VMS 3010 Introduction to Surgery 2024-2025 PDF

INTRODUCTION TO SURGERY ALISON LIVESEY WHERE DID MY JOURNEY BEGIN?  F O U N D AT I O N S U R G I C A L P R I N C I P L E S Basic Surgery-Day 1 skill Expectation of the public Expectation of the RCVS  W H AT M A K E S A G O O D S U R G E O N ? Meticulous attention to detail G...

INTRODUCTION TO SURGERY ALISON LIVESEY WHERE DID MY JOURNEY BEGIN?  F O U N D AT I O N S U R G I C A L P R I N C I P L E S Basic Surgery-Day 1 skill Expectation of the public Expectation of the RCVS  W H AT M A K E S A G O O D S U R G E O N ? Meticulous attention to detail Good knowledge of anatomy Practical skills and dexterity The right level of confidence Some luck A N AT O M Y V E RY I M P O R TA N T BEWARE! SURGICAL EQUIPMENT-ONLINE LEARNING H E A LT H A N D S A F E T Y- C A R E W I T H S H A R P S  IS IT SURGICAL IS IT MEDICAL? Always see if there is a medical alternative Changes in thinking about some diseases Non-surgical mast cell tumour treatment Bladder calculi Melanoma vaccine  B E AWA R E O F A LT E R N AT I V E S Laparoscopy Endoscopy Arthroscopy  CLINICAL NOTE WRITING SOAP S-Subjective-what the client has observed O-Objective TPR Weight A-Assessment on analysis-consolidation of the information P-What do you want to do, diagnostic and therapeutic considerations HEAP-History, examination, assessment, plan SURGICAL CHECKLIST SURGICAL CHECKLISTS R E TA I N E D S U R G I C A L S WA B  HALSTED’S PRINCIPLES Gentle tissue handling Control haemorrhage Preservation of blood supply Strict asepsis Minimise tension Accurate tissue apposition Eliminate dead space  CLINICAL HISTORY Regurgitation versus vomiting Faecal versus urinary tenesmus  C L I N I C A L E X A M I N AT I O N Nose to tail examination For orthopaedics-thorough limb examination Walk the dog! Check it is the correct limb. Neurological examination Ask owners to take videos at home  MAKE SURE YOUR DIAGNOSIS IS CORRECT Bone tumours can mimic other orthopaedic disease S TA B I L I S AT I O N O F Y O U R PAT I E N T  RULE OUT PRE-EXISTING CONDITIONS Bleeding disorders Fibrinolysis in Greyhounds-pretreat tranexamic acid Von Willebrand’s disease-Doberman and other breeds Lungworm- Angiostrongylus vasorum DOES IT MAKE A DIFFERENCE WHICH PAT I E N T ?  W H AT D O I N E E D T O C O N S I D E R ? Do I have enough information? How heavy is the patient? Can I treat this with a cast? Does this fracture need surgical fixation? Do I have the correct surgical equipment? Is that surgical equipment prepared? Will I need an assistant? Does the owner have the finances? Have they agreed to an estimate? Can the owner rest the patient? AFTERCARE RCVS CODE OF CONDUCT  S U R G I C A L E S T I M AT E S ? Estimated Costs for Canine Orthopaedic Surgery Patient: Max (Golden Retriever, 5 years old) Procedure: Cruciate Ligament Repair (TPLO - Tibial Plateau Levelling Osteotomy). Pre-Surgical Assessment Consultation Fee: £80 X-Rays (Pre-op): £150 Blood Work (CBC, Chemistry Panel): £120 Anaesthesia Evaluation: £50 Total Pre-Surgical Costs: £400 Surgical Procedure Surgical Fee: £1,200 Anaesthesia: £300 Surgical Implants (Plates/Screws): £600 Operating Room Supplies (Sterile Drapes, Suture Materials, etc.): £200 Total Surgical Costs: £2,550 POST OP CARE?  S P E C I A L I S AT I O N I N S U R G E RY Certificate in Advanced Practice Certificates provided by external companies Advanced practitioner status Postgraduate and post-registation qualifications Specialist status HOW IS THE COURSE STRUCTURED  YEAR 3 Wound Healing Surgical Site Infection Principles of haemostasis Traumatic Wound Management and Surgical Drains Instruments Implants Clinical record Writing  VMS 3010 PRACTICAL SESSIONS Nasogastric feeding placement Oesophagostomy tube placement Stifle examination Venous canulation Endotracheal intubation Surgical scrubbing Open and closed gloving Patient draping Thoracocentesis VMS 3011 Ophthalmic surgery Bladder sutures –Cushing and Connell Uterine sutures-Utrecht suture Catheter placement and care  YEAR 4 DRY RUN Assessment at Dry Dun-DOPS Intubation IV Canulation Gowning and glowing Tying a ligature Practice surgical procedures on models Open and closed castrate Cat Spay Bitch spay  N E U T E R I N G C L I N I C - M AY H E W O R B L U E CROSS Tuesday and Wednesday 8.30-5pm Per anaesthetic examination and an anaesthesia plan Prepare animals for anaesthesia and induction Monitor anaesthesia Recover a patient Prepare patient and surgeon for surgery Perform surgery Record a neutering procedure Discharge a patient Assessment EPAs  PRACTICALS IN YEAR 4 Lump removal practical and Suturing Practice different suture patterns Practice lump removal and skin reconstruction  GI AND UTERINE PRACTICAL Takes place in anatomy using cadaveric material Enterotomy and enterectomy Use of stay sutures Cystotomy Suture bovine uterus for caesarean HOW TO SUCCEED IN SURGERY Choose cases wisely Good preoperative stabilisation and diagnosis Stabilise patients prior to surgery Manage anaesthesia and analgesia appropriately Excellent client communication skills Excellent post op care Follow basic surgical principles DISCHARGE INSTRUCTIONS Advice to owners Important part of medical writing Ensure owner understand compliance Include in records as an attachment C O M P L I C AT I O N S These are not always your fault Pay attention to surgical principles Think about patient safety Checklists! Always own up to your mistakes  W H AT I S T H I S C O M P L I C AT I O N ? Could it be avoided? What would be your approach to this patient?  C O M P L I C AT I O N S What is this complication? How could it be avoided?  CASE What are the considerations for this patient?  CASE Diagnosis-Gastric dilation volvulus Must stabilise! Fluid therapy and analgesia Must give owners an estimate and explain prognosis Must be able to provide aftercare