Case No.

: Major Scrub 3
Name of Student: Mary Edella Acob
Year and Section: III-I

Name of Patient: C. N. U Age: 55 Sex: Male Civil Status: Married

Date of Admission: 10/6/19 Time Started/Ended: 4:35 PM –7:00 PM
Date of Surgery: 10/7/19
Bed #: Hospital No.: 19-210000239292 Admission No.:

Surgeon: Dr. John Hubert Pua

Anesthesiologist: Dr. Paraiso,
Scrub Nurse: Lara Katrina, RN
Circulating Nurse: Stephanie Reyes, RN

Chief Complaint: Non healing wound at the right foot

Rationale/Definition: The patient involved in a motor vehicle accident that traumatize his right foot up
to his leg. There was a big area that was affected when the right leg touches the
motor exhaust. The wound was also infected already because it has a lot of pus from
his leg down to his foot.
Pathophysiology:

Etiology:
motor vehicular accident
Risk factors:
• Age (55 years
old)

Severe open fracture of foot and

severe burn from foot to upper
portion of legs

Traumatized right
lower limb Tissue injury Prolonged, elevated
inflammation

Infection Destruction of Imbalanced protease

essential proteins and inhibitors

Non healing wound Dead tissue Amputation

Post-Op Diagnosis: Above the knee amputation of the right foot

Rationale/Definition: Due to worsened condition of the wound in the right foot. There is a lot of pus
coming from the wound and up until his legs and some area is severe burned. There
was a chronic infection that do not respond to surgical debridement.

Surgical procedure: Above the knee amputation of the right foot

Definition: Removal of a leg from the body due to accident or trauma to the body.
Indication: There is a traumatic injury which is a severe burn and non-healing wound due
to motor vehicle accident. Also, there are a lot of pus when the debridement
started that led to amputation.

Type of anesthesia: General

Specific technique: Inhalation and Spinal anesthesia
Main anesthetic agent: Sevoflurane and Bupivacaine HCl
Mechanism of action:
Sevoflurane - Induces a reduction in junctional conductance by decreasing gap junction channel
opening times and increasing gap junction channel closing times. Sevoflurane also activates
calcium dependent ATPase in the sarcoplasmic reticulum by increasing the fluidity of the lipid
membrane. It also appears to bind the D subunit of ATP synthase and NADH dehydogenase
and binds to the GABA receptor, the large conductance Ca2+ activated potassium channel, the
glutamate receptor, and the glycine receptor.

Bupivacaine – It blocks the generation and the conduction of nerve impulses, presumably by
increasing the threshold for electrical excitation in the nerve, by slowing the propagation of the
nerve impulse, and by reducing the rate of rise of the action potential. It prevents depolarization
by binding to the intracellular portion of sodium channels and blocking sodium ion influx into
neurons. In general, the progression of anesthesia is related to the diameter, myelination and
conduction velocity of affected nerve fibers. The analgesic effects are thought to potentially be
due to its binding to the prostaglandin E2 receptors, subtype EP1 (PGE2EP1), which inhibits the
production of prostaglandins, thereby reducing fever, inflammation, and hyperalgesia.

Position: Supine
Equipment used for Positioning: Pillow, safety strap and grounding pad
Incision: fish mouth incision
Skin preparation: Right Leg down to foot
Disinfectant used: Betadine and cutasept-F
Draping: Lap sheet, towel (4)

Sutures and Needles:

Tissue Layer Needle Name of Suture Used Suturing Technique

• Skin • Cutting • Prolene 3-0 • Skewed flap

• Subcutaneous Fat • Taper point • Vicryl 2-0 • Subcutaneous Suture
• Fascia • Taper point • Vicryl 0 • Deep Suture

Instruments:
Clamping Retracting Grasping Cutting Others

• Mosquito • Malleable • Thumb • Knife • Bowl

• Kelly • Army Navy Forceps • Mayo Straight • Kidney Basin
• Tonsil • Richardson • Tissue • Mayo Curve • Medicine Cup
• Peritoneal • Balfour Forceps • Metzenbaum • Cautery
• Bladder • Russian • Ronguer • Needle Holder
Retractor • De Bakey • Osteotome • Suctions
• Deaver • Kocher • Curette
• Allis • Rasp
• Babcock
• Sponge stick
• Towel clip