Professional Documents
Culture Documents
Indications in Srgery
Indications in Srgery
IN
SRGERY
Dr. Hiwa Omer Ahmed
Assistant Professor in General
Surgery
(‘a living problem
is better than a
dead “cert”’ )
Grey Turner
BURN
• The indications for admission include:
• (1) All patients liable to shock (that is all burns
over 10%).
• (2) Any patient who has burnt his face, eyes,
hands, feet or perineum, whatever the size of his
burn. ALWAYS admit a child with a burnt hand
size.
• (3) All patients who have inhaled smoke. If
possible, refer all these patients
• 4. Electrical and Chemical burn
• 5. cold burn
• 6. pregnant ladies
HEAD injury
• A head injured patient should be referred to
hospital if any of the following is present:
Impaired consciousness (GCS (15/15) at any
time since injury
– Amnesia for the incident or subsequent events
– Neurological symptoms, e.g.
• severe and persistent headache
• nausea and vomiting
• irritability or altered behaviour
• seizure
– Clinical evidence of a skull fracture (e.g. CSF leak,
periorbital haematoma)
– Significant extracranial injuries
– A mechanism of injury suggesting:
• a high energy injury (e.g. road traffic accident, fall from
height)
• possible penetrating brain injury
• possible non-accidental injury (in a child)
– Continuing uncertainty about the
diagnosis after first assessment
– Medical comorbidity (e.g. anticoagulant use,
alcohol abuse)
Indication of skull x ray
• History of ^ ICP
• Features of ^ ICP
• Suspected # skull
• Penetrating wounds of head
• HVM wounds of head
• Severe facial-maxillary injuries
• Unconscious patient with trauma
• Deteriorating patient
INDICATIONS OF Head CT scan
• CT remains the investigation for the
diagnosis and management of many
central nervous system diseases.
• MRI is superior in the posterior fossa and
parasellar region and for the assessment
in multiple sclerosis, epilepsy and
tumours.
• CT is superior to MRI in the assessment of
head injury.
• Indications for CT imaging, CT
Angiography, and CT venography include
CT Scan in Head Injuries
Selection of adults for CT Scan
• Urgent Scan if any of the following (results
within 1 hour)
– GCS <13 when first assessed or GCS<15 two
hours after injury
– Suspected open or depressed skull fracture
– Signs of base of skull fracture**
– Post-traumatic seizure
– Focal neurological deficit
– >1 episode of vomiting
– Coagulopathy + any amnesia or LOC since injury
• A CT scan is also recommended (within 8
hours of injury) if there is either:
– More than 30 minutes of amnesia of events
before impact
– Or any amnesia or LOC since injury if
• Aged ≥65 years
• Coagulopathy or on warfarin
• Dangerous mechanism of injury
– RTA as pedestrian
– RTA - ejected from car
– Fall > 1m or >5 stairs
Selection of children (under 16
years) for CT Scan
• Urgent scan if any of the following:
– Witnessed loss of consciousness >5 minutes
– Amnesia (antegrate or retrograde) >5 minutes
– Abnormal drowsiness
– ≥3 Discrete episodes of vomiting
– Post-traumatic seizure (no PMH epilepsy)
– GCS <14 in emergency room
(Pediatric GCS<15 if aged <1)
– Suspected open or depressed skull fracture or
tense fontanels
– Signs of base of skull fracture**
– Focal neurological deficit
– Aged <1 - bruise, swelling or laceration on
head >5cm
• Dangerous mechanism of injury (high
speed RTA, fall from >3m, high speed
projectile).
Indication of anti-tetanus
• Every simple wound in patient not
immunized in the previous 5 years
Give ATS
Examples
• Antithyroid day before OP
• beta blockers in toxic goiter 7-10day post-
OP
• Contraceptive 3 weeks pre OP in
1.operations on pelvis
2.operations on lower limb
3.using of tourniquet
• Oral antidiabetics day before OP and
replaced by soluble Insulin
DON’T GIVE
• Don’t give steroid in acute head injury
• Don’t give opiate in biliary disease and
surgery
• Don’t give opiate in head injury
• Don’t give analgesia in undiagnosed acute
abdomen before decision
• Don’t suture wounds (except facial and
scalp) after 6 hours from the injury
• Don’t give heparin I.M.
• Don't give PP I.V.
• Don’t give blood unless indicated
• Don’t give antibiotics unless indicated
• Don’t give K+ unless there is normal urine
output ( 30-50ml/ hr )
DON’T
FORGET
• Don’t forget that 15-20 of all suspected acute
appendicitis there is normal appendix, and this
well accepted scientifically
• Don’t forget to give antispasmolytics in biliary
disease and surgery
• Don’t forget to search for features of
hypocalcemia in scorpian stings
• Don’t forget to ask every patient about allergy to
any drug, contrast or anasthetic agents
• Don’t forget to remove any torniquet within 45
minutes
• Don’t forget that 50% of surgical diseases
not need surgery
• Don’t forget to mark with skin pencil the
side of OP in double organs in the body
• Don’t forget to sign informed consent and
sign by your patient
• Don’t forget that adult patients are free not
to any treatment ,drug, investigations
,imaging or OP
• Don’t forget that every inpatient / day
costs 380 $
The indications for
thoracotomy following
blunt thoracic trauma
• are the following:
1. 50—1000 ml of blood at the time of initial
drainage is common and may need no further
action, but greater volumes, especially if the
blood is fresh, require intervention;
2. continued brisk bleeding (>100 mI/15 minutes)
from the intercostal drains indicates a serious
breach of the lung parenchyma and urgent
exploration is required;
3. continued bleeding of >200 ml/hour for 3 or
more hours may require thoracotomy under
controlled conditions;
4. rupture of the bronchus, aorta, oesophagus or
diaphragm;
5. cardiac tamponade (if needle aspiration is
unsuccessful).
INDICATIONS OF
SURGERY IN PEPTIC
ULCERS
1.ulcer resist treatment for 5 years
2.Complicated PU as;
• Perforation
• Bleeding
• Obstruction
• Suspicion of malignancy
Priority in surgical lists
• Child first
• Major OP first
• Co-morbidity first
• Clean first
universal precautions for HIV &
HEPATITIS
• wearing either safety spectacles or a face
mask
• a gown which provides waterproof
protection to the sur-geon’s anterior trunk
and arms.
• boots rather than open-toed shoes should
be worn to improve protection to the feet
should something sharp be dropped.
• wearing two pairs of gloves: it is usually
more comfortable if the larger-sized glove
is worn on the inside next to the skin and a
half-size, smaller glove is worn as the
outer second layer
• carry out the procedure in an orderly
manner.
• Surgical assistants should be kept to a
minimum and should be instructed not to
move while the operation is proceeding.
• The operation should proceed in a slow and methodical
manner with meticulous attention to haemostasis, taking
care to avoid unexpected rapid bleeding which changes
the tempo of the procedure and increases the risk of
inadvertent injury to the operators
• No sharp instruments or scalpels should be passed
across the operative field from hand to hand. All
instruments are passed from the scrub nurse to the
surgeon and back to the scrub nurse in a dish