Category: General Surgery

  • Commonly Used Fluids in the Hospital

    IV Fluid Composition

    Intravenous Fluid Composition

    Reference table for common IV solutions. All concentrations are in mmol/L unless otherwise noted.

    Solution mOsm/L Glucose (g/L) Caloric value (kcal/L) NaCl Na⁺ Cl⁻ K⁺ Ca²⁺ Mg²⁺ Lactate ion Acetate ion Maleate ion Others
    Normal Saline (0.9%) 308 9 154 154 pH ≈ 5.5
    NaCl 3% 1026 513 513 pH ≈ 5
    Half saline (0.45%) 154 4.5 77 77
    Hartmann’s solution OR Ringer’s lactate 278 6 131 111 5 2 29 pH ≈ 6.5
    Dextrose 5% (D5%) 278 50 pH ≈ 4.3
    Dextrose 10% (D10%) 555 100 400 pH ≈ 4.3
    Dextrose 50% (D50%) 2523 500 pH ≈ 4.2
    NSD5% 585 50 200 9 154 (150) 154 (150) pH ≈ 4
    HSD5% 430 50 200 77 77 77 pH ≈ 4
    QSD1 OR 1/5 Saline D4.23% OR NaCl 0.18% D4.23% 296 42.3 170 31 (30.8) 31 (30.8)
    QSD10% OR 1/5 Saline D10% OR NaCl 0.18% D10% 615 100 400 1.8 31 (30) 31 (30)
    Sterofundin (1/1 E ISO) 304 (309) 6.8 140 127 4 2.5 1.0 24 5 pH 5.1 – 5.9
    Succinylated Gelatin 4% 274 154 120 Succinylated gelatin 40 g/L
    Mannitol 20% 1100 Mannitol 200 g/L
    pH 6.3
    Mannitol 10% 550 Mannitol 100 g/L
    pH 6.3
  • Helicobacter Pylori (H. Pylori) Infection

    Eradication Therapy ⭐️

    Proton-pump inhibitor

    • T Esomeprazole (Nexium®) 40mg OD for 6weeks, or
    • T Pantoprazole 40mg BD for 2 weeks, then 40mg OD for 4 weeks

    Antibiotics

    • T Amoxicillin 1g BD for 2 weeks + T Clarythromycin 500mg BD 2 weeks
  • Sutures

    Classification of Suture Materials

    • Absorbable VS Non-absorbable
    • Synthetic VS Natural
    • Monofilament VS Multifilament (i.e. braided)
      • Monofilament: lower risk of infection, but poor knot security
      • Braided: good knot security but higher risk of infection

    Suture Size

    A larger size suture has smaller diameter. Hence a 3/0 suture is smaller than a 2/0 suture.

    Surgical Needle

    • Swaged end
      • Connects the needle to the suture
    • Needle body
      • Round body: for friable tissues e.g. liver, kidney, cervical tear repair
      • Cutting (i.e. triangular shaped, with 3 cutting edges to penetrate tough tissue; cutting surface on the concave edge): For tough tissues e.g. skin
      • Reverse cutting (cutting surface on the convex edge): For tendon / subcuticular sutures
    • Needle point

    Examples

    Composition Example / Brand Natural / Synthetic Absorbable / Non-absorbable Monofilament / Braided
    Silk Silk, VESTISilk Natural Non-absorbable Braided
    Polypropylene Ecolene, VESTilene, PROLENE Synthetic Non-absorbable Monofilament
    Nylon (a type of polyamide) Tylon Synthetic Non-absorbable Braided
    Nylon (a type of polyamide) Dafilon, ETHILON Synthetic Non-absorbable Monofilament
    Polyglactin Vicryl, Vestiryl, Polysorb Synthetic Absorbable Braided
    Poly (Glycolide-co-Lactide) ECOSORB Synthetic Absorbable Braided
    Polyglyconate copolymer of glycolic acid and trimethylene carbonate Monosyn, Maxon Synthetic Absorbable Monofilament
    Collagen Catgut Natural Absorbable Braided
    Glycolide and epsilon-caprolactone Monocryl Synthetic Absorbable Monofilament
    No matches found.
  • Cerebral Concussion

    Criteria

    • GCS 15
    • No imaging evidence of brain injury
    • With or without history of LOC

    Grading

    Grade 1 Grade 2 Grade 3
    History of confusion Present Present
    History of LOC Absent Absent Present: brief (seconds) / prolonged (minutes)
    Concussion symptoms Resolved in <15 minutes Lasted >15 minutes
    Concussion symptoms:
    (1) Physical: headache, blurry / double vision, dizziness, problem with balance, vomiting
    (2) Cognition / Memory: slow thinking, difficulty to concentrate, difficulty to remember new information
    (3) Emotion / Mood: irritability, anxiety, sadness
    (4) Sleep disturbance (interruption of normal sleep pattern)
    No matches found.
  • Traumatic Brain Injury (TBI)

    Definition

    Blunt and/or penetrating injury to the head and/or brain due to external force, with temporary or permanent impairment in brain function which may or may not result in underlying structural changes in brain

    Changes in Brain after TBI

    Anatomical changes

    • Intracranial lesions e.g. contusion, cerebral oedema, acute subdural haemorrhage (ASDH), Intraventricular hemorrhage (IVH)
    • Skull fracture
    • Scalp wound
    • Facial wound

    Physiological changes

    • Alteration in mental state e.g. slow thinking, confusion
    • Loss / reduced consciousness
    • Loss of memory (amnesia) of events immediately before and / or after TBI
    • Neurological deficits e.g. change in vision, sensory loss, loss of balance, body weakness

    Classification

    Severity of head injury

    • Mild head injury: GCS 13 – 15
    • Moderate head injury: GCS 9 – 12
    • Severe head injury: GCS 3 – 8
  • Pain as the 5th Vital Sign & Acute Pain Management

    Scales for Pain

    Visual analogue scale (VAS):

    Documentation e.g. VAS 3, VAS – 7

    Modified WHO Analgesic ladder for acute pain management

    Further reading: CPG Pain as the 5th vital sign (3rd edition)
  • Ankle Brachial Index (ABI)

    ☀️Normal: 0.9 – 1.2
    ☀️Critical limb ischaemia: < 0.5
    ☀️Arteriosclerosis (calcification) of artery, especially in DM: >1.2

  • Wound

    Types of wound debridement

    • surgical
    • mechanical
    • enzymatic
    • autolytic
    • biological
    • Hydrosurgery debridement
+