Clinical Surgery in General - part 1 ppsx

[...]... balance W Aveling, M A Hamilton 10 Nutritional support J Payne James 10 7 12 5 11 Clinical pharmacology J Robin 12 Evidence-based practice J W McLenahan 13 1 13 8 13 Decision making 14 4 R M Kirk, K Cox XI CONTENTS SECTION 3 SECTION 4 PREPARATIONS FOR SURGERY OPERATION 14 Consent for surgical treatment L Doyal 21 Good surgical practice R M Kirk, J Dawson 15 5 15 Preoperative preparation for surgery S Bhattacharya,... Bhattacharya, G M H Wray 16 5 16 Preoperative assessment and anaesthesia M W Platt 17 Operating theatres and special equipment M K H Crumplin 18 Adjuncts to surgery A L G Peel 225 22 Surgical access: incisions, and the management of wounds 230 D J Leaper, L Low 17 2 23 Minimal access surgery A Darzi 237 18 3 24 Principles of skin cover 2 41 P E M Butler, J L Atkins 19 9 19 Prevention of infection in surgical practice... urinary catheter after inspecting the perineum for bruising and bleeding, and carrying out a rectal examination in an injured patient (see Ch 2) PART 2: MONITORING Key point • Throughout the initial assessment, resuscitate, monitor and react to changing clinical and vital measurements (see also Ch 9) • Pulse Remember that in an elderly or even a middleaged person a rate of more than 14 0 beats per minute... rate of 10 0 times per minute, adjusting the force and rate to the filling of the heart Open the pericardium, avoiding the phrenic and vagus nerves You may inject adrenaline (epinephrine), atropine and lidocaine (lignocaine), but not sodium bicarbonate, directly into the left ventricle, avoiding the coronary arteries For internal defibrillation use internal 6 cm paddle electrodes with saline-soaked... resuscitation room has a warming device, ideally as part of a rapid transfuser, so that intravenous fluid at 3 7-3 8°C can be immediately infused to the hypovolaemic or hypothermic patient • Urinary output The minimum normal obligatory output is 30 ml h -1 In a child it is easily remembered as 1 ml kg -1 h -1 Suspect renal pathology if you find more than a trace of +protein on stick testing • Central venous pressure... ml kg -1 h -1 in a child Alkalinization of the urine in an appropriate high dependency setting with adequate monitoring increases the excretion of myoglobin, and will help prevent renal failure 13 1 3{ EMERGENCY Table 1. 5 Synopsis of causes of collapse to be considered during secondary survey System Diagnosis Notes Respiratory Upper airway obstruction Inhaled foreign body (try Heimlich manoeuvre) Infection... capable of combining with Hb) and F is the small amount of oxygen dissolved in the blood The values are converted to give millilitres per minute: normal oxygen flux is 10 00 ml min '1 The minimum flux compatible with life is 400 ml min "1 Oxygen saturation is now routinely measured noninvasively by shining several infrared wavelengths of light across a finger, earlobe or other piece of skin A sensor detects... Advisory Committee in Training in General Surgery for Great Britain and Ireland M C Winslet MS FRCS Professor of Surgery and Head of Department, University Department of Surgery, Royal Free Hospital, London, UK Gillian M H Wray MB BS FRCA Consultant in Anaesthesia and Intensive Care Medicine, St Bartholomew's Hospital, London, UK Contents SECTION 1 SECTION 2 EMERGENCY PATIENT ASSESSMENT 1 Resuscitation... acetylcholine at muscarinic receptors, using atropine Give 2 mg intravenously every 1 0 -1 5 min in severe poisoning Support respiration, reactivate inhibited acetylcholinesterase with oximes (pralidoxime mesilate) and suppress convulsions with diazepam Pretreatment with pyridostigmine (reversible inhibitor of acetylcholinesterase) protects a proportion of the total quantity of enzyme present against a subsequent... Anxiety, tachycardia of 10 0 -1 20 mirr -1 , tachypnoea of 2 0-3 0 mirr -1 , skin mottling, capillary refill time of more than 2 s, and postural hypotension Initially assume hypovolaemia from occult bleeding if there is postural hypotension with a fall of systolic blood pressure of 20 mmHg, a fall of diastolic blood pressure of 10 mmHg and a rise of pulse of 20 beats per minute (20 :10 :20 rule) Supine systolic blood . acid-base balance 10 7 W. Aveling, M. A. Hamilton 10 . Nutritional support 12 5 J. Payne James 11 . Clinical pharmacology 13 1 J. Robin 12 . Evidence-based practice 13 8 J. W. McLenahan 13 . . Committee in Training in General Surgery for Great Britain and Ireland M. C. Winslet MS FRCS Professor of Surgery and Head of Department, University Department of Surgery, . sciences and their incorporation into clinical practice. In the past general surgery dominated teaching and postgraduate surgical examinations, but many of the included subjects have