General Surgery Presentation topic help

[jope]

Hi all, I'm on my gen surg rotation atm and we are supposed to do a 20 minute presentation on a topic of my choice.

Past examples have looked at utility of CT scan for appedicitis, or if antibiotic prophylaxis is useful preop etc. Anyone have a good idea of something new and controversial that they wouldn't mind sharing?

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[TaoistDoc]

the treatment of a prolonged air leak from chest tube is pretty controversial. They don't even have a consensus definition as to what a prolonged air leak is yet.

 

[Depakote]

Hi all, I'm on my gen surg rotation atm and we are supposed to do a 20 minute presentation on a topic of my choice.

Past examples have looked at utility of CT scan for appedicitis, or if antibiotic prophylaxis is useful preop etc. Anyone have a good idea of something new and controversial that they wouldn't mind sharing?

Perhaps something about fluid replacement in burn patients? It sounds like there isn't a general consensus on exactly what to give and when (just some more commonly used formulas) and it sounds like the proper use of albumin is debated as well.

 

[surg]

If your program is one that still bowel preps patients for bowel surgery, look at the utility of that in terms of anastamotic leaks and wound infections

Whether diverting ileostomies are indicated for ileoanal anastamoses

The use of NG tubes after bowel surgery, how useful are they

The utility of waiting for the return of bowel function as evidenced by flatus.

The use of almivopan for post-op ileus

The usefulness of supplemental oxygen to prevent wound infection

Indications for VATS for lung cancer surgery

The status of partial breast irradiation in breast cancer as an accepted modality (most popular ways of doing it require surgical intervention so it's relevant)

If someone is treated with antibiotics for a perforated appendix, do they need an interval appendectomy? If so, how long should you wait?

Are there inguinal hernias you don't need to fix?

The possibilities are endless. All of these should allow for interesting discussions.

 

[Substance]

One thing you could talk about is whether the dogmatic post-op fever Ws are accurate or not. I've always wondered this ...

 

[Winged Scapula]

PLEASE PLEASE discuss the nursing dogma that you cannot check BP, start IVs, exercise, draw blood etc. in any axillary node sampling, including SLNBx.

Absolutely NO evidence in sentinel node.

Weak, decades old bad "evidence" for full axillary dissection (when Levels 1-3 dissections were routinely done).

Residents are also told this crap and repeat the mantra.

(and as always, surg has given some excellent suggestions).

 

[Doctor Bob]

PLEASE PLEASE discuss the nursing dogma that you cannot check BP, start IVs, exercise, draw blood etc. in any axillary node sampling, including SLNBx.

Absolutely NO evidence in sentinel node.

Weak, decades old bad "evidence" for full axillary dissection (when Levels 1-3 dissections were routinely done).

It always bugs me when the nurses refuse to do a blood draw in the ipsilateral arm on someone who has had a mastectomy and ax dissection in the past.

Even if the arm is no good for BP checks and IVF administration (something I sometimes dispute, especially if it's been years and years since surgery)... why can't blood be taken from the arm?

<shrug> Maybe I'm missing something and practicing bad medicine and will kill most of my patients.

 

[Scaredshizzles]

It always bugs me when the nurses refuse to do a blood draw in the ipsilateral arm on someone who has had a mastectomy and ax dissection in the past.

Even if the arm is no good for BP checks and IVF administration (something I sometimes dispute, especially if it's been years and years since surgery)... why can't blood be taken from the arm?

<shrug> Maybe I'm missing something and practicing bad medicine and will kill most of my patients.

Well I suppose if you mess up, it would take a lot longer for extravasated blood (the fluid/serum content) to disappear if you have poor lymphatic circulation in that arm. The other issue is if you really have some lymphedema, it becomes harder to find the veins....It might also be kind of painful to have bp taken too if you have some fluid build up there. But it definitely shouldn't be a dogma if you have no better options, which seems to happen quite often.

 

[Winged Scapula]

It always bugs me when the nurses refuse to do a blood draw in the ipsilateral arm on someone who has had a mastectomy and ax dissection in the past.

Even if the arm is no good for BP checks and IVF administration (something I sometimes dispute, especially if it's been years and years since surgery)... why can't blood be taken from the arm?

<shrug> Maybe I'm missing something and practicing bad medicine and will kill most of my patients.

I know, I know. All of the nursing textbooks mention these avoidance techniques in preventing lymphedema.

However, they never mention the fact that the original studies were based on subjective measures of lymphedema, ie, asking the patient if their arm was swollen. Later studies which actually used objective measures found that the majority of women who reported lymphedema actually had no difference in arm circumference from contralateral side or pre- and post surgery. And as I noted above, lymphedema is much less common with the less radical surgery we do these days.

Nor is there any evidence that the risk of lymphedema exists more than 2 years post-surgery.

The issue of drawing blood is probably related to the fear of infection in a limb without extensive lymphatics. I have assumed its the same theory as the use of gloves when using a knife, gardening, handling any sharp objects.

None of the dogma makes sense to me either but it is perpetuated and greater than 95% of patients in one study practiced these precautions because its what they were taught, despite surgeons telling them they don't need to.🙄

 

[jhonny depp]

Hi all, I'm on my gen surg rotation atm and we are supposed to do a 20 minute presentation on a topic of my choice.

Past examples have looked at utility of CT scan for appedicitis, or if antibiotic prophylaxis is useful preop etc. Anyone have a good idea of something new and controversial that they wouldn't mind sharing?

Try role of preoperative biliary drainage in obstructive jaundice or role of bowel preparation in colorectal surgery

 

[jope]

Talking to some of my friends who have already done their surg rotations, I'm planning on looking at when it is indicated to perform elective colectomies after have diverticultis (ie. how many episodes before cutting, and examining the traditional idea of it being more aggressive in younger people).

Thanks for all the great ideas though. Hopefully someone else who has to do this will benefit too!

 

[Ashers]

It always bugs me when the nurses refuse to do a blood draw in the ipsilateral arm on someone who has had a mastectomy and ax dissection in the past.

Even if the arm is no good for BP checks and IVF administration (something I sometimes dispute, especially if it's been years and years since surgery)... why can't blood be taken from the arm?

<shrug> Maybe I'm missing something and practicing bad medicine and will kill most of my patients.

When I was a phlebotomist, before medical school, nurses and patients always told me I couldn't draw blood on patients after breast cancer. When I asked why, the only reason they gave me was "They had breast cancer." I'd see awesome veins on the arm I couldn't use, and the arm I could use had been poked so many times the veins sucked.

I know, I know. All of the nursing textbooks mention these avoidance techniques in preventing lymphedema.

However, they never mention the fact that the original studies were based on subjective measures of lymphedema, ie, asking the patient if their arm was swollen. Later studies which actually used objective measures found that the majority of women who reported lymphedema actually had no difference in arm circumference from contralateral side or pre- and post surgery. And as I noted above, lymphedema is much less common with the less radical surgery we do these days.

Nor is there any evidence that the risk of lymphedema exists more than 2 years post-surgery.

The issue of drawing blood is probably related to the fear of infection in a limb without extensive lymphatics. I have assumed its the same theory as the use of gloves when using a knife, gardening, handling any sharp objects.

None of the dogma makes sense to me either but it is perpetuated and greater than 95% of patients in one study practiced these precautions because its what they were taught, despite surgeons telling them they don't need to.🙄

Glad I wasn't the only one to whom it didn't make sense -- especially when no one could give me an answer that wasn't circular reasoning. Thanks for explaining the history of it, WS!