Introduction to surgery Flashcards
Demonstrate the relevance of common surgical problems in dental patients. Understand the implications of surgery and their associated conditions when undertaking dentistry
What is surgery?
The art of healing by manual operation
The branch of medical science that treats disease or injury by operative procedures
Surgical subspecialities
Maxillofacial ENT Plastics Neurosurgery Cardiac Thoracic Gynaecology
“General” sugery
Paediatric Urology Vascular Minimally invasive Oncology Trauma
Anaesthetics
“Shared airway” (by pt and surgeon mechanically)
Anaesthesia and sedation
Management of co-morbidities (one or more additional diseases/ disorder co-occurring with a primary disease/ disorder)
CPR and medical emergency algorithms
Types of surgery
Elective (planned in advance) Emergency (immediate, urgent - 12 hours) Expedited (usually within days) Laparoscopic, microsurgery Day surgery - must be stable and have chaperone etc.
Classifications of surgery
Major - cancer resection
Intermediate - hernia repair
Minor - excision of lipoma
What does a surgeon do?
Diagnosis -evaluate pt problem -investigations Treatment options - surgical/ non-surgical Operate Post-op care -immediate post-op care -rehabilitation -follow-up care
Methods
Clinical approach -history, exam, special investigations Decision making -balance morbidities, consider QOL -team working Leadership of operating team Leadership of ward team
Types of histories
Emergency -diagnosis oriented -HPC paramount; account for time Elective -diagnosis (usually) known -safety for operative procedure
History
Structured Presenting complaint Medical history Drug history Family history Social history -e.g. smokers susceptible to post-op chest infections after GA
Examination
General
Vital signs
-pulse rate and rhythm, BP, resp. rate, T
System Specific Exam
System Specific Exam
Abdo Orthopaedic Neuro Head and Neck Vascular
Pre-op care
Safe surgery -informed consent -anticipate complications (blood loss prevention/ replacement, infection issues) Safe anaesthetic -airway -assess co-morbidities -specific heart/ lung investigation
Physiological classification - ASA
I - healthy px
II - mild systemic disease with no functional limitation - controlled hypertension
III - severe systemic disease with definite functional limitation - COPD
IV - severe systemic disease that is a constant threat to life - unstable angina
V - moribund px not expected to survive for 24 hours with or without surgery - ruptured aortic aneurysm
Suffix E emergency procedure
Reasons for physiological classification
Estimate risk of complications
Guide choice of treatment
Other physiological classification used in combination with ASA
WHO performance status
-premorbid state of pt e.g. before operation how far could they walk? Could they do their own shopping
General principles of surgery
Accurate diagnosis
Surgical skills
Wound healing and wound care
Appropriate care of px
Perioperative care
Dealing with emergencies Airway Bleeding Vital signs Sedation
Postoperative care - general
Pain
Fluid intake/ loss
Nausea and vomiting
DVT prevention
Postoperative care - organ systems
CVS (arrhythmia, hypotension, hypertension)
RS (hypoxia, difficulty breathing, hypertension)
GI (nutrition, voiding, diarrhoea)
GU (retention urine, diuresis)
MS (mobility, pressure areas)
Surgical emergencies - airway
Tracheostomy
Surgical emergencies - bleeding
Pressure, elevation
Monitor P, BP
Suture?
*trauma, vascular disease
Surgical emergencies - trauma
Stop bleeding
Stabilise fracture
Relieve pain
Arrange transportation for surgery without delay
Surgical emergencies - blockages
Repiratory
Intestinal
Biliary
Vascular
Surgical emergencies - perforations
Intestinal
Vascular
Surgical emergencies - infections
Abscesses, internal organs (pleura, peritoneum), soft tissues, bone
