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Practice of Surgery
Exam
Diagnostics
Database, rule outs, diagnosis
Prognosis
Estimate
Informed Consent
Operative Theater
Anesthesia
Surgical procedure or operation - Do no harm
Recovery
After care and pain management
Physical therapy
Recheck and re-evaluate
Complications dictate outcome
3 hurdles of modern surgery
bleeding (hemostasis) - ligatures
Infection (asepsis) - handwashing, sterilization, gloves, disinfection
Pain (analgesia/anesthesia)
How can we surgically do less to help the patient
Minimally invasive surgery - arthroscopy, laproscopy, natural orifice trans-endoscopic surgery (NOTES), Laparo-endoscopic single site surgery.
Shorter hospital stays
Shorter recovery times
Lower morbidity
Good case selection
Client communication and mutual consent
veterinarians have the right to treat an animal only when there is mutual consent of owner and doctor - unless it is an emergency.
Provide the client with complete medical information
Written informed consent is best
Legal ramifications of informed consent
Disclosure of facts that other practitioners would reasonably disclose
Disclosure of all risks that would be material to a reasonable/ prudent owner
Provide a reasonable amount of information about risks, benefits, costs, and alternatives
Ethics of surgery
Do no harm
practice informed consent
know your limits
seek help if needed
refer surgeries if that is in the patient's best interest
Intra-operative decision making
Begins long before the operation
Do pre-operative planning and read up on
anatomy
planned procedure
alternative procedures
possible complications
plan B,C,D
Educate and communicate with your surgical team
In the surgery - the surgeon is captain of the ship
stay composed, give directions, be aware of whole situation, be professional
keep patient and owner's best interest in mind
Don't let your ego hinder you
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