Surgery Revision Lecture

Jul 8, 2024

Surgery Revision Session

Lecture by Dr. Omkar Sangeetha

Key Points

  • Languages: Lecture in both English and Hindi.
  • Focus: Surgery for FMG, NEET, and NEXT PG exams.
  • Format: Concepts explained in both languages, concise and focused on previous year topics and MCQs.
  • PDF: Class PDF shared via Telegram (Dr Bhanu Prakash's channel).

Introduction and Overview

  • Lecturer: Dr. Omkar Sangeetha, MS General Surgery.
  • Objective: Short, crisp, and concise revision of surgery relevant for FMG and NEET/PG examinations.
  • Outcome: Preparation to solve most MCQs, revisions of important topics.

General Surgery Topics

Hemorrhage and Bleeding

  • Hemorrhage: Bleeding due to trauma, can be physiological (e.g., menstruation) or pathological (e.g., trauma, infection).
  • Types: External (revealed) and internal (concealed).
  • Identification: Check vitals for signs of shock (hypotension + tachycardia).
  • Complications: Shock, reflex tachycardia.
  • Surgical Hemorrhage Categorization: Primary (during surgery), Reactionary (4-24 hours post-surgery, knot slippage), Secondary (post 24 hours, typically due to infection).

Blood Transfusion and Components

  • Whole Blood: 350-450 ml units, used in trauma (excessive blood loss).
  • Packed RBCs: For severe anemia (Hb < 7 gm/dL).
  • Fresh Frozen Plasma (FFP): Rich in all clotting factors, stored at -40°C.
  • Platelet-rich Plasma (PRP): For thrombocytopenia, stored at room temperature (20-24°C).
  • Cryoprecipitate: Rich in factors I and VIII, used in hemophilia, stored at -40°C.
  • Screening of Blood: For HIV, Hepatitis B & C, malaria, syphilis.

Transfusion Reactions

  • Most Common: Febrile non-hemolytic transfusion reaction (FNHTR).
  • Severe Reaction: ABO Incompatibility (mismatched blood transfusion), causing immediate reactions like pain, decreased urine output, hemoglobinuria.
  • Massive Blood Transfusion Complications: CHF, hypocalcemia, hyperkalemia, hypothermia.
  • Management in Shock: Fluid resuscitation (2 large-bore IVs), monitoring with CVP, urine output.

Surgical Positions and Instruments

Common Positions

  • Supine: Most common, used in abdomen and breast surgeries.
  • Trendelenburg: Pelvic surgeries, foot end elevated.
  • Reverse Trendelenburg: Abdominal surgeries (e.g., cholecystectomy), head end elevated.
  • Lithotomy: Ob/Gyn procedures, perineal surgeries.
  • Lateral/Kidney: Thoracic or nephrolithotomy surgeries.
  • Prone: Spinal or pilonidal sinus surgeries.
  • Fowler’s: Neurosurgeries, high risk of air embolism.

Important Instruments

  • Cannulas/IV Lines: Gauges indicating size, from 14G (orange) to 26G (violet/purple), with different uses and flow rates.
  • Common Surgeries: Green (18G) for males, Pink (20G) for females, Blue (22G) for children, Yellow (24G) for infants, Purple (26G) for neonates.
  • Retractors: Langenbeck, Doyen’s, Morris retractors for holding tissues during surgeries.
  • Needle Holders and Types of Knots: Surgeon’s knot (secure), Square knot (secure), Granny knot (insecure).

Surgical Wounds and Fractures

Types of Wounds

  • Abrasion: Superficial, epidermal layer injury.
  • Laceration: Irregular margins, deeper cut.
  • Incised Wound: Regular margins, sharp object cut.
  • Bruise/Contusion: Blood collection without significant tissue damage.
  • Crush Injury: Severe tissue and structural damage.
  • Burns: Defined by depth and extent (1st to 4th degree).
  • Hematoma: Blood collection that feels like a lump.
  • Infections and Complications: Paronychia, felon, pyoderma gangrenosum.

Skull Fractures and Cranial Nerve Injuries

  • Types: Linear, depressed, basilar fractures (anterior, middle, posterior cranial fossa).
  • Signs: ‘Raccoon eyes’ (anterior cranial fossa), ‘Battle’s sign’ (middle cranial fossa).
  • Intracranial Hemorrhages: Epidural (biconvex), subdural (crescent-shaped), subarachnoid (within Sylvian fissure), and intracerebral (within brain parenchyma).
  • Investigations and Management: CT, MRI (for DAI), burr hole/craniotomy for surgical intervention.

Trauma Management

ATLS Protocol

  • Sequence: A (Airway) - B (Breathing) - C (Circulation) - D (Disability) - E (Exposure with environmental control).
  • Resuscitation: ABCDE principle, cervical spine protection, airway management.
  • Chest Trauma: Pneumothorax, hemothorax, rib fractures, cardiac tamponade.
  • Abdominal Trauma: FAST/E-FAST, exploratory laparotomy, conservative management for hemodynamically stable patients.

Burns Management

  • Types of Burns: By skin layer involvement (1st - 4th degree).
  • Initial and Definitive Care: IV fluids (Parkland formula), antibiotic creams, debridement, grafting.

Critical Observations

  • Severity Assessment: GCS score, shock index calculation.
  • Quick Response: Immediate fluids for burn patients, rapid airway management for inhalation burns.

Conclusion

  • The session covered an extensive range of surgical topics, relevant for FMG, NEET, and NEXT PG examinations, focusing on high-yield and previously asked questions.
  • Ensuring a solid grasp of pivotal surgical concepts and emergency management techniques critical for medical exams.

Emoji: 🩺