Format of Surgery Long Cases

1.      History  and examination

a.      Introduction
b.      Previously well patient/ patient with co-morbidities
c.       DD
d.      Eatiology
e.      Complications
f.        Fitness for surgery
g.      Social factors
2.      Summary and problem list
3.      Discussion
a.      Management
b.      Theory
4.      Investigations
a.      For diagnosis
b.      To assess severity
c.       To assess fitness for the surgery
5.      Treatment
a.      surgical
                                          i.      Curative
                                        ii.      Palliative
b.      medical
6.      Pre-operative preparations
a.      Consent
                                          i.      Why/what surgery
                                        ii.      Type of anaesthesia
                                      iii.      What will happen after surgery
                                       iv.      Complications
                                         v.      Long term outcome
b.      Pre-operative assessment
c.       Optimize the patient for surgery
                                          i.      Diabetes mellitus
                                        ii.      Cardiovascular disease
1.      IHD
2.      HT
d.      Alter/modify drugs
                                          i.      Stop –
1.      antiplatelet drugs – clopidogrel 14 days prior to surgery
2.      warfarin – 72 hours prior to surgery and converted to heparin, UFH – 4-6 hrs prior to surgery, LMWH
– 12 before
3.      oral hypoglycaemics
                                        ii.      Continue –
1.      Antihypertensives
2.      other cardiac drugs
3.      antiepileptics
4.      asthmatic
e.      Special preparations for the surgery
                                          i.      Patient preparation
                                        ii.      ICU bed
f.        Premedications
                                          i.      Antiemetics
                                        ii.      PPI
                                      iii.      Anxiolytics
                                       iv.      For bowel preparations
                                         v.      Prophylactic antibiotics
g.      Fasting and pre-op fluid balance
                                          i.      6 hours for solids and 2 hours for liquids
 7.      Post operative management
a.      Post op monitoring
                                          i.      ICU/HDU/ward
                                        ii.      PR/RR/BP/IP OP chart
                                      iii.      Drains
                                       iv.      Active bleeding
b.      Management of pain
c.       Managing co morbidities
d.      Fluid and electrolyte
e.      Nutrition
f.        Complications
                                          i.      Bleeding
1.      Iry
2.      2ry
3.      Reactionary
                                        ii.      Atelactasis, pneumonia
                                      iii.      IHD, Heart failure, arrhythmias
                                       iv.      DVT, Pulmonary embolism
                                         v.      Wound
1.      Haematoma
2.      Seroma
3.      Wound infection
                                       vi.      Fever
                                     vii.      Nausea and vomiting