The Cutting Edge…

dhThese notes are about the CMF Developing Health Course 2014.

The focus of today is Surgery. I made notes on the whole course in 2012 – you can read about this day here.

Each day I’m just going to write about things that impacted me, and things I need to read later…

I started my morning devotion with starting to read through John 1. I was completely unsurprised to find that the word enlightened came up immediately, just like Ian’s talk from the first night, and bringing me back to that Ephesians 1 passage again:

The true light, which enlightens everyone, was coming into the world.
John 1:9

Anaesthetics

Following that, Hilary Edgcombe taught us about many cool intelligent things in the world of Anaesthetics.

“Is Ketamine a wonderful drug with terrible side effects, or a terrible drug with some useful side effects?”

She talked about Ketamine: It is not a fail-safe airway option… Give it over 5 minutes to reduce chances of impacting airway.

We touched on the terrible under-resourcing of many Majority world settings, from an anaesthetics perspective. The video below shows a bit of that – I shared it last time as well, but its still interesting.

On the Developing Health USB stick, there is an amazing link to a free online Developing Anaesthetia textbook for use in resource poor settings. It’s pretty brilliant…

A quality history and decent examination are important before anaesthetics. Just like Ian has been saying all week, a probing history, a thorough examination, appropriate investigations and careful synthesis is the fundamental base of clinical medicine.

She also recommended http://update.anaesthesiologists.org – which is a good resource for information about coping in resource poor areas.

Surgery

surgical questionsColin Binks and Mike Puttick took us through the next session on Surgery for the Non-Surgeon.

Two big questions: Can I do it? Should I do it?

Seeing red

If you see haemorrhage, pack it, pack it, pack it, pray, pack it, etc.

If the liver won’t stop bleeding, give the portal vein a squeeze.

Seeing green

Likely small bowel or gallbladder perforation. Wash and go approach.

  1. Clean it out.
  2. Close it up.
deadbowel
Necrotic Bowel – its black, so you excise it

Seeing black

This means there is necrosis.

  1. Excise the dead stuff.

The Acute Abdomen

An interesting talk, with lots of stuff that was way over my head: I think I am not competent to start popping in bowel anastamosis yet. The message was repeated from yesterday that:

“The solution to pollution is dilution.”

Lots of irrigation with saline in your friend in surgery.

With both talks, it was really useful looking at case studies, saying “What can you do, what should you do?”. It was recommended again that we buy the Primary Surgery book, which helps with knowing how to do things, if we decide doing them is the right option.

Anaesthetics tutor

We had some group work in the afternoon: in one of the sessions, the anaesthetist was teaching how to do a spinal anaesthetic. Given that I had more experience in this area than anyone else, I ran one of the stations. Whilst I may not have been particularly good, it was quite uplifting for me – namely that work I’ve done in previous years to learn clinical skills has led to me having skills that my 2012 self did not.

That’s a professional development reflection for my e-portfolio right there…

One cool tip the tutor gave us for finding the spine, especially if someone is laying on their side:

A patient can always find the middle of their back, so if you are struggling to find it, let them point to it for you.

Late night fellowship

Fellowship has been a great component of our time together on the course. Late this evening, me, Marli, Mike, Jakob, Justus and Linda all sat in my room, and shared Coke, alcohol free beer, prayer, bible verses, songs (inconsiderate after midnight?) and stories of how each of us came to know Jesus.

It was very uplifting, if a little tiring (we went to sleep after 1am). We ended by reading Philippians together:

Brothers, join in imitating me, and keep your eyes on those who walk according to the example you have in us.

For many, of whom I have often told you and now tell you even with tears, walk as enemies of the cross of Christ. Their end is destruction, their god is their belly, and they glory in their shame, with minds set on earthly things.

But our citizenship is in heaven, and from it we await a Savior, the Lord Jesus Christ, who will transform our lowly body to be like his glorious body, by the power that enables him even to subject all things to himself.

Therefore, my brothers, whom I love and long for, my joy and crown, stand firm thus in the Lord, my beloved.

Philippians 3:17-4:1

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