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Emergency General Surgery: A Practical Approach [PATCHED]

The field of emergency general surgery encompasses a wide array of surgical diseases, ranging from the simple to the complex. These diseases may include inflammatory, infectious, and hemorrhagic processes spanning the entire gastrointestinal tract. Complications of abdominal wall hernias, compartment syndromes, skin and soft tissue infections, and surgical diseases are significantly complex in special populations, including elderly, obese, pregnant, immunocompromised, and cirrhotic patients. This book covers emergency general surgery topics in a succinct, practical and understandable fashion. After reviewing the general principles in caring for the emergency general surgery patient, this text discusses current evidence and the best practices stratified by organ system, including esophageal, gastroduodenal, hepatobiliary and pancreatic, small and large bowel, anorectal, thoracic, and hernias. Chapters are written by experts in the field and present a logical, straightforward, and easy to understand approach to the emergency general surgery patient, as well as provide patient care algorithms where appropriate. Emergency General Surgery: A Practical Approach provides surgeons and surgery residents with a practical and evidence-based approach to diagnosing and managing a wide array of surgical diseases encountered on emergency general surgery call.

Emergency General Surgery: A Practical Approach

With health care expenditures continuing to increase rapidly, the need to understand and provide value has become more important than ever. In order to determine the value of care, the ability to accurately measure cost is essential. The acute care surgeon leader is an integral part of driving improvement by engaging in value increasing discussions. Different approaches to quantifying cost exist depending on the purpose of the analysis and available resources. Cost analysis methods range from detailed microcosting and time-driven activity-based costing to less complex gross and expenditure-based approaches. An overview of these methods and a practical approach to costing based on the needs of the acute care surgeon leader is presented.

This webinar discusses a practical approach to negotiating in medicine. Specifically, it focuses on the nuts and bolts needed by trainees as they get ready to negotiate for their first job. We also discuss ways to avoid common pitfalls.

Joseph Sakran, MD, MPH, MPA, FACS, is an assistant professor of surgery, director of emergency general surgery, and associate chief of the division of acute care surgery at the Johns Hopkins Hospital, Baltimore, MD. After a comprehensive general surgery training at Inova Fairfax Hospital, VA, Dr. Sakran completed his fellowship in traumatology, surgical critical care, and emergency general surgery at the Hospital of the University of Pennsylvania in Philadelphia. His past experience is in resource-poor settings, working with underprivileged and minority high school students, and has a public health background that has provided him with the skill set needed to take on the challenges of improving care among vulnerable populations both domestically and abroad.

The 'acute abdomen' is a clinical condition characterized by severe abdominal pain, requiring the clinician to make an urgent therapeutic decision.This may be challenging, because the differential diagnosis of an acute abdomen includes a wide spectrum of disorders, ranging from life-threatening diseases to benign self-limiting conditions (Table 1).Indicated management may vary from emergency surgery to reassurance of the patient and misdiagnosis may easily result in delayed necessary treatment or unnecessary surgery.Sonography and CT enable an accurate and rapid triage of patients with an acute abdomen.We present practical guidelines on the radiological approach of these patients.Interactive cases are presented in the menubar to test your knowledge.

Before you perform an examination, obtain relevant information from the referring clinician. Don't let the clinician simply 'order' a sonogram or CT, but discuss the patient's age and posture, laboratory results and the number one clinical diagnosis and differential diagnosis. Based on that information and your own degree of confidence with the modalities decide for yourself whether to perform sonography or CT. Sonography has the advantage of close patient contact, enabling assesment of the spot of maximum tenderness and the severity of illness without ionizing radiation. In general the diagnostic accuracy of CT is higher than sonography.In patients with inconclusive US-results, CT can serve as an adjunct to sonography, and vice versa.We advocate the following two-step radiological approach of an acute abdomen.1. Confirm or exclude the most common disease 2. Screen for general signs of pathologyYou have to be familiar with all the diagnoses listed in Table 1 to be able to recognize them.

ConclusionIn patients with an acute abdomen 'the stakes are high'. A misdiagnosis may have serious consequences. We advocate a systematic approach: 1. First focus on the most common diseases and make a firm diagnosis or exclude them.2. Always screen the whole abdomen for general signs of pathology.

The emergency setting remains one of the most important parts of daily clinical practice for surgeons. Moreover, the triage surgeon may be faced with complicated patients, who are often suffering from a wide range of diseases and emerging conditions. To this end, the emergency surgeon must know how to interpret the symptoms/signs of each condition and initiate appropriate management before directing the patient to the most correct path and specialist. Although several books have been published concerning a specific surgical field (e.g. emergencies in vascular, thoracic or general surgery), this book provides a concise and quick point of view describing the clinical and instrumental surgical pictures in all vascular, thoracic, and general surgical emergencies. This approach can be useful in gaining a practical understanding of different clinical scenarios in order to adopt a correct management and treatment. It offers a simple guide to discriminating between urgent and non-urgent conditions, avoiding unnecessary diagnostic and interventional workup. This book would like to be a practical help also for general practitioners and emergency physicians to learn more about primary management of life threatening pathologies.

The objective of this rotation is to give a broad spectrum of otolaryngology-head and neck surgery and its related fields. The students will be exposed to techniques of information gathering, physical examinations, analysis of problems and practical approach to the solution of problems. They will also have direct exposure and clinical experience in physical examination. 041b061a72


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