DAMS

MUST KNOW SERIES

GENERAL SURGERY
DR. SANDEEP SEERAMREDDI
TRAUMA
Indication for NCCT Brain in head injury
1. GSC< 13
2. GSC < 15 after 2 hours of admission
3. Age > 65 years
4. Retrograde amnesia > 30 mins
5. Coagulopathy
6. Dangerous mechanism of injury
Indication of craniotomy
EDH SDH
1. > 30 cc volume 1. Fixed and dilated pupil
2. > 1.5cm thick 2. > 1cm thick
3. > 5mm midline shift 3. > 5mm midline shift
4. GCS decreases by > 2 points
5. ICP> 20mmHg
Cattell braasch : right to left
Mattox : left to right
WOUNDS
Pressure ulcer/ decubitus ulcer
National Pressure Ulcer Advisory Panel Classification Scheme Stage Description
I - Nonblanchable erythema of intact skin – reversible

II - Partial-thickness skin loss involving epidermis or dermis; may present as an abrasion,

blister, or shallow crater

III - Full-thickness skin loss involving damage or necrosis of subcutaneous

IV - Full-thickness skin loss with damage to underlying support structures (i.e., fascia,
tendon, or joint capsule)

Unstageable - Full-thickness tissue loss with actual depth of ulcer unknown due to slough
and/or eschar in wound bed
DRAINS
T-TUBE Materials
20 cm 1. Latex
2. Red rubber
3. Silicon
4. PVC

• Ideal is latex

• Absorbable suture material

used, non absorbable will act
as nidus for stone formation

60 cm
Extra edge
Surgical drains : purpose driven
• By 7 days only 20% of drains are still functioning

• perioperative bleeding - removed after 24 hours, e.g. thyroidectomy.

• serous collections - removed after 5 days, or < 25ml e.g. mastectomy.

• infection - until the infection is subsiding or the drainage is minimal.

• colorectal anastomoses - 5–7 days.

• Common bile duct T-tubes - 10 days.

• Any suction drain should have the suction taken off prior to removal of the drain.

• During removal of a chest drain- Valsalva manoeuvre

TUBES
SUTURES
Knots
BURNS
THORAX
VASCULAR DISORDER
New addition to CEAP classification
Stratification surgical procedure and the associated risk of deep vein thrombosis.

Low
● Maxillofacial surgery
● Neurosurgery
● Cardiothoracic surgery
Medium
● Inguinal hernia repair
● Abdominal surgery
● Gynaecological surgery
● Urological surgery
High
● Pelvic elective and trauma surgery
● Total knee and hip replacement
LYMPHATICS
NUTRITON IN SURGERY
PLASTIC SURGERY
BENING BREAST DISORDERS
PHYLLOIDS TUMOUR CLASSIFICATION
ENERGY DEVICE
Extra Edge
 PRINCIPLES OF ADVANCED ENERGY DEVICES
Bipolar electrosurgery devices
Combination of pressure and
energy
withstand 3 times the normal
systolic pressure
Ligasure system: both seal and
divide
Ligasure can seal vessels of up to 7
mm diameter, with an average seal
time of 2–4 seconds
Harmonic scalpel devices Combination energy
devices
uses ultrasound technology to Bipolar+harmonic
cut tissues while
simultaneously sealing them
scalpel vibrates in the 20 000– Thunderbeat
50 000 Hz
haemostasis by means of
protein denaturation caused
by vibration rather than heat
seal and divide arteries and seal and divide arteries
veins up to 7 mm in diameter. and veins up to 7 mm in
diameter