstable angina Unstable Angina Characterised by high frequency, severity and duration of painful attacks that are no easily controlled with medications. Unstable angina symptoms carry the same degree of perioperative risk as having had a Ml in the past 6 months. Surgery is contraindicated until unstable angina is stabilised with medications or cardiac surgery. TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Respiratory Disease Post-operative morbidity and mortality significantly higher in individuals with pulmonary disease (GA and LA) Effects noted in pts with well established pulmonary risk factors- heavy smokers, pre-existing pulmonary disease, obesity + elderly Request expert opinion if unsure. Smokers should discontinue smoking at least 1week prior to surgery TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Blood Dyscrasias Anaemia Cardiopulmonary function and wound healing are dependent on tissue 02 levels. Anaemia rarely a contraindication to surgery unless severe in magnitude. Haematocrit values < 30 insufficient for elective foot surgery. Haemophiliacs (+ other patients with clotting disorders) Enquire about bruising, nose bleeds and other surgical problems Previous surgical problems? Obtain platelet count and bleeding time TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Sickle Cell disease Affects pts of African and West Indian descent Small changes in 02 level in blood cause HbS (instead of normal HbA) to polymerise into pseudocrystalline structures- rbcs form sickle shapes. Sickle cells increase blood viscosity and obstruct microvascular blood flow, leading to thrombosis and infarction. Sickle cell disease = LA WITHOUT ADRENALINE AND WITHOUT A TORNIQUET Sufficient peripheral circulation is required for healing. Sickle cell crisis… TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Pregnancy Status should be established during pre-operative assessment, checked again on day or surgery. LAs need to be used with caution during 1st and 1/3rd trimester of pregnancy. Phenol = potential carcinogen Due to brief exposure with nail surgery, not contraindicated for pregnant patients. However, pt’s can be offered conservative treatment or surgery without phenol. Nail surgery with phenol is thought to be safe during breastfeeding (as with LA). TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Pre-operative Hx for Nail Surgery (medications) Consider drug/medication history All prescribed medications All OTC medications Medications prescribed by other practitioners Herbal/alternative therapies Alcohol and recreational drug use TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Pre-operative History and Physical Examination Obese patients and nutrition Have a greater risk of post-operative complications – DVT and wound complications such as infection and dehiscence. Elderly – malnutrition can have a higher incidence. Serious underweight patients – may be suffering from a number of systemic conditions (or have poor nourishment due to alcoholism, drug abuse, anaemia). TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Pre-operative Hx for Nail Surgery History of allergies, reactions or sensitivities Local anaesthetics Latex Medicines Other TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Vascular Assessment In addition to taking a patient history, a lower limb vascular assessment must always be conducted to confirm/exclude significant PVD which may impact on nail surgery healing. As a minimum: Ø Establish modifiable/non-modifiable risk factors: Non-modifiable: age, gender Modifiable: e.g. hypertension, DM, current/previous smoker, CVD, PVD Presence of medical conditions e.g. DM, RA, renal disease TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry Vascular Assessment TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Vascular Assessment Venous status of lower limb should be assessed – review for presence of varicose veins, hx of DVT and varicose vein surgery. If there any indications of suspected PAD (e.g. non-palpable foot pulses, monophasic doppler signals, symptoms of IC or RP) – FURTHER NON- INVASIVE VASCULAR INVESTIGATION SHOULD BE PERFORMED IN CONSIDERING NAIL SURGERY. If non-severe PAD is identified, nail surgery must only be considered with caution, taking into account overall risks and benefits, and in consultation with pt, GP and/or vascular team. TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Vascular Assessment Where results indicate severe or critical limb ischaemia, issues and decisions relating to nail surgery must be discussed with vascular team. NAIL SURGERY MUST NOT BE PERFORMED WITH THE FOLLOWING VASCULAR FINDINGS (URGENT VADSCULAR OPINION NEEDED): Ø ABPI < 0.6 or ankle systolic pressure < 70 mmHg Ø ABPI is > 1.4 AND foot pulses non-palpable/monophasic Ø Toe systolic pressure is < 40 mmHg TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Vascular Assessment If an acute nail problem is identified and results indicate severe or critical limb ischaemia WITH infection present, this should be made clear to vascular team to help facilitate urgent triage. Severe ischaemia and infection combined create a high immediate risk of sepsis, tissue necrosis, gangrene and potential amputation. TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Neurological Assessment Neuropathy can result in foot deformity and abnormal plantar pressures. LOPS can delay healing through unnoticed trauma. Test for and establish any level of neuropathy – 10g monofilament, neurosthesiometer or 128 Hz tuning fork on bony prominences. TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Medication Considerations Anticoagulant therapy (ACMs) Most common anticoagulants/antiplatelets include warfarin, aspirin and clopidogrel. Newer oral anticoagulants include rivaroxaban, dabigatran, apixaban and edoxaban. Pts use ACMs to prolong blood clotting time and often have a hx of DVT, stroke, CAD, heart valve replacement, atrial fib and anti-phospholipid syndrome. TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Medication Considerations - ACMs ACMs should not prevent nail surgery (barring other contraindications), but pts should be aware that post-op bleeding may be prolonged and aftercare regime modified to reflect this. INR (international normalised ratio – measure of clotting time) (warfarin) vary in accordance to individual’s condition + higher INR, longer blood will take to clot. In most cases, INR between 2 – 3, which means that blood takes 2 to 3 times longer to clot than normal population. STOPPING USE OF ACMS OR AVOIDING SURGERY IS NOT USUALLY JUSTIFIED. TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Medication Considerations - ACMs With the new range of anti-coagulants, it is important to review manufacturer’s recommendations. Pts taking these medications not monitored by INR, so podiatrist needs to seek opinion of anticoagulant team prior to nail surgery. TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Medication Considerations – Cytokine inhibitors (CytI) CytI include drugs such as adalimumab, etanercept, infliximab, rituximab. Use for pts with conditions such as severe psoriasis, Crohn’s and many inflammatory arthropathies to slow disease progression/slow symptoms. Pts taking CytIs may need to have dose adjusted down or stopped by consultant rheumatologist/immunologist before nail surgery. Medication with these drugs may need to be stopped 2-8 weeks before the date of surgery and prophylactic antibiosis required from day of surgery and during the healing process. Podiatrist should liaise with pt’s prescribing consultant to seek advice on pt’s perioperative biologic management. TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Medication Considerations – Oral retinoids (ORs) CytIs used in tx of acne and PsO – acitretin, adapalene, tazarotene, tretinoin, isotretinoin (most potent). Oral retinoids likely to pre-dispose pts to IGTNs + have inmmunosuppressive and anti-inflammatory characteristics. Common side effects: skin fragility, pyogenic granulomas and paronychia with Staphylococcus aureus infection. Many pts on these drugs are adolescents – ppl most likely to have IGNT! TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Medication Considerations – Oral retinoids (ORs) Establish reason for use of ORs + duration of therapy (acne tx = 20 week course) Ø Can pt complete course before undergoing nail surgery? Conservative management in the meantime? Ø Is the presenting complaint paronychia due to side effects? Pts with PsO or chronic adult acne may be on maintenance dose of Ors, causing skin fragility and delayed post-op healing. Pts on OR therapy need to be reviewed post-op on a more frequent basis than normal due to increased risk of S.aureus infections and pyogenic granuloma. TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Psychosocial inquiry Health beliefs Self-efficacy in relation to post- operative care Locus of control – adapt to treatment plan and communication style? Individual environmental contests, personal goals and expectations TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Patient’s domestic circumstances Establish patient's home circumstances Who will provide transport for the patient to and from surgery Who will assist patient through post-operative recovery period - if necessary (dressing changes)? Lack of home support may rule out surgery TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Patient’s Sports and Hobbies Find out information in relation to patient's sports and hobbies Time will need to be dedicated to postoperative healing- cessation of sporting activity must be emphasised to patient. Typical post-op surgery advice TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Patient’s Occupation Patient may experience difficulty in reducing work activity (or taking time off if needed) and needs to aware of the time needed to heal. The patient who cannot or will not devote time to heal after surgery is not a good candidate. Typical post-op advice for nail surgery TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Inadequate Assessment Patient is placed at risk: Inappropriate or unsafe surgery because of missing knowledge concerning pt medical history High risk of post-operative morbidity in patients with certain systemic pathologies Many conditions can complicate surgical practice…unstable angina? Rheumatoid arthritis? SLE? Schizophrenia? Sickle cell anaemia? TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Inadequate Assessment An increased risk of clinical emergencies Ø For e.g., hypertensive crisis, cerebrovascular accident, myocardial infarction TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Inadequate Assessment The podiatrist is potentially placed at risk: Blood and tissue fluids are encountered during surgery Potential failure to identify known or potential blood borne diseases (e.g. Hep B) places practitioner at risk. TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Inadequate Assessment Poor treatment outcomes If disease and health status are overlooked, poorer treatment outcomes will result A SYSTEMATIC APPROACH TO THE ASSESSMENT IS REQUIRED TO ENSURE THAT ALL AREAS OF ENQUIRY ARE COVERED. TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Legality Minor vs Adult Written vs informed consent Consider What happens when patients can’t give consent? Who can give consent? TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Consent for medical treatment Adult: person over 18 can consent or refuse medical treatment if they: Understand the information about the treatment Can make responsible choices based on this information An enduring power of attorney An enduring power of attorney can authorise someone to make medical decisions on your behalf if you become unable (don’t have the capacity) to make a decision yourself Advanced Health of directive An advance health directive (sometimes called a ‘living will’) is a document containing instructions about your future health care. It comes into effect if you become unable (don’t have capacity) to make the decisions yourself. Statutory Health Attorney If you haven’t made an advance health directive or appointed someone as an enduring power of attorney and you’re unable to make your own decisions, then the law allows certain people to make decisions about your health on your behalf. They are called a statutory health attorney. TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Minor: under 18 (child or young person) Parent or guardian can agree to treatment on the child’s behalf a child or young person under 18 years of age may make decisions about their own medical treatment if they are capable of understanding its significance To consent to medical treatment (have capacity) you must be capable of making your own decision on what is proposed (forming a sound and reasoned judgment), which shows you understand the nature, consequences and risks of the treatment, and it's in your best interests. Need to consider: maturity and intelligence whether they understand what the recommended medical treatment is why the medical treatment is needed what the medical treatment involves, and any risks related to it, such as effects on their health, potential complications and also side effects. If you're 16 or over, it's generally assumed that you have the capacity to consent to medical treatment, but if you're under 16 years of age, you will have to prove that you have capacity to consent to the treatment. TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  How to obtain consent Consistent with ethical and legal principles, it is a patient’s right generally to decide what health care they wish to receive. As a matter of policy, no health care (examination, investigation, procedure, intervention or treatment) is provided without the informed agreement of a patient who has capacity to make decisions (or via a parent/ guardian etc). TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Informed consent The patient has received the relevant information in a way they can understand, to enable them to make an informed decision and they voluntarily give permission For informed consent to be valid, certain principles must be fulfilled: Patient has the capacity to make a decision and is not affected by therapeutic or other drugs Consent is voluntarily given, free from manipulation or undue influence The discission between practitioner and patient is transparent, well balanced and involves 2-way communication The patient is able to clearly understand in information because it is provided in a language or by other means the patient can understand Diagnosis or likely nature of the condition Recommended heath care, including expectations, adverse effects and alternative healthcare options Significance of long term outcomes Degree of certainty of eh diagnosis Degree of certainty of about the therapeutic outcome Whether treatment tis experimental or conventional Anticipated recovery implications The patient has sufficient time to consider and clarify information The information is related to the specific intervention TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Verbal consent form of express consent where a patient says they agree to healthcare Written consent patient or decision maker provides written evidence of their agreement for healthcare Is not considered enough to show consent is valid and informed Needs to be supported with specific and detailed information of the treatment TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry  Next week Lower limb anatomy for LA and Surgery https://id.elsevier.com/as/authorization.oauth2?platSite=SD%2Fscience&additionalPlatSites=GH%2Fgeneralhospital%2CSC%2Fscopus&scope=openid%20email%20profile%20els_auth_info%20els_idp_info%20els_idp_anal ytics_attrs%20els_sa_discover%20urn%3Acom%3Aelsevier%3Aidp%3Apolicy%3Aproduct%3Ainst_assoc&response_type=code&redirect_uri=https%3A%2F%2Fwww.sciencedirect.com%2Fuser%2Fidentity%2Flanding&auth Type=SINGLE_SIGN_IN&prompt=login&client_id=SDFE-v4&state=retryCounter%3D0%26csrfToken%3Dacee9e29-80d3-40e8-9fa4- 7217e540a028%26idpPolicy%3Durn%253Acom%253Aelsevier%253Aidp%253Apolicy%253Aproduct%253Ainst_assoc%26returnUrl%3D%252Fscience%252Farticle%252Fpii%252FB9780128154496000408%26prompt%3D login%26cid%3Darp-31daba2b-d5cc-488e-a7e2-c62efe4b3607 TEQSA Provider ID PRV12079 Australian University | CRICOS No.00213J CSBS539 Podiatric Anaesthesiology and Surgery Bachelor of Podiatry, School of Podiatry