University - General Surgery

PREFACE

  • A decade has passed since the previous Russian edition of the manual.

  • Significant changes in surgery have influenced teaching methods.

  • This manual focuses on serving English-speaking medical students and house officers.

  • It aims to assist in preparing for practical classes and clinical training in general surgery.

Importance of Practical Knowledge

  • The application of knowledge from lectures and textbooks is critical for all healthcare professionals.

  • Mastery over various topics in general surgery is essential, including:

    • Asepsis and antisepsis

    • Blood transfusion

    • Management of hemorrhage

    • Resuscitation fundamentals

    • Anesthesia principles

Clinical Examination

  • Routine methods of clinical examination are emphasized as a priority in general surgery education.

  • The manual provides guidelines for clinical examination principles for surgical patients.

  • It includes criteria for assessing:

    • Surgical infections

    • Trauma

    • Vascular diseases

    • Tumors

Evolving Medical Knowledge

  • Medical knowledge is continuously evolving and requires healthcare professionals to stay updated.

  • The information in this manual has been vetted for accuracy and relevance but should be aligned with current practices and regulations.

Chapter I: ASEPSIS AND ANTISEPSIS

  • Surgical infections are common and can be life-threatening despite high-quality operative techniques.

  • Asepsis involves preventing infection from entering a wound, while antisepsis focuses on excluding or destroying harmful microbes.

  • Both principles are essential for the prevention of surgical infections.

Sources of Infection

  • Exogenous Sources: From outside the body, e.g., infected patients, asymptomatic carriers, animals.

  • Endogenous Sources: From within the body, e.g., chronic infections from skin, gums, or infected organs.

Modes of Transmission

  • Exogenous: Airborne, direct contact, implantation.

  • Endogenous: Direct contact, lymphatic, and hematogenous spread.

Surgical Hospital Functional Blocks

  • Sterile Zone: Operating theatre, scrub-up room, sterilization room.

  • Clean Zone: Personal hygiene area for staff.

  • Technical Zone: Storage for air-conditioning and oxygen devices.

  • Dirty Zone: Areas for non-sterile handling, e.g., head nurse's room, dirty laundry.

Equipment and Procedures

  • Operating theatres equipped to maintain sterile conditions are essential.

  • Surgical procedures require specific cleaning and sterilization protocols for instruments and environments.

Disinfection and Sterilization Techniques

  • Chemical agents for disinfection include:

    • Iodine solutions for skin cleansing and wound preparation.

    • Chlorhexidine for cleaning operative sites and instruments.

    • Formaldehyde for disinfecting various surgical materials.

    • Ethanol and other compounds for sterilization and disinfection of surfaces, hands, and instruments.

Sterilization Stages

  1. Preparation of Materials: Thorough cleansing of used instruments, careful handling of blood-stained items.

  2. Packaging for Sterilization: Proper arrangement in sterilizers ensuring adequate airflow and steam reach.

  3. Sterilization Process: Methods such as dry heat sterilization and autoclaving detailed for effective results.

  4. Safe Storage of Sterilized Materials: Maintenance of sterility standards and durations specified for different materials and conditions.

Hand Preparation for Surgery

  • Clean hands are pivotal in infection prevention.

  • Various scrubbing methods outlined, including:

    • Mechanical cleansing with soap and sterile brushes or solutions.

    • Application of antiseptic agents post-scrubbing.

Antiseptic Procedures

  • Four types of antisepsis identified: mechanical, physical, chemical, and biological.

    • Mechanical: Surgical debridement to remove non-viable tissue.

    • Physical: Enhancing drainage and cleaning procedures.

    • Chemical: Use of antiseptics and antibiotics to combat infection.

    • Biological: Incorporation of antibiotics, but with consideration for resistance.

Antibiotic Therapy

  • Importance of antibiotics for treating infections; however, prescription only when necessary.

  • Proper management and assessment of patient reactions are crucial to avoid complications.

  • Discussion of various antibiotics, their uses, and potential side effects.

  • Emphasis on addressing antibiotic resistance and tailored treatment combinations according to susceptibility.

Immune Compounds

  • Utilization of immune compounds for infection prevention and treatment, including therapeutics like:

    • Tetanus anti-toxins and gamma globulin to bolster immunity.

Conclusion

  • Effective surgical practice requires comprehensive knowledge of asepsis, antisepsis, disinfection, and current medical practices to ensure patient safety and positive outcomes.