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FACTOR V LEIDEN MUTATION

FV acts as a cofactor for FXa. Protein C degrades FV. The factor V Leiden mutation inhibits this degradation process, leading to thrombogenic disease.

FACTOR VIII CONCENTRATE

Description

FVIII may be derived from plasma or be a recombinant product. It is used to treat haemophilia A. See Haemophilia. There are standard life products (half-life 8–12 h) and extended life products.

Dose

1 unit/kg will increase FVIII levels by 2%. 50 units/kg will increase FVIII levels by 100%. Round dose up to nearest vial. For patients with severe bleeding or surgery, give as an IV bolus LD then an infusion of 3 units/kg/h.

FACTOR IX CONCENTRATE

Description

FIX may be derived from plasma or created by recombinant technology. Used to treat haemophilia B. See Haemophilia. 1 unit/kg increases FIX levels by 0.7–1%. 50 units/kg would increase levels by 30–50%.

Dose

For patients with severe bleeding or surgery, give a bolus dose 100 units/kg then infusion of 3 units/kg/h.

FASCIA ILIACA BLOCK

Indications and rationale

This block is used for analgesia for hip injury such as fractured neck of femur and hip surgery such as joint replacement. It can also be used for femoral shaft fractures. The aim of the block is to anaesthetise the femoral, lateral femoral cutaneous and the obturator nerves. These nerves are sandwiched between the fascia iliaca and the iliopsoas muscle.

Use 20 mL of ropivacaine 1% mixed with 40 mL N/S (total volume 60 mL) and an 80 mm short-bevelled block needle.

Anatomy

The medial surface of the ilium is lined by the iliacus muscle. The psoas muscle attaches proximally to the vertebral bodies of T12 to L4. These muscles fuse to form the iliopsoas muscle, which passes under the inguinal ligament to insert into the lesser trochanter. Overlying these muscles are the fascia lata and, more deeply, the fascia iliaca. The femoral artery and vein lie under the fascia lata but are superficial to the fascia iliaca, whereas the femoral nerve is deep to both fasciae.

Contraindications

  1. Infection at the site of insertion.

  2. Anticoagulation.

  3. Inguinal hernia or repaired inguinal hernia.

  4. Femoral artery surgery.

  5. Patient refusal (as for any other procedure).

Technique

  1. Position the patient supine and insert an IV cannula.

  2. Using aseptic technique, place the ultrasound (U/S) probe on the anterior superior iliac spine (ASIS). This bony prominence is obvious on U/S.

  3. Orientate the probe so the marker end is pointing halfway between the xiphisternum and the umbilicus.

  4. Move the ...

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