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Instruments in SurgeryPradeep Chopra, MBBS,MS,FRCS Ed
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Life saving
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Life Saving
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Tracheostomy
Obstruction of upper air passages
Improve respiratory function
Respiratory paralysis Operations on upper airway
Prolonged ETT, ICU
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Tracheostomy
Obstruction of upper air passages
FB impaction
Acute infections
Odema of the glottis Bilateral abductor paralysis
Tumours of the larynx
Trauma, crushed larynx Congenital webs or atresia
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Tracheostomy
Improve respiratory function
Reduce dead space, anatomical
Aspiration of bronchial secretions
Bronchopneumonia Chronic bronchitis with emphysema
Chest injuries, flial chest
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Tracheostomy
Respiratory paralysis
Helps in PPV and toilet
Unconsciousness, head or facio-maxillary injury
Coma
Bulbar polymelitis
Tetanus
Endotracheal intubation
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Tracheostomy
After care
Bedside; tracheal dilator, oxygen
Humidifier
Suction with sterile catheter Inner tube care, crusting
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Tracheostomy
Complications
Crusting
Surgical emphysema
Mediastinal emphysema Tracheal stenosis
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Percutaneous tracheostomy
Used in the ICU
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Endotracheal intubation
Substitute for tracheostomy, respiratory
paralysis
Less desirable in long term:
Toilet is easy with tracheostomy
Intubation granuloma of vocal folds and
subsequent stricture
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Life Saving
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Treatment of massive haemorrhage
3rd
stopped3rdoozing
3rdheavily bleeding
Resuscitation Arrest of Haemorrhage General Management Prevention
Blood Tx
Avoid sodium
Care with opiates
Tamponade
Drugs
Sclerotherapy
Operations
Devascularisation
Transection
Shunt operations*
*best avoided
Decrease protein load- bowel
Lactulose
Clears bowel
BacteriaNeomycin
Blood catharticRepeated Sclerotherapy
2 weeks,1m,6m
nonthrombosed, new
Operations
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Life Saving
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Intercostal Drainage
Indications:
Trauma: Haemothorax, Pneumothorax
Surgery: Entering pleural space
Pleural Effusions:
Transudate- CCF
Exudate- infections (turbid) and tumours
Blood stained- trauma, tumour, Tb, infarction,pancreatitis
Chyle
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Intercostal drainage
Site
Space
Procedure
Direction
Removal
Precautions
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Intercostal drainage
underwater seal
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Pneumothorax
Spontaneous
Rupture of bulla
Trauma: penetrating, # ribs, iatrogenic( lung Bx, Central line)
PPV
Rare: asthma, cystic fibrosis, resuscitation &ventilation of new born.
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Haemothorax
Indication for thoracotomy
Initial drainage > 1000 ml
Continued bleeding of > 250 ml/ hr first 4-5 hr or >
2000 ml in 24 hrs.
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Life Saving
Central Venous
Pressure Monitoring
Haemodialysis
TPN
Chemotherapeutic
drugs
TIPPS IVC filters
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Limb/Life Saving
Embolectomy
catheter (Fogarty)
Acute Ischaemia of
the limb Embolus retrieval
Acute on chronic
Pulmonary embolus
Endoscopic retrievalof CBD stones
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Essential
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Essential
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Drains
Types:
Open: gloved, penrose, corrugated
Closed:
Gravity
Suction
Sump
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Drains and indications
Nonfunctioning GI tract
Extensive dissection in closed space
Large flaps
Abscesses that do not communicate
Difficult abdominal surgeries
Certain operations: LN dissection, thyroid,
pancreatic, pelvis, peritonitis etc., Peritoneal lavage: peritonitis, pancreatitis,
peritoneal dialysis
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Drains and complications
FB reaction and isolation
Colonisation by bacteria
Not a substitute for hemostasis Erode: blood vessel, intestines (rigid)
Excessive suction: necrosis (intermittent love
level suction safer)
Break, dislodge (radio-opaque marker)
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When to remove the drain
Fulfilled their purpose
No further drainage is present or if the
drainage is minimal
Document
Note the completeness of removal
C/S if indicated
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Essential
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Essential
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Nice to Know
Condom catheter
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Essential
T tube
CBD exploration
Injury to the CBD
Traumatic Iatrogenic
Surgery on CBD ie.,
anastamosis
Size at least 14F
MTBE
Removal after 3-4 weeks
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Essential
Isotonic Solutions
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Essential
Hypertonic Solutions
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Essential
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Essential
Colloids
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Nice to Know
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Complications of TPN
Insertion related
air embolism
arterial puncture
arrhythmias catheter embolus
chylothorax
Haemo/hydro
pericardium
Hematoma
Hemothorax
Hydro-TPN-othorax
Malposition Pneumothorax
Late complication
infection/sepsis
thrombosis displacement
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Essential
TED Stockings
SCD
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Essential
Colostomy
Temporary (loop/end)
Defunction anastomosis
Injury to colon / rectum High fistula in ano
Hartmans procedure
Mucous fistula
Permanent (end)
APR for ca rectum
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Colostomy complications
Prolapse
Retraction
Necrosis Stenosis
Parastomal hernia
Internal herniationintestinal obstruction Bleedinggranulomas around margin
Diarrhoea
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Other ostomies
Loop ileostomy
Caecostomy
Impeding perforation, colonic obstruction
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Essential
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Haemorrhoids Treatment
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Nice to Know
Laparoscopic
instruments
Indications Insuffulation
gases
Techniques
Contraindication
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Nice to Know
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