Hernia under LA[] Just a job, if here will work like workers of stanley hostel/ hospital.

Only possible if small hernia
Lig + sensor + hyal + adr
10 ml along incision line with spinal needle
then 10 ml below external oblique before incising

Lap umb hernia
if port comes out, it needs to enter thru same hole, but it is not as big a complication as hitting a artery of puncturing bowel.

fistula in ano
probe passed and then LA given.

Just a jo

We cant do magic

We can remove the focus of infn, but the inflmatn will take time to subside...
Baby has to take 9 months to deliver.

Getting serious about surgery

Today got serious about surgery bcos was not being taken seriously here.
post normal lap app

post bad lap app

post norml chole

Diverticulitis

started on npo ivf
magnex forte, ornida
today on liquid diet as passed loose stools

fecal impaction

peglec 1 satchet given yest.
pt passed stools
today soft diet with t. cintopro 3 mg od

DM foot nec fascitis

skin well demarcated, pallor and blue.
fascia black, not bleeding,
foul odour
seen over base of toe. tip of toe pink.

post lap app/ tep

orals from 6 hrs, sips to 30-50 ml/hr clear liquids as tolerated.

FNAC thyroid

fix swelling after painting with betadine
24 g needle 10 ml syringe
insert needle with 3 ml air. pull with index and middle finger back.
pull back 6 times
change direction in the middle.
keep 6 glass slides ready
inject into1. withdraw air, push into 2nd slide. take 2nd slide and drop over 1st to make smear, then slide each over the other.
put into kopliks jar.

yellow is to red is to blue is black

Yellow: infected degradable waste. No harmful fumes on burning.
Red: infected non degradeable waste. Harmful fumes on burning.
white: sterile plastic
Black: sterile paper and unrelated material.
blue: glass
black box: sharps

Thyroidectomy

points marked on suprasternal notch, 1 finger breadth above sc joint and in middle.
skin crease incision made bw 2 scms with blade spread bw 2 fingers
incision deepened with monopolar until platysma seen dividing.
finger used to pull back skin and show sub-platysmal layer and monopolar used to make slipght plane below it.
jolls retractor placed.
platysma held with 3 allis and pulled up.
.flap raised just below the platysma and above the white cervical fascia.
anterior and posterior borders of scm released n the side of snt.
fascia held up with 2 mosquitos and monopolar incised at midline bw 2 ajv.
ajv can be buzzed with bipolar or toothed and monopolar.
2 sterno hyoids split in middle and allis applied to it, lifted up and separated from sternothyroid.
allis re-applied to lift sternothyroid and plabe created above capsule, all the while pulling thy more and more medially.
Retractor put for muscle.
MTV ligated with 3-0 and divided.
1 fascia is at posterior border. bipolar division done. pusher used to free the space in bw pedicles at  posterior border to reach t-o groove.
index finger and thumb used to hold the lobe and pull it down.
above muscle strands divided with monopolar.
pusher used to make space.
right angle makes window laterally and medially.
and 2 ligatures made on superior pedicale with 2-0, not divided.
thin fascia over inferior pole, mosquito dips and opens above pedicle, dips and opens below pedicle, lift up the thin fascia over pedicle, divide with bipolar.
hunt for rln in t-o groove keeping curve upwards. then hunt for it below thy.
once found follow it upto untry point.
ligate STA again and divide with blade.
 bipolar division of berrys very close to thy gland surface from above descend upto isthmus level.

Di-alysis

Dialysis takes 4-6 hours to finish.

Inj Reflin 1 gm bd - Cefazolin
Inj Magnex forter 1.5 gm bd - Cefaperazone sulbactum
Inj Zienam 500 mg bd/ qid - Imipenem- cilastatin
Inj Ornida 500 ml bd - ornidazole
Inj tavanic 500 mg - levoflox
T. Klox-d 500 mg bd Dicloxacillin
T. Sporidex 500 mg bd Cefalexin for swelling excision
T. Novaclox 500 mg bd
Tab. Ceftum 200 mg bd Cefuroxime
inj dalacin c 300 mg tid for 5 days
tab. dalacin-c 600 mg tid for 5 days
Inj metrogyl 500 mg tds
tab lasilactone 50 mg 1-0-0
Inj Zanocin - oz 100 ml bd ofloxacin 200 + orn 500
Smuth Ointment for hemorrhoids
Inj leuprolide 11.75 mg s/l
Inj deriphylline 1 amp iv tds
Neb Combimist L 6th hrly
Tab Lanoxin .25 mg 1/2-0-0
 Tab Ivabradine 5 mg 1-0-1
Tab Tazzel 20 mg 1-0-0
Tab Dytor plus 10 mg 1-0-0
Tab Domstal 10 mg tid
Tab Cintopro 3 mg od
Tab Cintodac od
Tab Neksium 40 mg od bf Esmo
Syp Sucrafil-o qid
Nu patch 200 mg od
Tab Voveron SR 100 mg od
Tab Combifla/ Enzoflam/ Ultracet sos
Syp Cremaffin 15-30 ml hs
Peglec 1 satchet in 1 litre ( stronger than duphalac)
Oint Proctosedyl before and after foods
Tab Orni-o oflox 200 + orni 500
Inj oflin 200 mg bd oflox
Tab ornida 400 mg bd
Tab Refzil-O 500 mg bd Cefaprozil
Tab Ceftum 200 mg bd Cefuroxime
Tab Novaclox 500 mg bd
Inj Perfalgan 1 gm sos
Inj Tramazac 50 mg slow iv infusion/ im tds
Inj perinorm 10 mg iv tds

Scar on toe with cellulitis

Magsulf dressing left for 2 days with scar left open. Healed well.

IV line thrombophlebitis

Mag sulf dressing * 2 days without opening

Post op bottom case

NPO for 6 hrs f/b clear liquids, if tolerated normal diet.
inj zanocin-oz 100 ml bd for 1 day/ inj oflin-oz 30 ml bd
Anal pack removal at 6 am followed by sitz bath tds warm water with betadine 1 cap f/b placing a gauze pad or sanitary pad over which tight underwear for 15 days.
 syp. cremaffin plus 30 ml tds/hs as per constipation level for 15 days.
loz 2% jelly/ proctosedyl ointment/ smuth ointment if hemorrhoids for 1 week
tab. zanocin-oz 200 +500 mg bd for 5 days/ tab orni-o 1-0-1 500+200/ tab. oflin-oz 200+500
tab. pan, ultracet,

SOFT HIGH FIBRE DIET

Post op fluids after chole

 After 6 hrs, oral sips of water f/b 30-50 ml of clear fluids ( water, juice, coconut) as tolerated by patient not vomiting.
pca, nupatch 200 mg od, ultracet tds, tramazac sos, nupatch to voveran sr 100 mg od from day 1
Pan. perinorm
magnex forte 1.5 gm bd
if cholangitis add amikacin 500 mg od
steam inhalation
mobilise pt at 6 hrs
watch for bleeding, soakage

ALL young age fissure

ALL pt on chemotherapy- develops constipation easily so develops fissure.
Prophyllactic sphicterotomy can be done but nothing after wbc falls.

Aplastic Anemia

Peri-folliculitis - blisters in the cheek occurs without pus as no pus forms in aplastic anemia.