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Surgery lecture for final year

1. Sepsis
2. Sirs
3. sutures and knots
4. Haemorrhage.Types of brain hematomas
5. Blood transfusion and it’s complications
6. Hernia
7. cardiac tamponade
8. Types of pneumothorax
9. Air under diaphragm
10. wounds.Types of scars
11. Pressure sore and VAC therapy
12. leg ulcers
13. Clostridia’s infections ( tetanus,gas gangrene)
14. Thyroid gland disease and thyroidectomy complications
15. Breast
16. Hydatid cyst
17. Acute pancreatitis
18. Acute cholecystitis and gall stones
19. Acute appendicitis
20. Capnography
21. Intestinal obstruction
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Haemorrhage

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-
*

-
-
·
3 what is the function
of
-

11 size blade .

[
absos
drainage
.

Ans + incision and

drainage .
(Stab
incision)
- 15 size
+ small cosmetic

size -> incision

>
- 22
long
7 Ident these
Ty
·

.
images .

O
&

Burn
O
#

large
e
.

> PAD
-

monopolar
diather my
-
1

-
net
=

- -

-
-

>
G
mcQ
mcQ
-

pencils e
nonopolar cautery
ma ↳ yello - Like
blue
- coagulation .

b -poler cautery (safe to use close

to vital nerves and
> earlobule
penis
-

,
end arteries)
.
>

Thyroid , parotid surgery

.
 O
-
Accured
produces
ecrod

-
M

- -

v
=>

electro
Diathermy or
surgery
 =>

Y USG
-
use
=
=>>
technology
-

- scalpel vibrate Fam

-
>

20
,
we-so , on H2
-

ranged
.
-

-denaturation
of protein
by O
- -

vibration &

McQ
.

-
>
>

heart
in
causing by -
-

↓
-

- -

diathesny
-
I

and veins
>divide arteries
-

↳ Imm .

-less thermal damage

- reduce operative
time
.

>
- faster recovery
.
 cast application -
>
-
severe
pain .
If O
-
tight
-- ↳ p ainpassive movement
-
on

distal
&

~ g affect comp
. .
pulse
-sorgical emergency· Present↳ sensations (parenthesia
·
no
pelvictracture
.

- ↳ later stages -
-
no
=
pulse
⑮ -

4
- -
-

- - -

- -

-
amputation
-

-
mcQ
>
-

- -

↓
↓
↑ 4 X .

f,
muscles are
out.
bulging

Black, African
& .

⑫S

getologyunknown
- ↳ Atuphic

C
↳
hypertroph
G
.

peloids
↓
car ↳ Klid .

-
>
-Scar grows
begand the boundaries
&

I or wound
.
of incision
 neve
SCN- Vague
QeSurgecarotid
damage
a .

nerves
of Krynx (XCN) -

adductor
tensor

-
>
↳ Sin ext (motor
branch
↳ .

-
int
. cricothyrid
muscle
↓
above
sensory to
cord
larynx
vocal .

- ext
> branch in close
-

relation to sup .

Thysid artery
> Recurrent
-
Laryng nerve
.
all muscles
↓ is passing ↳ glazynx
except cricothymid
tracheo esophageal > sensory below the
grove
-

.
Vocal card
↳ mas
external
g branch
a STA CPA

8
ITA .

Ring
+
PE

+ Fat
embolism
↓

embolism
=↓ -

First IOC-TEE
evessels
ugate
↳ MTV
I
Congenital
ap nagmatic
d
↑

&

herna - Borchdalk
>
- posterolateral hernk

>
-
41-bag and mask
ventillation .

-
Acute
pancreatitis.
 -

O
mcQ
-
French- oufer
normal
& distilled diameter
.
(Saline water
not
used < I Fr = 0 .
33 mm

Imm = 3 Fr
.

Baby Turp cases irrigation of

blood clots
-
&

.girls↳
5 &
males
. &

Retained
Foley's > removed
-

by usa
guided puncture of
-
ballon
1-
epidural anesthesia
-
last structure
-
pierce
↓
Toohy needle lig
-

flavum
-longtime
surgery markings are
present swings
2-
spinal needle

-short duration surgery

-
>
-

Spinal
anesthesia (LA) .

>
- lumbar puncture -
in
subarachmid
types & - space

↓
spinal -laststructure
layers
skin
needle
pierce
↳ ↓

- subcut arachnoid
mater
>
-
supraspinous
-
interspinous ↳
. Herum > epidural
Can
> lig
-
-
use for
- mater
dura space lumbar
mater
- arach .

puncture
SAS
 26- purple
> IV
- Cannula
size >
-
newborn
.
24 1
.

Paeds .

22
.

adults .

207
18(
omx1
I 14

Q) This inhalational
agentcauses
turane Desfura
is

asnephrotoxicity
be repatitis
O
cardiotoxic

↳
Cf
d - bronchial astman ·
IY
.

haldthane
isofluranehalothane
causes .

B hepatitis Vaporizer
>
-
heart
. is
- 36

-
-55
-90
Bier's block (IVRA)

↳ main complication
↳LAS T

Dose
>
- lignocaine 5mg/kg LigtAdryimg/kg
- Bopivacaine 2mg/kg

LAST

↳ DOC
↓
20 % intralipid
emulsion
 13 -
CYLINDERS - Store carrier

gases
.

and all others are in

>
- egisoflurane
vapor form to that
,
carry agent,
carrier
gas
is
required co2-grey
1900 Pei ↳ air >
-

blackbody ,
white

>
- M20 +
blue sund
Pin-index
Pipeline
A
0
-

-
1 5
,
2
,
5
- white black

T white
,
"laughing gas
N -

31
-
5 blue - 760 psi ·

-
>
vaccum >
-
yellow - diffusion hypoxia
104
> MAC -
-
.

> second gas effect

-

14-LMA-
laryngeal mask
airway
.
device (SAD)
esupraglottic airway .

-
LMA classic
&Is+
generation umA

Bonly one tube

 -
- neuve- by poglossal
2nd LMA neuve
generalism
&

LMA damaged
↳ 2 tubes ↳
supreme
↳ airw
ay E
↳
gastric for single use

For
fast track (intubating)
LMA
>
-
intubation
&
ma used o
upa

-daycare
surgery
most
[
preferred
↳ non-disposable
in
day areSX
LMA ambu ↳

I-gel -
kno
cuff .

↳ laryngeal tube
· is made
o
thermoelastic material
 15-laryngoscope never lifts up votal
card

&

McCoy

E
Macintosh
↳ adults (Mc)
Miller L
↓
children (MC)

video
yngo
scape
 4-6 cm above Carina
#
16-Endotracheal tubes

pole tube
south

> head anda

north pole
ballan L neurosurgery
O tube (

pilot ↓
z

RAE
tube E

armored tubes
③ "Hexometallic
o
prevents
subglottic
Stere
ET tube a
Taspiration L uncuffed t O
Y
be
↓
Fibreoptic
banchoscopy
Mocheck
correct
pl a cement paediatrics
Doub le lumen ( Ventilating
>
one
lung
⑤
-

tube
↳ used in thoracic SX
 17- AIRWAY ADJUNCTS .

Oropharyngeal gred e
airway
a

>
-
nasopharyngeal
airway !

Bougie .

-
[
Gar difficult intb alo

first pass bongie than

ET an it) .

Stylette
↓
in
helps
ET tubes curving
.
 -
18
Oxygen delivery device
.

> non-invasive ventilation

- .

Fioz + 100%

nasal cannular (
40%
pangs Fio-
Y litlmin .

Non-rebreathingU
mask (NRBM)
+80 % -
FiQ 9 15//min
nasal
-high to
canula (HFNC)
FiQL - 100% &
70 4 min

Face mask or Hudson mask C

151/min , FiO2-60 %

ventio
mask
 mcnewe
plex 19-surgical position is injury
Brachial position
head up
down
headvital capacity Gulner
neuve
-me FRCH
and

↑
&
↑ &

Reverse
·
BP
con paley
↳
↑10, 10p)
&
-GBP;
venous
air
embolism
or

Beye injury semi-sitting

position
.

↓
RAMP
& position
rapid management
↓
airway in obese
pt.
 CAPNOGRAPH
20- ETCO2 is measured at -

> Phase III

due to
↳ 35-45mm can
be
anaphylaxis
G gHg -

dominant
-
aut
>
-
succinglcholine
stepladder pattern nperaerbia

↳ DOC - dantrlene
ETCOn Lmu

time
-

↳
-

Rebreathing
give musce
relaxant
Cor
 >
- Double plateau sign > Faulty
- etco
,

sampling
-PE #M line .

↳ ↓ ETCO

21-Preanesthetic medication
orders
regarding
continue all
1 -

Antihypertensive ->
ACE inhib
except >
-

ARB
Antidiabetic
I >
-
2- cause
refractory
↳ OHA tomit day on
hypotension
Insulin
>
-
of surgery
. continue
Thypoe thyroxine If
3-
Thysid ↳ hyper- antithred.
on day y
surgery
M
 Tocilar pillar
PUSH >
-

- ↳ Would
in OPD L soft palate
Hard palate
-

& &
-

& intra-operative
2- Cormack - Lehane system

Claryngoscopic view at intubation)

- BIS-monitor
↳ EEG

- tells about depth

anesthesia
of

+ 100 -
Fully
in
aware
coma
-0-

it 40-60(GA)
ideally must be -
&

carrier
>
-

Anesthetic machine gas(02

N20]
-
main
. component in
Calcium X &
pink
.
color
hydroxide Sodalime

Mos
t ↓ -

absorb
to

when it becomes
don't
white >
- ETCO2 graph
come to line(base line)

(timetochang
the
N20 is
having max MAC , so its less
can't
potent ,
neuce it cause GA alone
.

t
inhalational -halothane
it
requires other
agent
to
produce effect↳ 2nd
gas effect
- so When M20
hal
and the is
negoe
if takes O
2
3
rdgas effect
-

Y Of

FINk effect
D
iffusional
hypoxia .

>
-

if psig liters
↳
Psix. given
>
- it barry lites

barry 5 5 .

Fergiven ↓ ↓
Cos
Or
nitr
oxid e
 1-Brain stem death
2-shock
.
3 septic shock with bundles

Y - ARDS
5- VAP
6-
tracheostomy
7 -
pancreatitis
I-wearing and
critically ill
pt transfer
.

I
, Areg V5 , V6 >
-
Lateral Wall M1 - Lt. circumbly
ant wallm/
Vi Vu -
.

me
=

auF A
II ,
III , >
-

inf . wall

lead 11 >
-

arrthymia
lead V5
>
- ischemia (75% ) . .
v5 +
Vy -
is chemia detection
-90 %
V5 + 11
+ Vu > -
1
17 96 %
 CVP
-

Tricuspid regurgitation - prominent C-V waves

Atrial Fibrillation >

- absent a waves

cardiac tamponade > Steep X

- ,
loss
of y descent

AV dissociation - cannon "A "waves

constrictive
pericerditis -> Steep X , Steep y descent
&

TEE Findings
most sensitive
and
specific<
-
↓
RV/ LV diastolic
collapse
.
 Cup
- risky complication 4
from pul artery
Catheter placement
is less than
5%
↳ 0 .

at
- a
tip of pul . Catheter enters pul. artery
>
- 35-45
approx .
cm
 0
5-6 , 0

mild -> 5
.

-7 :

-6
.

↑ moderate

we
 arein
ficity
> guild
7
spas
fir

-neuve
F

I
25
.

mg/kg
immed .

Iv bols.

Max lo .

mg
/kg .
Serumtryptak
Glienzy
agni me

# IgE

Ty
pe ↳
7
immune
media
OC
ted
HS
-

-
↓
reaction ↓
adrenaline
N
*

most
dangers

buncho
mc
sign >
-
hypotension
first
hallmark- -
spasa

least common(late)
> -
urticari a
anaphylactid complement
mediated
AMBU BAG
 G > EnV5M6
-

>
- Ey

Us

M6

↳ for prognosis
E

minimum
GCs >-
3

mAX - 15
 Lower limb innervation
leg compartments Lu
15 , S1 , Sc S3
, ..

②plantar
on
S kneeflexio
E
>·
-
S
Foot Tibial
eversion P nerve Sciatic nerve

% PN-
↳ DF
extension --
Tibial
>

Common peroneal nerve nerve

neckytibula result
Th ptwalk
<

.
-
damage
Foot drop popilitealag
an
superficial Deep penneal
peroneal
nerve
nerve
CAnt
Tibial nevve) Post tibial
- neuve

(lat leg comp) (Ant -

leg Camp)
.

↳
gastronemius
· .

ef
↳ peroneus longus chile
↳ Tib ant
brevis
.

A planter's
peroners > dig ext
-
long
(S1)) +soleus
.
.

a
muse

> ext hallucis lugus

> eversion foot
- .

> Skin dorsum foot to ↳ Tibilair post

L
-
on .

extensors Flex
>
dig long
-
.
.
,

dorsiflexion >
-
Flex halluc .

long
skin dersumfoot >
-
Flexor refinaculum
on
↓
in 1st
webspace n Tarsaltunnel
syn
(L5) lat
plantar Med A

p lantar
neuve .
nerve

- muscles Ifsole
↳ sking sole
.
 *

dersum
.

>
-

.
newe
zemeral
SPN
in

branch porttibial
neuver
↳ -
↑

a
DPN
.

neve ↳ 25

SIN aka 30N

DFNakaDPN
 APGAR SCORE

Pul embolis
Monstable
.

↓ > - TEE
least ↳ Stable - CT PA
↓

stethoscopy
.
Tiamdrive
spirnolactone
↑
it sparing heypokalAlekmiala
&
.

m
&

aldosterme
excess
↳ allcalo *

↳ hypokaleme
aldosterone deficiency
D

↳ Hyperkalemen
acides
①

↳
DOC for Pl >
- labetalol
↓
it no

hydralizine
an
Mason
Pre-eclampsia
↓
>
- no
seizure
&

GA eclampsie - seizure
severe pre-eclampsie (HELPP syn ) .

↳ GA
VW Disease
CBF =
55 ml/min/100 gm
75-105
CPP = mm
Htg
MAP 90-110
ICP
=

5- 15
mm
mm Htg
=
Itg
CPP =
MAP-ICP
 ↓ CP
-

↳ hypervent
-
mannitol

-zefaltte Haldane
alkal ↳ effect
C n
X ↑

m
.

& ↳ Bohr's
↳ M .
Acid
.

-SCA
That
>
-

>
- preg.
 neuve HUMERUS FRACTURE
axillary
&
&

↳
Radial
neuve

↓
median #nar nerve
nerve .
 ↑ mcFn Ghrs

↓
MC cause death
g
after BT DUT
T virchoo's
triad .

↳ Ally above
.
 Anesthesia Stages

>
- intubation -
> orbicularis oculi

- extubation -
adductor
policin
>
-

<-Cyfracture >
- Mills best for
intubation
.
 than
Bless year
z

criterial/
zur
extubation
↓
insp press
.

> IoCMH,O

X
induction
by -

inhalation
agents .

Quinsy

&
CPR
 -
mc-
> colfarea (popliteal
teins

↓
Pneumatic stocking
virchow's 4
triad .
Ms SUT
>
-
Stable
pt
↳ Yadenine
unstable 16 , 12 12)
,

↳ cardioversion

Sui - unstable C
-ardioversion
>
stable -
vagaland
↓
-
manear
>
adenosine 16 , 12, 1)

asthma - verapamil
pt diaparmedol (3 ,
6
,
6)
 -weiss and
Mallory
Boerhaave syndrome
SHOCK
 SAS-CSF Sub arachnoid
and
circle
G
Will is

> -

haemorrhage a ↑
mc cause 7↓
-
bleeding
↳trauma in sas
- -

⑰S

⑮ -
=>

②> -

spontaneous
YSAS
⑭T O
D

berry
rupture X

Sylvian
aneurysm zissure
-1-S
↓
CIF ~

X
↳ loss consciousness
- g -

rewast headache
- glize -↓
⑭

> neck
-
stifner and
-

thunderclap
headachevomiting
.
star g
.
death
-Xanthochromia
.

↑
W
lumbar
puncture
nuchal
- rigidity
-
10C - NCCT

my - conservatic .

>
-
-
DOC - nimodipine (((B)
X ↑
--
starg
·

I& death

↓
⑫ ⑦ presence
>
-
B
O
Pr ↑ ar

O Gelombpuncture
-

-
X
↳ ⑰
S

Triple HHHPtherapy
↳ vasospasm after
thermia
↳ hyper