Sunday, January 10, 2010

SurgeXperiences 314

Updated 3/2017:  links removed as many of the blogs/posts are no longer active and it was easier than going through all the links.

It is my pleasure to host the first edition of SurgeXperiences of the new year (2010) and new decade.  I hope you’ll grab something to drink and enjoy the reading.
Life in the Fast Lane (multiple authors) has had several surgery related post recently.  This first one is from Chris Nickson in which he presents William Ernest Henley’s poem Operation.   You’ll have to go over to read the entire poem, but it begins
You are carried in a basket,
Like a carcass from the shambles,
To the theatre, a cockpit
Where they stretch you on a table.
Then they bid you close your eyelids,
And they mask you with a napkin,
And the anaesthetic reaches
Hot and subtle through your being………

Mike Cadogan, sandnsurf,  presents with a wonderful primer on elbow dislocation over at Life in the Fast Lane. 

Also at Life in the Fast Lane, check out by Paul Young’s  post:  Renal Riddle-001.
…….It is important to remember that the commonest cause of the ‘classic’ presentation of renal colic amongst patients presenting to have a post-mortem is ruptured abdominal aortic aneurysm…….

MedZag, Training Grounds, writes about Flying Solo in the operating room for the first time.
……….Well this moment was my proverbial 240 yard approach shot plopped down 6 inches from the pin. The first time I get to take the lead during an operation. I step into position above the patient's head and gaze down at the base of the mouth. Just as I get bovie in hand, the attending laughs and says: "Don't worry... the first tonsillectomy I ever scrubbed on, the patient lost 1800ml of blood. The bar's set pretty low." Great. My resting tremor kicks up a couple notches…..

I’m a sucker for a good dog/man friend story, so I greatly enjoyed the one told by Bongi, other things amanzi -- friend's best friend.   Not all the commenters agree with me.
Bongi also writes about a patient who needs a fasciotomy
being south african these days sometimes means we see things in a slightly skewed way. it seems to be the way we have become. i have touched on this before, but there is another story which illustrates the point.
the recent run of hijackings were fresh in all our minds because the perpetrators had shot and killed, execution style, a mother and her three year old child just the previous week.

Academic Life in Emergency Medicine shows us a Trick of the Trade: Finger nailbed laceration repair.
This technique requires that the fingernail has a simple linear laceration through it. The fingernail has to be relatively still adherent to the nailbed. The case below is a patient who sustained a fingertip laceration with an industrial skill saw.

SA Anaesthetist  writes about Comfort Zones - or "A day in the life of an anaesthetist who hasn't gone away for the holidays"
………….So what, you say, you are a cardiac anaesthesiologist, how hard could it be? And therein lies the rub. The biggest problem facing me now is not the pre-terminal patient. We get enough of those in our fine ivory tower on the hill. No, my problem is that I am going to be way out of my usual haunts. New hospital, new surgeon (although widely respected), and unfamiliar team = something approaching palpitations…………….

The Sandman tells us his Rule Number 10.  Read his post for the story that goes with it:
Response number two aka Rule #10:
A surgeon is assigned the anesthesiologist he/she deserves.

Oystein, Sterile Eye, tells (and shows) us how to  Remote Rig for Filming Open Surgery  (photo credit)
A couple of years ago I decided to make my own remote rig for filming open surgery. For a lot of operations in the abdomen and deep in the pelvis, the commercially available equipment could not provide the access I wanted. Designed by me and built at the hospital’s own instrument shop, the rig provides an excellent view of the surgical field and less strain on the cameraman………

Ask The Burn Surgeon has written an informative response with photos,  Management of 2nd degree superficial burns, to the following question:
Dear burn surgeon,
My daughter has a burn with hot soup on the hand with a lot of ugly looking blisters. Am worried as it’s quite painful. How will it heal and will it leave a scar?
Magaret p

Buckeye Surgeon discusses  Lymph Node Retrieval in Colon Cancer Surgery and ALS Entrapment.

GruntDoc tells us about removing The Foreign Body that Didn’t Exist
Except, of course, that it did…
A patient comes in with the entirely understandable complaint of “I have a fishbone lodged in my throat”. Came straight from dinner to the ED. When I ask a stupid question I’m given a stupid answer: “It feels like…a fishbone…”. Duh on me.

hjluks,  Sports Medicine and More.... , shares an x-ray with us simply entitled “ouch!”

Movin' Meat tells us the story that goes with this x-ray in his post, It's a wonder I survived my teen years

Movin' Meat also tells us the tale,  There's no bone in there, but it can still break, with MRI images included.
……So recently I saw an unhappy young man with such an injury.  It was sustained in the usual manner, but it was in fact the mildest one I have ever seen.  The hematoma was not large and the angulation of the injured member was slight.  I thought it was clearly a fracture, but the urologist who examined the patient was uncertain, and the patient, understandably, was quite unwilling to undergo surgery if the diagnosis was unclear.  We discussed diagnostic options.  Ultrasound apparently has a low sensitivity, but, the urologist had read, MRI was supposedly a useful tool.  I did not know that.  So I proceeded to order the first and only MRI of the penis of my entire career.  After an incredulous phone call from the radiologist to confirm the order, we obtained the following images……

Dr Toni Brayer writes about Regional Variations in Total Knee Replacement Surgery
……….Now that I am recovering from a total joint replacement, I am amazed to see the differences in how physicians, doing the same surgery, treat the patient. Total knee replacement (TKA) is one of the most common orthopedic procedures done today. Despite this, the patient cannot expect the same post op care.
I am in contact with a patient in rural Minnesota who had the same surgery 8 days prior to me. Here are some differences in treatment for the same surgery (TKA):………….
H/T to @nursingpins and @ThyroidMary who provided the link to cancer survivor Roger Ebert’s blog post: Nil by Mouth
………A third surgery was attempted, using a different approach. It seemed to work, and in a mirror I saw myself looking familiar again. But after a little more than a week, that surgery failed, too. Blood vessels intended to attach the transplanted tissue lost function, probably because they had been weakened by radiation. A fourth surgery has been proposed, but I flatly reject the idea. To paraphrase a line from "Adaptation's" orchid collector: "Done with surgery."
During that whole period I was Nil by Mouth………..

From Adam’s Heart Surgery Blog comes a reminder that often it is the scar that the patient remembers:  Even With A Crooked Scar, Sandy Is Extremely Thankful  
Well… I am extremely thankful ………..
However… I do have one small complaint that serves as a reminder of the fact that 10 months ago I was in an operating room with my mind blank and my chest opened up. My scar is crooked!

I have been following this story regarding baby Christopher who needs a heart transplant.  I first learned of him through a story via Arkansas Blog Christmas day.  Christopher was  born Nov. 30 in Oregon, but later flown by Angel One to Arkansas Children’s Hospital.   He was born with hypoplastic right heart syndrome and an AV canal defect.  As of this posting, he is still waiting for his transplant.  Here's a link where you can sign up to check in on family updates on the baby's situation.

SurgeXperiences is a blog carnival about surgical blogs. It is open to all (surgeon, nurse, anesthesia, patient, etc) who have a surgical blog or article to submit.  If you would like to be the host  for SurgeXperiences315 or a future edition, please contact Jeffrey who runs the show here.
Here is the catalog of past SurgeXperiences editions for your reading pleasure.


Bongi said...

great. thanks for the mention.

StorytellERdoc said...

Great post...I have to tell you, after hitting most of your recommendations, you are right on to mention them all. Now, though, I am ready to collapse in a great fit of sleep!

Thanks, as always, for a great post!

Mike Cadogan said...

Fantastic post
Congratulations on a great start to the 2010 collection of SurgeXperiences.
Has stimulated the team to write more surgical related posts (from the ED perspective)