Medicine Surgery Basics

# Medicine Surgery Basics

## 1. Perioperative Management
### Pre-op Assessment
- **ASA Classification**: Standardized risk stratification for anesthesia (I: Healthy to VI: Brain-dead organ donor).
- **NPO Guidelines**: Strict adherence to prevent aspiration. Clear liquids (2h), breast milk (4h), light meal (6h), fatty meal (8h).
- **Risk Mitigation**: VTE prophylaxis (mechanical + pharmacological), antibiotic prophylaxis (within 60m of incision).

## 2. Aseptic Technique & OR Protocol
- **Surgical Scrub**: Mechanical removal of microbes. Chlorhexidine or Povidone-iodine.
- **WHO Checklist**: Sign-in (before induction), Time-out (before incision), Sign-out (before patient leaves OR).

## 3. Wound Healing & Suturing
- **Healing Phases**: Hemostasis -> Inflammation -> Proliferation -> Remodeling.
- **Healing Types**: 
  - Primary Intention: Clean, approximated edges (sutures).
  - Secondary Intention: Granulation (open wound).
  - Tertiary Intention: Delayed primary closure (infected/contaminated).
- **Suture Selection**: Absorbable (Vicryl, Monocryl) vs. Non-absorbable (Nylon, Prolene). Gauge: Higher number = thinner thread.

## 4. Surgical Complications
- **SSI Prevention**: Skin prep, glucose control, normothermia, oxygenation.
- **Post-op Fever (The 5 Ws)**:
  1. Wind (Atelectasis/Pneumonia)
  2. Water (UTI)
  3. Wound (SSI)
  4. Walk (DVT/PE)
  5. Wonder Drug (Drug fever)

## 5. Fluid & Electrolyte Management
- Maintenance fluids: 4-2-1 rule (4ml/kg for first 10kg, 2ml/kg for second 10kg, 1ml/kg thereafter).
- Monitoring: EBL, urine output (>0.5ml/kg/hr), hemodynamics.