PRE OPERATIVE PREPERATION
You loose any battle if fought without preperation.
We know you're your role. Unfortunately you do not realise the importance
of your job.
Neglegiance is because one does not understand the implications of
Accomplishment of successful surgery is a team work.
Reception is like an Air hostess for a plane. They give you warm welcome
and guide you in.
Pre op preperation is like maintainace ground staff working at 2 AM
in midnight in hangers, checking every thing minutely for the flight
due to take off at 8 AM in morning.
Surgeon is a Pilot, Assistant co pilot and the anaesthetist is navigator.
Take off is smooth if pre flight check up wasthourough.
Post op care is post op maintainace again by the ground staff.
Any airliner is a hospital which gains good reputation if the accident
rate is zero.
Will it be possible if there is lacuna or carelessness at any point?
The strength of any chain is it's weakest link. Don't become a weak
link for any organisation.
Realise your importance, do your job sincerely and enjoy your job wherever
you are posted. At times you will be rewarded without any efforts, like
in labour room. The lady inside will be taking pains for you and you
will be greeted outside by grand parents when you hand them over the
cute baby. Where as when you will be posted in OT doing steralisation,
your sincerity will bring down the infection rate, but no body will
know you. So enjoy your work.
Knowledge brings fear. Once you know the importance of each pre op
order, you will do it by heart. If you know that the BP falls immediately
after spinal anaesthesia , you will like to start the drip 2 hrs before
surgery. If you know that wound gets infected in diabetes, you will
get a Blood sugar done. If a person doing shaving knows it's importance,
he will do it carefully.
The main lesson for today is become knowledgeble, teach to your juniors,
sincerity will automatically follow.
PRE OPERATIVE ORDERS
It is to reduce the infection rate and make the patient fit to undergo
Anaesthesia and Surgery.
Why not suggestions??
Why not request??
Because it has to be followed without any alterations, without applying
any brains, like that followed in army.
Routine Pre Op orders
Take written consent.
It is written, not verbal.
Explaination is necessary in his own language.
Wittnessess should be other than his own family.
You should explain and take the permission for mutilation, like an amputation,
hysterectomy, Oopherectomy, Mastectomy or removal of the Testes etc.
It is his body and he has full right to take the decision, may it be
wrong according to you.
Now we also offer the choice of anaesthesia to the patient and try to
make it possible.
Consent should be taken a day before, so he has time to think over finally,
not on the way to OT or after shifting in the OT. It is a serious matter,
Do Xylocaine ST
It is a risky drug, hence we do a sensitivity test. It is not mere
an elevation of a bleb intradermally, making a roung circle all around
and going away without even telling your friend in over.
Do it in presence of a duty doctor, keep the emergency drug tray fore
hand. Write Xylocaine on the spot so others know about what is this
Take history of previous allergies before you inject.
Do not do it if no relative is around.
Prepare the parts
Preperation of the operative area and around needs the knowledge of
procedure planned. Ask the surgeon if you do not know it. It is necessary
to reduce infection and makes easy for adhesive tape.
Do not forget back. It is for the hygeine of spinal anaesthesia. Shaving
of pubic hair makes catheterisation clean. Trimming of scalp hair is
Cuts and abrasions make patient more prone for infections and the whole
purpose is defeated.
A good bath with hot water and soap, cleaning of feet, specially in
villagers, and thorough cleaning of operation area will reduce infection
rate and keep OT clean. It is a good practice to make them purchase
a new pair of socks. Similarly do not forget to clip the nails and remove
all bangles, ornaments and nail polish. It affects pulse oxymeter and
makes difficult to apply the leads.
All above is nothing but making the patient more and more clean, in
turn reducing the bacterial load wihich he is carrying with him.
An enema to be give previous night should be planned in such a way
that he has eased fully before you give him a shot of sedation.
Sedation should not be give to a sleeping patient. Don't make him sleepless
whole night due to a harshly given Inj Calmpose.
First shot of antibiotic should be given in presence of a duty doctor.
Are advised to screen the organs. Apart from blood sugar, Serum creatinine
is to know about the functioning of kidneys, LFT is for liver.
To know about heart
X Ray chest
Tells a lot about lungs.
Please attach all investigations in chronological order. If any investigation
is before more than one month please inform your consultant. At times
we miss it and we appreciate if you point out.
May be a lady informs you about the date of menstruation and has the
hesitation to tell a male consultant. Your information could alter the
date of surgery.
Your active participation is expected.
Blood which is arranged a night ago should be properly labelled and
Wraping in cotton never makes it warm. Best way is to hold it against
the body. Again, it is a wrong practice to make the patient do this
and drain her body heat.
Pre op loading of fluids
Cannot be done in haste. When it is written to start before 2 hrs,
you have no choice.
Shift the patient to OT when called.
Please do not do it early and do it fast when called.
Don't hesitate to ask that you do not know.
This is a game of life and death. Your one lie could kill the patient
and we rely on you.
it is Yes,
it is NO
it is I DON'T KNOW Sir.
There should not be any fourth reply like Jahan tak yaa shayad blood
sugar ho gaya hai.
You are dealing with a patient, who is a living thing with all feelings
like you, for you he may be one of the case in your list of 6 or 8 operations,
but for him, his life is at stake, may be he has come to the hospital
ar for that matter to any city for the first time. Imagine his anxiety,
fear and apprehension and behave accordingly.
All of us are employed by God and given the opportunity to serve the
humanity and we are doing it with skills bestowed by him.
Don't loose it !
With all good wishes
Dec 14th 2005
JABALPUR HOSPITAL AND RESEARCH CENTRE , RUSSEL CHOWK, JABALPUR (MP)
Dept of General Surgery and Laparoscopy
MS FICS FACRSI
Reg No - 3091.
Dipl Lap Surgery
Ex Executive Menber & Vice President Asso of Colon & Rectal
Sutgeons of India.
Trained in Lap Surgey Basic at Sir Gangaram Hosp New Delhi
Advance course at Gem hospital Coimbatore
Life member :
AMA, ASI, ACRSI, IAGES, AMASI, IASG, ISG, IASO, ICS.