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