ASBHDS III - Session 3 - Lecture 1 - Quality Improvement Flashcards
11 - Point 1
Point 1 – QI is everyone’s responsibility
•Change takes courageous leadership and teamwork – you can’t do it on your own!
“QI = quality improvement”
13 - What is an emergency laparotomy?
An emergency laparotomy is a surgical operation that is used for people with severe abdominal pain to find the cause of the problem and in many cases to treat it. You will have a general anaesthetic and the surgeon will make an incision (cut) to open the abdomen (stomach area). Often the damaged part of an organ is removed and the abdomen washed out to limit any infection.
An emergency laparotomy might be carried out for several reasons including bowel obstruction (blockage), bowel perforation (burst) and bleeding in the abdominal cavity (internal bleeding). These are conditions which if left untreated could be life-threatening. An emergency laparotomy is used either to save life or to limit illness, and in many cases it might be the only option available in order for the patient to get better.
14 - Label the image.
“Small bowel. You can tell that because it all has one tube. Looks unhappy.
Small bowel obstruction. Unwell. Right side is dark red. Middle bit is nice, pink, happy – distended so not great. But the right is really not happy – it’s black, dusky, got different little patches – if you flicked it, you’d see this bit of bowel would peristalse. This bit probably wouldn’t. So what this patient has, almost certainly, is a band adhesion or a twist – band adhesion – bit of scar tissue gone across base of mesentery here and clamped it off – a closed lumen; nothing can get through it. Really common.
Emergency laparotomy’s account for 450ish a year in the UK – in the world, we are the 2nd biggest centre in the UK – national mortality is 11%, and it’s bad news – indicated for things like small bowel obstruction.”
15 - Label the image.
“Stomach here – so this is an upper midline laparotomy. Liver’s under there, what do you think that is (hole)? Perforated ulcer – pt comes in with abdominal pain – bang, stomach acid, frantic cascade, makes them v unwell, leave this and they’ll die in 24-48 hours: this is the sort of thing that if rung in the middle of the night, will get done (emergency operation bc can result in death)”
https: //www.nhs.uk/conditions/stomach-ulcer/complications/
https: //www.nhs.uk/conditions/peritonitis/
16 - Label the image.
“Appendix (can tell it’s done in USA bc there are staples on the end which aren’t available on NHS England (too expensive!))
Appendicitis. Sometimes really straightforward. More complicated, treated by appendectomies - both the easiest and hardest surgeries you can do, even with the best of surgeons (it once took a consultant surgeon 7 hours!).
So, emergency laparotomies, very common, but 11% mortality, 1 in 10 will die. Thus, it’s a big area of focus for QI.”
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