003 - Time Management
Surgical knowledge and productivity tips. This week the topics covered are:
💉 Subcuticular sutures
💉 Acute peritonitis
⌛ Time management tips
And an interesting link 🔗
Welcome to the third newsletter email!
If you're a returning reader, welcome back!
If you’re new, welcome! You can have a look at the previous posts so you don’t miss anything!
The plan for this week's newsletter:
1- Surgical skill: Subcuticular sutures
2- Surgical topic: acute peritonitis
3- Productivity tip: Time management
5- Interesting link: RxGuidelines
Let's begin!
Surgical skill: Subcuticular sutures
This suture gives a very fine and neat scar because approximation of skin margins is perfect. A continuous subcuticular suture to appose the dermal layer of the skin is a fast and cosmetically satisfactory method of skin closure.
Use it only if there is no tension, Or if you have overcome the tension by inserting deeper sutures first. Suitable smooth, non-absorbable material is monofilament, polyamide. polypropylene or polyethylene.
Advantage of a subcuticular suture
Its main advantage is that additional scarring from sutures is avoided.
Disadvantage of a subcuticular suture
It gives no support to the underlying tissue.
1- BTK Boot Camp Ep. 7 Running Subcuticular Stitch (Youtube Channel: Behind The Knife: The Surgery Podcast)
2- How to Suture Like a Surgeon: Subcuticular Suturing (Youtube Channel: Buck Parker, M.D.)
Tip: keep practicing till you can do it absentmindedly.
The subcuticular suture is one of the most commonly used closure methods in surgery. Whenever you’re practicing, if you’re still a student, keep in mind that one day you’ll be closing a real incision and the more you practice the better-looking the scar will be and the more comfortable you’ll feel doing the closure.
Topic of the week: acute peritonitis
Definition: Acute inflammation in the peritoneal cavity.
Causes:
May be primary (rare) or secondary (common)
Primary peritonitis
Typically streptococcal with probable portal of entry via bloodstream rather than intra-abdominal organs.Secondary peritonitis
Acute perforated appendicitis —commonest cause of peritonitis especially in under 45s).
Acute perforated diverticular disease —commonest cause in elderly.
Upper GI perforation.
Perforated tumours (colonic or gastric).
Perforated ischaemic bowel, e.g. due to adhesions.
Acute pancreatitis (usually inflammatory rather than infective).
Peritoneal dialysis-related—often atypical or cutaneous organisms gaining entry via contaminated dialysate bags or catheter.
Post-surgical intervention, e.g. anastomotic leak, enteric injury.
Clinical features:
Symptoms
Anorexia and fever.
Severe generalized abdominal pain radiating to shoulders and back.
Abdominal pain worse with movement, coughing, sneezing.
Signs
Fever, tachycardia.
Generalized abdominal tenderness with guarding and rigidity.
Differential maximal tenderness may indicate the possible underlying cause.
Gentle palpation may allow identification of an underlying mass.
Emergency management
Establish large calibre IV access.
Catheterize and place on a fluid balance chart.
Send blood for FBC (Hb, WCC), U&E (Na, K), CRP, amylase, group and save.
ABGs if shocked or ischaemic bowel/pancreatitis suspected.
Definitive management
Depends on established cause.
References
1- Oxford Handbook of Clinical Surgery - 4th Edition
2- Basic surgical skills & techniques
Productivity tip - Time management
Here are seven of the most popular and heavily used time management tips that are known to be effective:
1- Multitasking doesn’t work.
Even if you feel you’re able to do multiple things at once, your productivity levels are probably not as high as you think. It is best to focus at one task at a time and you’ll end up completing tasks at a faster rate and a better quality of work.
2- Always take notes.
Don’t rely on your memory for everything. If you have a small thought/idea/meeting or whatever it is that pops up during your day, write it down on a small post-it or on your journal if you have one - later on you can assign some time to get it done.
3- Set deadlines.
Otherwise you’ll find your self spending hours or days on a task which should have finished faster.
4- Work in sprints.
It is better to have short periods of hard works followed by small breaks rather than spending a long time working hard and being too tired to continue afterwards. Having short breaks helps you regain your energy and refocus your mind.
5- Just start.
Many of us keep procrastinating and making up excuses of why we aren’t being productive or studying when we should be. If you start, even with the smallest of tasks, then you’ll be more likely to continue to get the job done.
6- Sort out your priorities.
You know your deadlines and workload more than anyone else and you’re the only one who can sort the tasks according to their urgency and priority.
7- Buffer time.
It is quite important to schedule time which can be used as a buffer, in case you don’t manage to finish a task on time or if something comes up. Give yourself some time in case things don’t go as planned.
Interesting link/app
One of my go-to websites is Rx Guidelines. This website helps you access information specific to your hospital trust. This includes the hospital’s prescription guidelines, antimicrobial therapy guidelines and other management guidelines.
Click on the link and explore to find guidelines specifically related to your hospital trust.
This is also present as an app! You can download the app from the following links:
2- Download on the Apple app store
Do you have any specific surgical topic that you want to read about next week? You can always make suggestions as I plan to make this newsletter as useful to you as possible. Feel free to contact me at scrubsandsutures@gmail.com or on twitter and I will try to tailor the next one for you.
Thank you for reading and stay tuned for more topics next week!
