I love LC. If I had to do 3-4 a day for the next 20 years I would be a happy general surgeon. It's an elegant operation. I haven't done thousands, but I've done enough where it's become almost automatic. I try not to waste any moves. Every act is purposeful. Rarely is there struggling or the sort of futzing around that can occur when doing a laparoscopic colon resection. So here are my tips:1) Never use a Veress needle. Why blindly stick a needle into your patient's belly? It's ridiculous. I do an open Hasson insertion. It's not slower. It's definitely safer. It's a no brainer……………..
…………………On the whole, though, what I typically see is a lot of exasperation from surgeons whenever a medical condition precludes speedy progress to the O.R. – ……………… I always wonder: didn't they look through the chart themselves and see that the lab value was egregiously abnormal, or examine the patient and hear the lung crackles practically from across the room? Surely they, too, did a history and physical, as we're all expected to do?……………….A good surgeon will also respect an anesthetist's or anesthesiologist’s instructions inside the O.R. when safety is at issue. Rarely have I seen this to be a problem. ………………But I did encounter one surgeon whose behavior I consider among the most appalling I’ve seen. I'll call her Dr. Myrtha Banshee…………
In surgery, a huge amount of time and attention is devoted to the issue of on-time starts. Extra focus is often placed on the on-time starts for first cases of the day. ……….When I was scheduled at Giant Hospital for my own surgical experience, I was delighted to get a Tuesday at 9:15am. ………When the procedure had to be moved to Almost Giant Hospital, I was happy to keep the same day of the week, but obviously the time had to be changed……..On my surgery day, I lay in the pre-operative area wearing one of those stylish gowns, watching the IV drip, and wishing time would move faster. …………..
More trauma. This tale from Karen Little, Just Up the Dose – Monday, Bloody Monday.Gentleman working on a landscape project. The worker above him falls and drops one of these on him:
And they strike him in the neck. He arrives alert and oriented, but every time he speaks or coughs air comes out of the wound on his neck. Off to the operating room..
(Via Uveal Blues) Eyeborg Project: An Exciting and Creepy Hack I Hope You Never Try -- Go watch this but rememberI was driving back to The Crater one Monday morning …….Running towards me from the other direction were a bunch of men in overalls - he'd just flown off the back of a lorry………This guy was badly hurt. ………………. but as I did this his major injury became apparent. As we carried him, hot, sticky, bright red arterial blood pulsed out of his ear and over my hand - a textbook skull-base fracture, and a massive one at that.
It goes without saying that experimenting with your eyesight is neither the easiest hack in the world or the safest, but apparently a few brave souls out there are driven to take it on regardless. The Eyeborg Project is the brainchild of one of those.Bruce Campbell, Reflections in the Head Mirror, tells us about a patient in “Role Model”
KeaGirl, UroStream, talks about “redemption” in her practice.Nothing has come easily. Her cancer was difficult to control and she required radiation and then extensive surgery and more radiation. The side effects led to additional treatments, a feeding tube, and expensive pain medications. ………………..Of course, to hear her tell the story, she is doing fine. She feels well and has adjusted reasonably well. She celebrates her freedom from cancer every single day.I was worried, therefore, when she arrived for a follow-up visit. She looked distracted. I moved into position to perform the examination.“What’s this?” I blurted out. “Have you started smoking again?”……………..
SandnSurf, Life in the Fast Lane, discusses the John Thomas Sign in trauma patients.…………………..And then just yesterday, I had a patient come into the ER with testicular torsion. He was one of the rare patients who presented in enough time for me to swiftly whisk him to the OR and save his testicle! (there is a window of 6 to 8 hours before the testis undergoes permanent damage for lack of blood flow and oxygen, at which point I have to do an orchiectomy). I felt some degree of redemption, and all was right in the world again....
The sign tends to be commented on by middle-aged male radiologists and orthopedists suffering from Peter Pan syndrome. Some may even suspect an occult fracture purely based on the observed radiographic penile orientation. While this can clearly be very amusing (in the same way that some people can’t help but laugh when they hear the word “Uranus”) the question remains - is the sign actually of any use?
WIRED Science has put up an article with “10 Gory Surgical Triumphs on YouTube”. Although their approach is somewhat sensasionalist, the idea to collect surgical videos available on YouTube is good. It has actually inspired me to start a series of posts where I’ll pick a surgical video from YouTube every week and review it.
http://twitpic.com/3ckz8 - more from the OR. take a look at this cervical spine CT. can you spot the problem? 7:39 AM Apr 15thIt is teardrop fracture C6. patient ejected from a car through the windshield. now, neurologically normal. tomorrow, will show you post op! 3:43 PM Apr 15th
I've had a run of large bowel obstructions (LBO) lately. ……………... Cancer, volvulus, and hernias are the usual culprits and an operation is often mandated. A colonic obstruction is technically a surgical emergency. …..
I think a lot of people are pretty intimidated by surgery, especially if you don't see yourself as the surgery type. But honestly, surgery is a lot of fun if you work hard and make an effort to learn how to be useful in the OR. Here are my tips for getting more out of your OR experience.
More help for humans from our animal friends with a history of xenographs by Chris Sweeney “The Beast Within: Implanting Animal Organs into Humans”The move from clinical veterinary to human medicine is inspiring and unusual; we normally see the translation happening the other way around," said Nicola Maffulli, a sports medicine expert and orthopedic surgeon who will help conduct the trial.
A public safety announcement for bloggers from Sheepish, The Paper Mask -- Healthcure.com is a Fraudulent Scam. Go read the entire post.Getting an organ these days is no easy task. Currently, there are more than 100,000 people on waiting lists for organ donations in the United States, but fewer than 30,000 transplants were performed in 2008. The Mayo Clinic estimates that in the United States, 17 people die each day while waiting for a suitable organ to come along………..Still, the concept of cross-species transplantations is nothing new. As far back as 1889, physicians were shooting up slivers of dog and guinea pig testicles to study “human revitalization therapy.” Through the years, though, there has been significant progress made in the field, and biotech companies have invested heavily in developing transgenic animals and immunosuppressant drugs……………….
I can't make it much simpler than that, can I?and another post from Sheepish on Meeting Fatigue
Barry, An Explorer’s View of Life, describes his “First Meeting with the Surgeon”
Follow up with these posts by Barry:This is a preliminary meeting he tells us. He would just like to go over the probable fate that awaits me, but the specific plan will have to wait for the results of the CT scan on Monday.The usual course of treatment involves 3 months of combined chemo and radiation therapy at Princes Margaret Hospital to shrink the tumor in my throat followed by the removal of half my esophagus and half my stomach. They will use my stomach to rebuild the missing esophagus because it is composed of the same material as my throat. The surgery will require me to be in hospital for ten days to two weeks followed by five to six weeks recovery at home.I will need five months off work. If all goes well.
Linda has turned pale at the mention of the removal of half my stomach and I can only wonder what my face looks like.
* Immediately (Part 2) And Then Then News
* Answers (Part 2) And A Big New Question
* My Decision and Why I Made It
Surgeon Heals Patients and Their Violent Ways
“Finders Keepers”, a story about a little boy who is going to have heart surgery.Dr. Carnell Cooper, a Baltimore surgeon, is saving lives inside and outside the operating room.Dr. Carnell Cooper's Violence Intervention Program provides training and support to trauma victims.Since becoming a trauma surgeon 16 years ago, he has dedicated himself to treating the many young African-American men who've been shot, stabbed or beaten, only to see them return to the ER with another severe injury just months later…………..
Tomorrow morning,” the surgeon began, “I’ll open up your heart…” “You’ll find Jesus there,” the boy interrupted.The surgeon looked up, annoyed. “I’ll cut your heart open,” he continued, “to see how much damage has been done…” “But when you open up my heart, you’ll find Jesus in there.”The surgeon looked to the parents, who sat quietly. “When I see how much damage has been done, I’ll sew your heart and chest back up and I’ll plan what to do next.” ……………………
Why it’s past time for GPS in the OR (via Book of Joe)
The Mechanic vs the Heart Surgeon (via Jeffrey, Vagus Surgicalis)
Cast Anatomy (via Street Anatomy) with explanation here. You really must go see these casts. It’s enough to make you wish you had a broken arm!
* Double Hand Transplant Awakens Brain Control --
* Kuwaiti surgeon succeeds in neurosurgery operation implanting two batteries in the spinal cords of patients who have difficulty in walking.The brains of patients who've received double hand transplants can recreate lost neurological control systems, according to new brain data from a French surgical team.
* Second U.S. Face Transplant Performed in Boston on a man who lost the middle of his face in a freak accident.
* SoCal Docs Help Woman With Severe Deformity: Rodarte's face covered in tumors
* That’s Sp-early Got to HurtAt an early age, tumors began to grow on Ana Rodarte's face. By age 25, her advanced neurofibromatosis had deformed the left side of her face, leaving her homebound and unable to see out of one eye.
Docs had to remove a SIX INCH fishing spear from this clumsy fisherman's brain after he managed to fire it into his own head.
* 5 cm. fir tree removed from patient’s lung (photo credit)Ayman Batarfi, 38, told a military review panel that he was a humanitarian worker who found himself at the battle of Tora Bora while Osama bin Laden was in the area, according to a Pentagon transcript. He was captured in Afghanistan and sent to the prison camps here in 2002.
A five-centimeter fir tree has been found in the lung of a man who complained he had a strong pain in his chest and was coughing blood.The 28-year-old patient, Artyom Sidorkin, came to a hospital in the city of Izhevsk in Central Russia last week,
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