A B C of Residency - Learning the Basics

1. A B C of Residency - Learning the Basics

2. Dr Anahita Chauhan Associate Professor & Unit Chief Seth GS Medical College & KEM Hospital Honorary Consultant Saifee Hospital & St Elizabeth Hospital

3. A B C of Residency- Learning the Basics Ward Procedures Labour room procedures Active session O T procedures Tips for Practice

4. Rights of first year !!! • Sleep while assisting • To fall sick every season • To bluff whenever asked • Move in the market in OT dress

5. To have firing from everybody Double blind Ct all ! To have personal abbrevations To keep mobiles off or batteries discharged Rights of first year !!!

6. Ward Procedures Venepuncture, Venoclysis • Which vein should be taken ? • How to make vein prominent ? • How to take vein ? • Drip not going ? • How to increase drip rate ?

7. Arm vein preferred, first on left arm Away from Joint Fairly straight vein Y junction of vein preferred Relatively immobile even if less easily seen Depends upon rate of fluid administration If no vein accessible take femoral or basilic vein or do venesection Which vein should be taken ?

8. Veins of the Hand

9. P/A examination - always P/V examination  Get properly scrubbed ( Gloves proper )  3 swabs technique  Don’t remove fingers before all the points are checked Practical Tips “There is no elevator to success , You have to take stairs” Labour Room Procedures

10. Leaking History P/S examination Cough or strain P/V during pain – central part, push the pp , meconium ? Tests – ferning , pH , heat test U S G ? Genuine mistakes  2 membranes, High leak, Hydrorrhoea gravidarum, urine ? Labour Room Procedures

11. Epsiotomy Local – adequate Thinner the perineum more lateral you cut Shorter the perineum more lateral you cut Adequate length(Vag.Incision=perineal incison) Suturing :- Illumination, Apex secured (Allis), Tampoon(same habit), Muscles tightly Episiotomy even if gapped heals nicely. Hematoma !!! Labour Room Procedures

12. Catheterization Anatomy – 4 cm long , 6 mm dia. Identification of ext. urethral meatus  1.5 to2 cm post.to clitoris, margins are raised, puckered or palpable, small opening of paraurethral glands Length to be introduced No. as per age – 16 for adult How much to inflate ? 7-8 cc usual Difficulty – Pull the dependent fat from pubic area - Place an index finger in the vagina & elevate it Labour Room Procedures

13. Active session 1. How many total squares ??

14. O T Procedures “ Many positions bear the name of residency but fail to give the resident sufficient operative work to justify the name ” - Telinde

15. Dilatation problems ( D& C , MTP, Hysteroscopy, Laproscopy ) Repeat P/V examination Catch post. Lip  Fluid injection  I/V injection of cervical relaxants  P G s Under control :- USG, Laproscopy , Hysteroscopy , Finger control O T Procedures

16. Incisions Knife position Fiddle bow – whole arm Dinner fork – wrist joint Pencil – Fingers Perpendicular One stroke Predecide the length O T Procedures

17. Putting an incision

18. Incisions ( ctd ) Traction by forefinger & thumb Traction on fat Patient’s abdomen(Incision) should be at the level your waist ( not at the level of chest ) Avoid keyhole “ Big surgeons put big incisions “ O T Procedures

19. Halsteadian principles :- Meticulous dissection Precise approximation of tissues Accurate hemostasis Gentle tissue handling Absolute asepsis O T Procedures

20. Steadying the Scissors

21. Holding the forceps

22. It is desirable to keep no. of clamps in the operative field to absolute minimum Artery – catch , Needle holder – clamp , Clamp - Crush O T Procedures

23. Don’t cross your hands Don’t go beyond the clamps & tie Tie the knots from nearer area Vascular pedicles are doubly ligated ( proximal simple ligation , distal transfixation ) & never preserved O T Procedures

24. Hysterectomy – your hands cramp Cesarean – Assistants’ hands cramp When you go deeper instruments lengthen & needle shorten Obstetricians work with hands while gynecologists work with instruments “Regular practice makes one almost perfect” O T Procedures

25. Needle holder & needle

26. Sutures – Continuous – simple, locking Interrupted Mattress – vertical, Horizontal Lambert Base ball Subcuticular Scar is called surgeon’s signature O T Procedures

27. Law of suturing

28. Subcuticular suture

29. Knots Surgeon’s knot ( Friction ) Reef Knot ( Square ) Grany knot ( Sliding )  NO One should attempt to excel in knot tying Vicryl, Dexon, Catgut , Silk – 3 knots Prolene, Novafil, Nylon – 4 knots O T Procedures

30. Reef Knot

31. Call the patient by name Use drugs of standard companies Never speak loose of others Take second opinion as & when required Operate with qualified assistant Never pronounce bad prognosis/Never play GOD Value of good communication & proper documentation cannot be overemphasized Practice tips

32. Liscences / Registration PNDT MTP Spirit Biomedical waste disposal Nursing home registration Minimum wages Practice tips

33. Insurances Mediclaim Medical indemnity Nursing home insurance LIC Personal accident policy Social security scheme Practice tips

34. Learn from Your Mistakes

35. Learn from Others Mistakes

36. Learn from your successes also

37. God Bless You All ‘ The day you don’t face any problems, think that you are walking on a wrong path ’ Swami Vivekanand

38. Thank You