Decreasing anesthetic riskSeptember 13, 2019Knowing how to recognize risk and respond appropriately can greatly decrease the likelihood of anesthesia-related complications.
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Using feeding tubes in general practiceAugust 15, 2019Nutrition is quite often overlooked in hospitalized patients, which depending on what the patient is being treated for, can worsen the situation.
Four bold questions about hand asepsisMay 24, 2019Hand asepsis is one of the most critical components of surgical asepsis to lower the risk of nosocomial diseases. In this column, we answer four critical and bold questions related to hand asepsis. Could you lose your driver's license by scrubbing in? With the emergence of alcohol-based hand-rub solutions (ABHRS), you may be concerned that with repeated use, you could have enough alcohol in your bloodstream to lose your driver's license. Alcohol is indeed absorbed through the skin, and you inhale plenty of it while scrubbing (or "rubbing"). So could a breathalyzer test be positive? A 2006 Australian study1 looked at 20 health-care workers and their use of ABHRS repeatedly over a short period of time: 30 applications in an hour! Then serum and breath ethanol and isopropanol absorption were assessed. Traces of ethanol were detectable in the breath of 30 percent of subjects at one to two minutes after application and in the serum of 10 percent of them at five to seven minutes postexposure. Serum isopropanol levels were undetectable at all time points. Even though ethanol did have a positive result, whether through cutaneous absorption or inhalation of fumes, neither level would be considered positive during a police-issued …
How to improve your surgical skillsMay 6, 2019What can you do to improve your surgical skills? Assuming your career path does not include a surgery internship or a residency and board certification, here are some tips to raise the surgical bar. Prerequisites Some traits are self-understanding. In order to perform surgery, you need to have dexterity and think in 3D. You'll also need the following: "Good hands"—no shaking allowed. A keen sense of observation. Observe the patient. Observe the tissue. Observe others perform surgery. Some will teach you what to do, while others will teach you what not to do. Use the correct suture material, the correct needle, and the correct size. Know and apply the seven principles of William Stewart Halsted, MD, our 19th-century forefather (see The basics of surgery). Speaking of forefathers… believe the sayings they crafted: "Measure twice, cut once." "If it's worth taking out, it's worth turning in" (i.e. masses belong in the lab, not the trash). "There are routine surgeries, but there is no routine anesthesia." "Dilution is the solution to pollution." It is critical to thoroughly understand anatomy, indications, and surgical approaches. Reading books to acquire a good understanding of anatomy and a great knowledge of approaches is a must. But …
Osteosarcoma: Beyond amputation and euthanasiaMarch 12, 2019When a patient is diagnosed with osteosarcoma, we tend to focus on three options: • the "gold standard," i.e. amputation with or without chemotherapy; • what many call palliative care, meaning pain medication and rest; or • euthanasia. But what if amputation is not an option? What if chemotherapy or radiation is out of the owner's financial capabilities? Or a couple of medications are not enough to numb the pain? What if visible metastasis to the lungs is already present? Bob Stein, DVM, pain management guru and founder of the Veterinary Anesthesia & Analgesia Support Group (www.vasg.org), recently shared another valid option.* "With my suggested approach, we can often provide quality of life to even large-breed dogs for six to 12 months and sometimes more than 20." Let's detail Dr. Stein's protocol. Pamidronate Pamidronate, a bisphosphonate, is an injectable drug that is inexpensive and easy to administer (ref: TM Fan et al. JVIM 2007). It helps to reduce pain (in 30 to 50 percent of patients), inhibit bone osteolysis, and has potential cancer-suppression effects by impeding proliferation and inducing apoptosis. The drug has a wide safety margin and can even be used on patients with renal or …
10 golden rules of cancer surgeryFebruary 20, 2019Surgery plays a critical role in the management of cancer. One significant advantage of surgery is a chance at an immediate cure—after a single session. No other treatment modality can offer that. Here are 10 rules that must be followed to ensure the best possible surgical outcome. Do the math: Surgery is only 10 percent of the entire story. What follows mainly pertains to skin masses, but it applies to any tumor, even intrathoracic or intra-abdominal. 1) Client communication Whenever a mass is discovered, it is important to take the time to prepare the client for the worst, while hoping for the best. Don't sugarcoat things. Don't make assumptions. Don't claim to have microscopic vision. Don't overpromise. Remember, for example, that a mast cell tumor is called "the great imitator" for a reason. It can feel like anything, including a lipoma. 2) Preop workup Even though we typically say you can't diagnose cancer by looking at blood work, it will occasionally show abnormalities, such as infection, hypercalcemia, or increased liver values. Staging the patient (i.e. determining the extent of the disease) is a mandatory part of the preop workup. Before surgery is ever considered, perform three views of the thorax …
How to reduce surgical site infectionsJuly 11, 2018Considering the emergence of resistant bacteria, having a solid plan to decrease infection risk becomes increasingly important. A surgical site infection (SSI) is defined by the Centers for Disease Control and Prevention as an infection occurring at the surgical site within 30 days following a procedure, or within one year of placing an implant. You can significantly decrease risk in your practice by scrutinizing four factors that contribute to SSI incidence: patients, environmental and human factors, and miscellaneous risks.
