internal-master
12-05-2006, 07:21 PM
Guidelines & Basic Skills for House Officers for Surgery Round
<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p>
Non specific skills:<o:p></o:p>
1- Accurate measuring of blood pressure, pulse and temperature.<o:p></o:p>
2- Withdrew many venous samples and insert many canulae.<o:p></o:p>
3- Withdrew arterial samples and know WRERE to analyze and learn reading.<o:p></o:p>
4- Inserting male and female urinary catheters.<o:p></o:p>
5- Dealing with central lines (see insertion, how to give through, withdrew from and how to measure CVP).<o:p></o:p>
6- When, what type, why and how to prepare blood transfusion and other blood components.<o:p></o:p>
7- How to communicate with residents, staff, nurses and patients (how to tell bad news, death, cancer, risky operation and strict follow up?<o:p></o:p>
8- How to write requests for consultation and referral? And stay beside every consultant and see how they examine and take decision.<o:p></o:p>
9- Try to read every X ray, C.T., ECG, MRI, ERCP, …….. you meet.<o:p></o:p>
10- Don't go to any request unless you know its value and every thing about the patient. <o:p></o:p>
Specific skills:<o:p></o:p>
Surgical dressings<o:p></o:p>
1- How to do proper dressing for clean, septic, open and closed wounds. <o:p></o:p>
2- What is the frequency of dressings?<o:p></o:p>
3- When to use saline, alcohol, betadine, iroxol, EUSOL, paraffin oil, glycerin, tincture benzoic and others?<o:p></o:p>
4- How to use instruments, gauze and bandages.<o:p></o:p>
5- How to make wound depridement.<o:p></o:p>
Drains:<o:p></o:p>
1- What is the value?<o:p></o:p>
2- How to read, evacuate, fixate and dress?<o:p></o:p>
3- When and how to remove?<o:p></o:p>
Suters and stiches:<o:p></o:p>
1- What are their types and when to use every type?<o:p></o:p>
2- Take simple interrupted, continuous, mattress and subcuticular stiches.<o:p></o:p>
3- How to give local anesthesia and ring anesthesia? <o:p></o:p>
4- Know how and when to remove.<o:p></o:p>
5- Know their care (dressing & antibiotics).<o:p></o:p>
<o:p></o:p>
Management of specific cases:<o:p></o:p>
1. Polytraumatized patients:<o:p></o:p>
Resuscitation, needed history, proper examination, essential investigation, initiative and definitive treatment.<o:p></o:p>
2. Post concussion:<o:p></o:p>
Definition, when to admit, when to discharge, investigation and treatment?<o:p></o:p>
3. Chest trauma:<o:p></o:p>
Watch intercostals tube insertion; know its care, indication and when to remove?<o:p></o:p>
4. Acute abdomen:<o:p></o:p>
How to differentiate between surgical and medical causes?<o:p></o:p>
How to take history, do examination and ask for investigation for:<o:p></o:p>
-Acute appendicitis.<o:p></o:p>
-Acute cholicystits and biliary colic. <o:p></o:p>
-Intestinal obstruction.<o:p></o:p>
-Perforated viscus.<o:p></o:p>
-Renal colic and acute retention.<o:p></o:p>
Watching and doing P.R. examination.<o:p></o:p>
Watch and interpret upper GI endoscopy, colonoscopy, ERCP, mammography, Ba enema and gastrographin meal and follow through.<o:p></o:p>
Preoperative preparation:<o:p></o:p>
1. How to write and take surgical consent?<o:p></o:p>
2. How to do colonic lavage, ask for shaving, fasting, resuscitate and give preoperative analgesics and antibiotic?<o:p></o:p>
Operations:<o:p></o:p>
1. Sterilization and toweling for the patient.<o:p></o:p>
2. Sterilization of you and how to wear gown and gloves?<o:p></o:p>
3. Watch induction and termination of anesthesia try to do endotracheal intubation.<o:p></o:p>
4. Assist in some operations and do closure of: thyroidectomy, hernial repair, appendectomy and mastectomy.<o:p></o:p>
5. Watch other major operations to take an idea e.g. Whipple's, colectomy and others.<o:p></o:p>
6. Interested personal can do appendectomy, abscess drainage and removal of cysts and swellings.<o:p></o:p>
7. How to use surgical instruments and why every one?<o:p></o:p>
8. How to write operative details?<o:p></o:p>
Postoperative management:<o:p></o:p>
1. What is the treatment given to every case?<o:p></o:p>
2. When to do postoperative dressing?<o:p></o:p>
3. When and how to start oral feeding and what are the fluids given to nothing per os N.P.O. patients?<o:p></o:p>
4. What Total Parentral Nutrition TPN and when to start?<o:p></o:p>
<o:p></o:p>
Conference ((المرور:<o:p></o:p>
1. Try to learn how senior staff take decision and think of surgical cases e.g. obstructive jaundice, breast lump, bleeding per rectum etc.<o:p></o:p>
2. Ask about any thing you don't understand. Don't be ashamed it's your last chance to learn surgery.<o:p></o:p>
<o:p></o:p>
CONCLUSION:<o:p></o:p>
Try to learn and do what junior resident surgeons know and do.<o:p></o:p>
<o:p></o:p>
N.B.<o:p></o:p>
5 Days in burn unit:<o:p></o:p>
1. Try to know and see surgical dressings of burns.<o:p></o:p>
2. Watch some surgical management of burns e.g. grafts, flaps and escharecromy.<o:p></o:p>
أعمال اداريه لكنها هامه:<o:p></o:p>
حجز تذاكر المرضى (حوادث-عيادات) – كتابة تقارير طبيه- ملخص حالة المريض عند الخروج- تجديد علاج- عمل ارتباط-اذن شراء أدويه- كتابة شهادة وفاه.<o:p></o:p>
<o:p></o:p>
Any feedback are welcome on my email: Mokhtar931@yahoo.com (Mokhtar931@yahoo.com)<?xml:namespace prefix = v ns = "urn:schemas-microsoft-com:vml" /><v:shapetype id=_x0000_t75 stroked="f" filled="f" path="m@4@5l@4@11@9@11@9@5xe" o:preferrelative="t" o:spt="75" coordsize="21600,21600"> <v:stroke joinstyle="miter"></v:stroke><v:formulas><v:f eqn="if lineDrawn pixelLineWidth 0"></v:f><v:f eqn="sum @0 1 0"></v:f><v:f eqn="sum 0 0 @1"></v:f><v:f eqn="prod @2 1 2"></v:f><v:f eqn="prod @3 21600 pixelWidth"></v:f><v:f eqn="prod @3 21600 pixelHeight"></v:f><v:f eqn="sum @0 0 1"></v:f><v:f eqn="prod @6 1 2"></v:f><v:f eqn="prod @7 21600 pixelWidth"></v:f><v:f eqn="sum @8 21600 0"></v:f><v:f eqn="prod @7 21600 pixelHeight"></v:f><v:f eqn="sum @10 21600 0"></v:f></v:formulas><v:path o:connecttype="rect" gradientshapeok="t" o:extrusionok="f"></v:path><o:lock aspectratio="t" v:ext="edit"></o:lock></v:shapetype><v:shape id=_x0000_i1025 style="WIDTH: 11.25pt; HEIGHT: 11.25pt" o:bullet="t" type="#_x0000_t75"><v:imagedata o:title='\\"mso2\\"' src="file:///C:/DOCUME~1/samur/LOCALS~1/Temp/msoclip1/01/clip_image001.gif"></v:imagedata></v:shape><o:p></o:p>
<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p>
Non specific skills:<o:p></o:p>
1- Accurate measuring of blood pressure, pulse and temperature.<o:p></o:p>
2- Withdrew many venous samples and insert many canulae.<o:p></o:p>
3- Withdrew arterial samples and know WRERE to analyze and learn reading.<o:p></o:p>
4- Inserting male and female urinary catheters.<o:p></o:p>
5- Dealing with central lines (see insertion, how to give through, withdrew from and how to measure CVP).<o:p></o:p>
6- When, what type, why and how to prepare blood transfusion and other blood components.<o:p></o:p>
7- How to communicate with residents, staff, nurses and patients (how to tell bad news, death, cancer, risky operation and strict follow up?<o:p></o:p>
8- How to write requests for consultation and referral? And stay beside every consultant and see how they examine and take decision.<o:p></o:p>
9- Try to read every X ray, C.T., ECG, MRI, ERCP, …….. you meet.<o:p></o:p>
10- Don't go to any request unless you know its value and every thing about the patient. <o:p></o:p>
Specific skills:<o:p></o:p>
Surgical dressings<o:p></o:p>
1- How to do proper dressing for clean, septic, open and closed wounds. <o:p></o:p>
2- What is the frequency of dressings?<o:p></o:p>
3- When to use saline, alcohol, betadine, iroxol, EUSOL, paraffin oil, glycerin, tincture benzoic and others?<o:p></o:p>
4- How to use instruments, gauze and bandages.<o:p></o:p>
5- How to make wound depridement.<o:p></o:p>
Drains:<o:p></o:p>
1- What is the value?<o:p></o:p>
2- How to read, evacuate, fixate and dress?<o:p></o:p>
3- When and how to remove?<o:p></o:p>
Suters and stiches:<o:p></o:p>
1- What are their types and when to use every type?<o:p></o:p>
2- Take simple interrupted, continuous, mattress and subcuticular stiches.<o:p></o:p>
3- How to give local anesthesia and ring anesthesia? <o:p></o:p>
4- Know how and when to remove.<o:p></o:p>
5- Know their care (dressing & antibiotics).<o:p></o:p>
<o:p></o:p>
Management of specific cases:<o:p></o:p>
1. Polytraumatized patients:<o:p></o:p>
Resuscitation, needed history, proper examination, essential investigation, initiative and definitive treatment.<o:p></o:p>
2. Post concussion:<o:p></o:p>
Definition, when to admit, when to discharge, investigation and treatment?<o:p></o:p>
3. Chest trauma:<o:p></o:p>
Watch intercostals tube insertion; know its care, indication and when to remove?<o:p></o:p>
4. Acute abdomen:<o:p></o:p>
How to differentiate between surgical and medical causes?<o:p></o:p>
How to take history, do examination and ask for investigation for:<o:p></o:p>
-Acute appendicitis.<o:p></o:p>
-Acute cholicystits and biliary colic. <o:p></o:p>
-Intestinal obstruction.<o:p></o:p>
-Perforated viscus.<o:p></o:p>
-Renal colic and acute retention.<o:p></o:p>
Watching and doing P.R. examination.<o:p></o:p>
Watch and interpret upper GI endoscopy, colonoscopy, ERCP, mammography, Ba enema and gastrographin meal and follow through.<o:p></o:p>
Preoperative preparation:<o:p></o:p>
1. How to write and take surgical consent?<o:p></o:p>
2. How to do colonic lavage, ask for shaving, fasting, resuscitate and give preoperative analgesics and antibiotic?<o:p></o:p>
Operations:<o:p></o:p>
1. Sterilization and toweling for the patient.<o:p></o:p>
2. Sterilization of you and how to wear gown and gloves?<o:p></o:p>
3. Watch induction and termination of anesthesia try to do endotracheal intubation.<o:p></o:p>
4. Assist in some operations and do closure of: thyroidectomy, hernial repair, appendectomy and mastectomy.<o:p></o:p>
5. Watch other major operations to take an idea e.g. Whipple's, colectomy and others.<o:p></o:p>
6. Interested personal can do appendectomy, abscess drainage and removal of cysts and swellings.<o:p></o:p>
7. How to use surgical instruments and why every one?<o:p></o:p>
8. How to write operative details?<o:p></o:p>
Postoperative management:<o:p></o:p>
1. What is the treatment given to every case?<o:p></o:p>
2. When to do postoperative dressing?<o:p></o:p>
3. When and how to start oral feeding and what are the fluids given to nothing per os N.P.O. patients?<o:p></o:p>
4. What Total Parentral Nutrition TPN and when to start?<o:p></o:p>
<o:p></o:p>
Conference ((المرور:<o:p></o:p>
1. Try to learn how senior staff take decision and think of surgical cases e.g. obstructive jaundice, breast lump, bleeding per rectum etc.<o:p></o:p>
2. Ask about any thing you don't understand. Don't be ashamed it's your last chance to learn surgery.<o:p></o:p>
<o:p></o:p>
CONCLUSION:<o:p></o:p>
Try to learn and do what junior resident surgeons know and do.<o:p></o:p>
<o:p></o:p>
N.B.<o:p></o:p>
5 Days in burn unit:<o:p></o:p>
1. Try to know and see surgical dressings of burns.<o:p></o:p>
2. Watch some surgical management of burns e.g. grafts, flaps and escharecromy.<o:p></o:p>
أعمال اداريه لكنها هامه:<o:p></o:p>
حجز تذاكر المرضى (حوادث-عيادات) – كتابة تقارير طبيه- ملخص حالة المريض عند الخروج- تجديد علاج- عمل ارتباط-اذن شراء أدويه- كتابة شهادة وفاه.<o:p></o:p>
<o:p></o:p>
Any feedback are welcome on my email: Mokhtar931@yahoo.com (Mokhtar931@yahoo.com)<?xml:namespace prefix = v ns = "urn:schemas-microsoft-com:vml" /><v:shapetype id=_x0000_t75 stroked="f" filled="f" path="m@4@5l@4@11@9@11@9@5xe" o:preferrelative="t" o:spt="75" coordsize="21600,21600"> <v:stroke joinstyle="miter"></v:stroke><v:formulas><v:f eqn="if lineDrawn pixelLineWidth 0"></v:f><v:f eqn="sum @0 1 0"></v:f><v:f eqn="sum 0 0 @1"></v:f><v:f eqn="prod @2 1 2"></v:f><v:f eqn="prod @3 21600 pixelWidth"></v:f><v:f eqn="prod @3 21600 pixelHeight"></v:f><v:f eqn="sum @0 0 1"></v:f><v:f eqn="prod @6 1 2"></v:f><v:f eqn="prod @7 21600 pixelWidth"></v:f><v:f eqn="sum @8 21600 0"></v:f><v:f eqn="prod @7 21600 pixelHeight"></v:f><v:f eqn="sum @10 21600 0"></v:f></v:formulas><v:path o:connecttype="rect" gradientshapeok="t" o:extrusionok="f"></v:path><o:lock aspectratio="t" v:ext="edit"></o:lock></v:shapetype><v:shape id=_x0000_i1025 style="WIDTH: 11.25pt; HEIGHT: 11.25pt" o:bullet="t" type="#_x0000_t75"><v:imagedata o:title='\\"mso2\\"' src="file:///C:/DOCUME~1/samur/LOCALS~1/Temp/msoclip1/01/clip_image001.gif"></v:imagedata></v:shape><o:p></o:p>