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………
…….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…..
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.
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. (photo credit)
………….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…………….
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………
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?
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.
Movin' Meat tells us the story that goes with this x-ray in his post, It's a wonder I survived my teen years (photo credit)
……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):………….
………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 (photo credit)
Well… I am extremely thankful ………..
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 (photo credit) 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.