Sadea Cirugía Segura
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The document discusses strategies and objectives for ensuring safe surgery based on World Health Organization guidelines. It aims to reduce surgical deaths worldwide by strengthening safety measures, implementing safe anesthetic techniques, preventing surgical infections, and optimizing communication among surgical teams. It outlines essential objectives like performing the correct procedure on the correct patient, preventing anesthetic risks and pain, managing difficult airways and major bleeding, avoiding allergic reactions and adverse drug effects, and minimizing surgical site infections. It also provides a checklist for surgical safety with phases for entry, pause before incision, exit, and follow up to minimize common and preventable risks.
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Surgical Safety & Safer surgery
1. Safety is everybody’s business. According the Hippocratic oath from 5th century : “ Never do harm to anyone” Safer Surgery can be defined as a reduction in avoidable harm to a surgical patient
2. It is a part of medical specialty that uses operative manual and instrumental technique on a patient to investigate or treat a pathological condition. Surgical team: 1. Surgeon 2. Surgeon’s assistance 3. Anesthetist 4. Scrub nurse 5. Scouting nurse 6. Surgical technologist
3. Time or duration when patient admitted and discharge after completion of surgery. So, surgical safety has broadly included in different phases: 1. Preoperative(Diagnosis, investigation) 2. Per operative 3. Postoperative(Up to discharge)
4. 1. Adverse events: An incident which result in harm to the patient. 2. Near Miss: An incident which could resulted in unwanted harm but did not. 3. No-harm events: An incident that occur and reach to the patient but result in no injury.
5. An article in the Gurdian newspaper UK in March 2013 claimed that “five worst medical” nightmares a Pt faces, three related to surgery: 1. Wrong site surgery 2. Wrong patient surgery 3. Retained instruments and swabs The rate of harm in surgical patient is unknown but probably occur in about 10% surgical patient, though much of this harm will be minor.
6. 1. Patients themselves. 2. Healthcare professional 3. System failure. 4. Medical complexity
7. Patients Themselves 1. A variety of presentation. 2. Differing co-morbidities 3. Differing response to treatment 4. Patients are reluctant to speak up. 5. Refuse to co-operate 6. Hide and seek
8. Healthcare professional 1. Inadequate Pt assessment(delay or error in Diagnosis) 2. Failure to use or interpret appropriate test 3. Error in performance of an operation and test. 4. Inadequate monitoring or follow-up. 5. Deficient training or experience 6. Fatigue, overwork or time pressure. 7. Personal or psychological factor i.e. drug abuse or depression. 8. Lack of recognition of the danger of medical errors.
9. System failure 1. Poor communication between healthcare provider. 2. Inadequate staffing level 3. Overreliance on investigation 4. Lack of coordination at handover 5. Drug similarities. 6. Equipment failure due to lack of skilled operators. 7. Inadequate system to report and review patient safety incident.
10. Medical complexity 1. Advance and new technologies(laparoscopic, robotic surgery) 2. Potent drug and their side effects and interaction. 3. Working environment- Surgical ICU, HDU and Operation theatre
11. Surgery is one of the most complex health intervention to deliver. More than 100 million people worldwide require surgical treatment every year for different reason. Great Professor of Surgery Sir Alfred Cuschieri and other describes surgical errors in different categories that committed by the surgeons during care of the Patients.
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The document discusses the Universal Protocol created by The Joint Commission to prevent wrong-sided surgeries, which are considered sentinel events. The Universal Protocol consists of three steps: 1) pre-procedure verification of the correct patient, procedure, and surgical site; 2) marking the intended surgical site before the procedure; and 3) a final timeout immediately before incision where the surgical team verbally confirms again the correct patient, procedure, and site. Following the Universal Protocol helps ensure effective communication and safety for patients undergoing surgical procedures.
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The document is an implementation manual for the WHO Surgical Safety Checklist from 2009. It provides guidance on how to use the checklist to improve safety in the operating room. The checklist divides surgery into three phases - before induction of anesthesia, before skin incision, and before the patient leaves the operating room. It describes the safety steps to be completed in each phase, including confirming the patient's identity and consent, checking for allergies, and making sure counts are correct before the patient leaves the OR. The goal is for teams to consistently follow critical safety steps to minimize risks for surgical patients.
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1. Safety is everybody’s business. According the Hippocratic oath from 5th century : “ Never do harm to anyone” Safer Surgery can be defined as a reduction in avoidable harm to a surgical patient
2. It is a part of medical specialty that uses operative manual and instrumental technique on a patient to investigate or treat a pathological condition. Surgical team: 1. Surgeon 2. Surgeon’s assistance 3. Anesthetist 4. Scrub nurse 5. Scouting nurse 6. Surgical technologist
3. Time or duration when patient admitted and discharge after completion of surgery. So, surgical safety has broadly included in different phases: 1. Preoperative(Diagnosis, investigation) 2. Per operative 3. Postoperative(Up to discharge)
4. 1. Adverse events: An incident which result in harm to the patient. 2. Near Miss: An incident which could resulted in unwanted harm but did not. 3. No-harm events: An incident that occur and reach to the patient but result in no injury.
5. An article in the Gurdian newspaper UK in March 2013 claimed that “five worst medical” nightmares a Pt faces, three related to surgery: 1. Wrong site surgery 2. Wrong patient surgery 3. Retained instruments and swabs The rate of harm in surgical patient is unknown but probably occur in about 10% surgical patient, though much of this harm will be minor.
6. 1. Patients themselves. 2. Healthcare professional 3. System failure. 4. Medical complexity
7. Patients Themselves 1. A variety of presentation. 2. Differing co-morbidities 3. Differing response to treatment 4. Patients are reluctant to speak up. 5. Refuse to co-operate 6. Hide and seek
8. Healthcare professional 1. Inadequate Pt assessment(delay or error in Diagnosis) 2. Failure to use or interpret appropriate test 3. Error in performance of an operation and test. 4. Inadequate monitoring or follow-up. 5. Deficient training or experience 6. Fatigue, overwork or time pressure. 7. Personal or psychological factor i.e. drug abuse or depression. 8. Lack of recognition of the danger of medical errors.
9. System failure 1. Poor communication between healthcare provider. 2. Inadequate staffing level 3. Overreliance on investigation 4. Lack of coordination at handover 5. Drug similarities. 6. Equipment failure due to lack of skilled operators. 7. Inadequate system to report and review patient safety incident.
10. Medical complexity 1. Advance and new technologies(laparoscopic, robotic surgery) 2. Potent drug and their side effects and interaction. 3. Working environment- Surgical ICU, HDU and Operation theatre
11. Surgery is one of the most complex health intervention to deliver. More than 100 million people worldwide require surgical treatment every year for different reason. Great Professor of Surgery Sir Alfred Cuschieri and other describes surgical errors in different categories that committed by the surgeons during care of the Patients.
12. 1. Diagnosis and management erro
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234 million major surgeries are performed worldwide each year, and complications occur in up to 25% of patients, with a 0.5-5% mortality rate. Known safety principles are inconsistently applied. To address this, initiatives like Safe Surgery Saves Lives aim to standardize safety practices, such as requiring verification of patient, procedure, and site before starting through processes like pre-operative briefing and marking of the site. These measures could help reduce the estimated 50% of adverse events considered preventable.
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2) Video laryngoscopy and new airway devices have reduced risks that were previously associated with direct laryngoscopy. Physiologically difficult airways in critically ill patients remain high risk.
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Presentación de la ponencia "Cierre Percutáneo de Orejuela Izquierda. Evidencia clínica: dónde estamos?" realizada por Raul Moreno en los Diálogos EPIC_Cierre Percutáneo de la Orejuela Izquierda el 15 de Marzo de 2018 en Madrid (España)
Left atrial appendage closure. Clinical evidence; where we are? by Raul Moreno at Diálogos EPIC_Percutaneous left atrial appendage closure, March 15th 2018 in Madrid (Spain)
PBM. MANEJO DE LA ANEMIA PREOPERATORIA. Dr García Erce. Roma 2015
This document discusses strategies and protocols for optimizing hemoglobin levels in patients through patient blood management. It begins by outlining the high rates of preoperative anemia seen in various surgical specialties, from 25% to over 50% depending on the procedure. Preoperative anemia is associated with increased risks of mortality, morbidity, length of hospital stay, blood transfusions, and healthcare costs. The document emphasizes the importance of treating preoperative anemia to improve surgical outcomes and lower transfusion rates. It promotes the use of patient blood management strategies that include early anemia screening and treatment, as well as alternatives to allogeneic blood transfusions when possible.
PBM. Preoperative Anemia Management, Dr García Erce. Roma 2015
This document discusses strategies and protocols for optimizing hemoglobin levels in patients through patient blood management. It begins by outlining the high rates of preoperative anemia seen in various surgical specialties. Preoperative anemia is associated with increased risks of transfusion, mortality, and morbidity. Allogeneic blood transfusions also carry various risks. Therefore, effective management of preoperative anemia through treatment of underlying causes and use of alternatives to transfusion can help optimize patient outcomes and reduce transfusion rates. The document advocates following principles of patient blood management to safely and effectively meet patient blood needs.
Guia das 2015
The document presents updated 2015 guidelines from the Difficult Airway Society for managing unanticipated difficult intubation in adults. Key points of the guidelines include:
1) Emphasis is placed on assessment, preparation, positioning, preoxygenation, maintaining oxygenation, and minimizing trauma from interventions.
2) If tracheal intubation fails, supraglottic airway devices are recommended to provide oxygenation while considering next steps.
3) When both tracheal intubation and supraglottic airway insertion fail, waking the patient is the default option, but cricothyroidotomy should be performed if face mask oxygenation is impossible due to muscle relaxation.
2 - Advanced ECMO Management Strategies.pdf
Echocardiography plays an important role in extracorporeal membrane oxygenation (ECMO) support. It is useful for:
1) Assessing cardiac pathology and ruling out contraindications pre-ECMO; 2) Guiding cannula insertion and positioning; 3) Monitoring the heart and troubleshooting issues during ECMO support. Echocardiography also helps evaluate cardiac function for weaning patients off ECMO. Overall, it is a valuable tool throughout the entire peri-ECMO period.
Role of retrograde transpopliteal angioplasty for superficial femoral artery ...
Role of retrograde transpopliteal angioplasty for superficial femoral artery ...SAMEH ATTIA ALI ABDELHAMID
This document discusses retrograde transpopliteal angioplasty for treating superficial femoral artery occlusion. It provides details on:
- The inclusion/exclusion criteria for patients in the study evaluating this technique's effectiveness and safety.
- The procedure, which involves accessing the popliteal artery from behind the knee and recanalizing the femoral artery in a retrograde manner.
- The results of the study, which found the technique achieved technical success in all cases and led to significantly improved ankle-brachial indices. Post-operative complications were minor. At 6-month and 1-year follow-ups, most arteries remained patent.
- The conclusion that retrograde popliteal access is aPrevention vs Treatment MGB Leaks v2
Management Post Op Leaks
1. First Prevent Leaks
2. Categorize: Early Leaks vs Late Leaks
3. Simple Management Protocol
In short:
Management Post Op Leaks
1. First Prevent Leaks
2. Categorize: Early Leaks vs Late Leaks
3. Simple Management Protocol
Simple Leak Management Protocol
Leak found 24-48hr
= No Diagnostic Tests
= Immediate Exploration
= Usually Simple Suture Repair
Fear Leak: Suspect a Leak in Every Case
Leak found 24-48hr
= No Diagnostic Tests
No WBC
No CAT Scan
No Chest XRay
If patient does not feel well reexplore early
= Immediate Exploration
Expect many negative explorations when you begin
= Usually Simple Suture Repair
Leak Found More than 72 hours
Categorize:
1. Acute peritonitis, sepsis, leak NOT contained
= Take down GJ (1 Staple Firing) 5-10 min
= Gastro-Gastrostomy (5-10 min)
= Get Out (Drain and ABx)
2. Stable patient, not septic, leak contained
= Conservative:
ABx, Drainage and Feeding
Complication Management; Better to Prevent a Leak than to be Expert in Man...
Managing Complications FIRST Prevent Complications
Better to
Prevent a Leak than to be
Expert in
Managing a Leak
They're bleeding, stop it
The document discusses hemorrhage control and fluid resuscitation for trauma patients. It provides statistics on injury deaths in the US and discusses various methods for controlling bleeding, including tourniquets, wound packing, and hemostatic agents. It then discusses fluid resuscitation, noting that for non-TBI patients the goal is a systolic blood pressure of 90 (MAP of 65) and for TBI patients a systolic of 110 (MAP of 90). Studies found that a controlled resuscitation strategy giving less initial fluid (1L vs 2L) resulted in similar outcomes and lower mortality compared to standard resuscitation.
Valvula mitral conroversias
Mitral stenosis surgery is recommended for adolescent or young adult patients with congenital mitral stenosis who have symptoms such as shortness of breath (NYHA class III or IV) and a mean mitral valve gradient over 10 mm Hg on echocardiography. Mitral valve surgery is also reasonable for asymptomatic patients with mild symptoms (NYHA class II) and a mean gradient over 10 mm Hg, or asymptomatic patients with pulmonary artery systolic pressure over 50 mm Hg and a mean gradient over 10 mm Hg. The effectiveness of surgery is uncertain for asymptomatic patients with new onset atrial fibrillation or embolisms while on anticoagulation.
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Stroke prevention in patients with atrial fibrillation
Stroke prevention in patients with atrial fibrillation
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EWMA 2013 - Ep543 - Evidence Based Wound Conversion Algorithm for University ...
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PBM. Preoperative Anemia Management, Dr García Erce. Roma 2015
PBM. Preoperative Anemia Management, Dr García Erce. Roma 2015
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
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Recomendamos muito.
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Esta publicação só está disponível em inglês até o momento.
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1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
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1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
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