Goals/Objectives Anatomy Indications Technique Office-Based Procedures: Fine-Needle Aspiration Biopsy of a Mass in the Head and Neck Robert L. Ferris From Myers EN: Operative Otolaryngology: Head and Neck Surgery, 2nd Edition (Saunders 2008) Fine-needle aspiration biopsy (FNAB) has become a standard technique in the initial office evaluation of a mass in the head and neck. These masses encompass a variety of benign and malignant tumors and tumor-like…

Goals/Objectives Basic Principles Anatomy Physiologic Considerations Technical Considerations Post-Operative Care Skin Graft Saja S. Scherer-Pietramaggiori Giorgio Pietramaggiori Dennis P. Orgill From Neligan PC, et al: Plastic Surgery, 3rd edition (Saunders 2012) Skin Appendages and Functional Structures Hair follicles, sweat glands, and dermal nerves can often be transferred within thick, split-thickness skin grafts (STSGs) and full-thickness skin grafts ( Figure 87-1-1 ). Thin STSGs will not allow the transfer of hair…

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Goals/Objectives Indications Anatomic considerations Technical considerations Inguinal Hernias and Hydroceles Charles L. Snyder From Holcomb GW, Murphy JP: Ashcraft's Pediatric Surgery 5th edition (Saunders 2010) Inguinal hernia repairs are one of the most common operations performed by pediatric surgeons, and consultations for inguinal hernia are among the most frequent reasons for pediatric surgical referral. An inguinal hernia in a child usually refers to an indirect inguinal hernia…

Goals/Objectives Indications for chest tube Anatomic landmarks Care of chest tubes Perioperative Care of the Thoracic Surgical Patient Elisabeth U. Dexter From Selke F: Sabiston & Spencer Surgery of the Chest, 8th edition (Saunders 2010) Wound Care Incision care is usually routine if the skin is closed. Open wounds historically are packed with gauze moistened with saline, dilute antibiotic solution, sodium hypochlorite (Dakin's) solution, acetic acid solution,…

Goals/Objectives Indications Techniques Complications Indwelling Access Devices Franklin W Huang Janet L. Abrahm From Hoffman R, et al: Hematology: Basic Principles and Practice, 6th edition (Churchill Livingstone 2013) Indications for Removal Debate continues over cost-effectiveness and salvage rates for catheters once a catheter-related bloodstream infection (CRBSI) is documented. Exit-Site and Tunnel Infections Exit-site infections caused by bacteria rarely require catheter removal for resolution, because most (69% to 100%) respond…

Goals/Objectives IABP IVC Filter Mechanical Support in Cardiogenic Shock Jay K. Bhama Robert L. Kormos Thomas G. Gleason From Vincent JL, Abraham E, Moore FA, Kochanek PM, Fink MP: Textbook of Critical Care, 6th edition (Saunders 2011) A n estimated 61.8 million people in the United States have heart disease, among whom 950,000 die annually. Of these, 540,000 people suffer myocardial infarctions each year; 193,000 succumb to complications directly…

Goals/Objectives Basic Principles Anatomy Physiologic Considerations Technical Considerations Management of Complications Hemodialysis and Vascular Access Madhukar S. Patel Juan Carlos Jimenez Samuel E. Wilson From Moore WS: Vascular and Endovascular Surgery: A Comprehensive Review, 8th edition (Saunders 2013) Autogenous Arteriovenous Fistula The autogenous arteriovenous fistula, usually constructed by joining a superficial vein to an adjacent peripheral artery at the level of the wrist or in the mid forearm, remains…

Goals/Objectives Anatomy and Physiology Review Indications Technical considerations Hemodialysis Access: Failing and Thrombosed George H. Meier From Cronenwett JL, Johnston KW: Rutherford's Vascular Surgery, 7th edition (Saunders 2010) Although placement of an autogenous fistula for dialysis access is an important step in end-stage renal disease patients, almost as important are maintenance and repair of the access once it is created. Dialysis access is a lifeline for such…

Goals/Objectives Indications/Etiology Anatomic considerations Technical considerations Varicose Veins: Surgical Treatment Mark D. Iafrati Thomas F. O'Donnell From Cronenwett JL, Johnston KW: Rutherford's Vascular Surgery, 7th edition (Saunders 2010) Surgical Techniques Surgery for superficial varicose veins should be individualized according to the patient's preoperative evaluation. A combination of ligation, axial stripping, and stab phlebectomy may be applied as needed to the GSV, SSV, tributary veins, and perforating veins. Technical…

Goals/Objectives Indications Access Complications Vena Cava Interruption Marc A. Passman From Cronenwett JL, Johnston KW: Rutherford's Vascular Surgery, 7th edition (Saunders 2010) Clinical Indications Recommended indications for the use of vena cava filters are shown in Box 78-1-1 . Systemic anti­coagulation is the therapy of choice for venous thromboembolism. However, anticoagulation may be contraindicated in some patients. Without anticoagulation, the risk of PE developing in patients with…

Goals/Objectives Indications Techniques Complications Lower Extremity Operations and Interventions T. Gregory Walker Sanjeeva P. Kalva John A. Kaufman From Ho VB, Reddy GP: Cardiovascular Imaging, 1st edition (Saunders 2010) Revascularization Procedure: Surgical Thromboembolectomy Description and Special Anatomic Considerations Lower extremity arterial occlusions resulting from distal embolization or acute thrombosis may manifest as a profoundly ischemic limb and constitute a surgical emergency. Initially, the underlying cause of the occlusion should…

Goals/Objectives Anatomy Indications Technique Complications Cerebrovascular Disease: General Considerations William C. Mackey From Cronenwett JL, Johnston KW: Rutherford's Vascular Surgery, 7th edition (Saunders 2010) Pathology, Pathogenesis, and Pathophysiology Atherosclerotic Carotid Plaque Carotid plaque places asymptomatic patients at risk for TIA and stroke. The degree of stenosis, plaque density, and plaque progression are correlates of the degree of risk related to carotid artery atherosclerotic lesions. Patients at highest…

Goals/Objectives Basic Principles Anatomy Technical Considerations Lower Extremity Amputation: General Considerations Wayne W. Zhang Ahmed M. Abou-Zamzam From Cronenwett JL, Johnston KW: Rutherford's Vascular Surgery, 7th edition (Saunders 2010) Addressing Associated Heart Disease The evaluation of any potential amputee depends on the urgency of the intervention. In patients with acute ischemia, embolic disease directs the focus of the investigation toward embolic sources – most often cardiac. Any arrhythmias…

Goals/Objectives Anatomy and Physiology Review Indications Technical considerations Soft Tissue Infections Sharon Henry From Asensio JA, Trunkey DD: Current Therapy of Trauma and Surgical Critical Care, 1st edition (Mosby 2008) Soft tissue infections occur frequently and account for approximately 48.3 in 1000 outpatient visits. The severity of these infections varies from trivial to life-threatening. Severe soft tissue infections have been described throughout the medical literature since ancient…

Goals/Objectives Indications Anatomic considerations Technical considerations The Abdomen that Will not Close Adil H. Haider From Cameron JL, Cameron AM: Current Surgical Therapy, 10th edition (Mosby 2011) Temporary Abdominal Closure Once the decision has been made to leave the abdomen open, the most optimal TAC technique should be used. This technique should be based on the experience of the surgeon and the practice environment. An ideal TAC…

Goals/Objectives Management of small bowel injury Enteric Fistula Management of Acute Trauma R. Shayn Martin J. Wayne Meredith From Townsend CM: Sabiston Textbook of Surgery, 19th edition (Saunders 2012) In contradistinction to spleen injuries, the operative intervention for liver trauma is less definitive and can be challenging. Therefore, hemodynamic decline requires operation but slow decreases in hemoglobin levels are at times tolerated and even occasionally treated with transfusion.…

Goals/Objectives Indications Technique Diagnostic Peritoneal Lavage and the Focused Assessment with Sonography in Trauma Gerald R. Fortuna From Stehr W: Mont Reid Surgical Handbook, 6th edition (Saunders 2008) Fast Sonography in trauma was first introduced by Kristensen and colleagues in 1971. It was popularized in the 1990s with several studies reported in the emergency medicine and surgery literature. You’re Reading a Preview Become a Clinical Tree membership…

Goals/Objectives Indications Technique (Male vs Female) Complications Urinary Bladder Catheterization Dan Vetrosky From Dehn RW, et al: Essential Clinical Procedures, 3rd edition (Saunders 2013) Procedure Goals and Objectives GOAL: To perform urinary bladder catheterization on a patient safely and accurately. OBJECTIVES: The student will be able to: Describe the indications, contraindications, and rationale for performing urinary bladder catheterization. Identify and describe common complications associated with performing urinary bladder…

Goals/Objectives Basic Principles Anatomy Physiologic Considerations Technical Considerations Management of Complications Ultrasound-Guided Vascular Access Andrew W. Shannon Christine Butts Justin Cook From Adams JG, et al: Emergency Medicine Clinical Essentials, 2nd edition (Saunders 2012) Key Points The use of ultrasound for vascular access is now standard. Although bedside ultrasound improves the overall success of venous access and decreases complications, it is not without potential pitfalls. Introduction Emergency physician expertise in…