Hemostats: Mosquito clamps

Hemostats: Mosquito clamps

SURGERY RESIDENT RESOURCES

Mosquito clamps have short pointed jaws, and horizontal serration extends the entire length of jaws.

The instrument is 5 inches long.

It is used to clamp fine vessels and structures in addition to performing fine dissection.

tools of the trade, p.328

SURGERY RESIDENT RESOURCES

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Hemostats

Hemostats: Background

MEDICAL STUDENT RESOURCE GUIDE

These instruments are the main means of establishing hemostasis during an operation and come in a variety of sizes, with the mos tocmmonly used ones known by specific eponyms (eg. mosquito, Crile, and Kelly clamps)

(Fig . 13)

They are used to establish hemostasis at the divided ends of blood vessels of all sizes.

Since the clamped tissue is destroiyed, the tip of the clamp should grasp the end of the blood vessel only and as little adjacent tissue as possible.

The majority of hejmostats have curved tips that allw the surgeon to visualize the working end of hte instrument.

However, the choice between straight and curved-tipped hemostats in many circumstances is a matter of personal preference.

Figure 13.

A) Mosquito clamp

B) Crile clamp

C) Kelly clamp

Note that the Kelly clamp has serrations only halfway up the blade, in contrast to the mosquito and Crile clamps where the serrations run the length of the blade.

tools of the trade, p.326

MEDICAL STUDENT RESOURCE GUIDE

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Don’t talk trash about other services because you don’t know who might be listening

This morning was quite interesting.  You know how you talk about people not knowing their best friend is listening? That’s sort of what happened today. The general surgery residents were explaining how one ortho resident was horrible, how ortho residents don’t want to manage the floor stuff, etc. etc. Well, it turns out that one of the people sitting right across from them is an ortho intern. Go figure. Be careful the next time you talk trash about another service. They could have an unwilling spy.

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I wonder when he noticed his balls had turned black

I wonder when he noticed his balls had turned black

He was 40 years old, so I don’t think age was an excuse. He didn’t have a history of mental illness or psychosis, so we couldn’t use that as an excuse either. But he did come in with black balls, and we did take him to the operating room.

“Maybe,” said a nurse, “his glucose was so high, he wasn’t in his right set of mind. Maybe that is why he came in so late, when the disease had significantly advanced.” Maybe, I thought.

At the emergency room, he was somnolent and altered. The physicians there then intubated him. He was then brought to our hospital.

When we met him, he was already intubated. A decision was made, incorrectly likely, to put in a central line.  I say incorrectly because this was an obvious case of necrotizing fasciitis, specifically Fournier gangrene, or in laymen’s terms,  “infected, black balls.” This was not the time to mess around with a central line in the emergency department. But it was then, and they also gave him  gift of a pnemothorax, requiring us to place a central line.

The balls were really back. The scrotal sac, I mean, was dark green/black. Ok, so I’ve made my point, I think.

The smell was outrageous. We each asked for Oil of Wintergreen to be plastered on our masks.

The guy’s scrotal sacs had to go. His abdominal wall had to go. The extent of this necrotizing fasciitis was incredible. His penile tissue had to go.

Anyone who can bear child, probably wants their organs to be preserved. Lucky for him, his testicles were not infected. We disseced out the spermatic cord and the testicles. The rest of the skin in that area had to go.

Oh did I forget to mention that he also was a diabetic? His blood sugars were in the 900’s during the operation. His lactate was 4.6. His potassium was 1.3. Those labs were corrected during the operation, thanks to the magic of the anesthesiologists.

But, clearly his diabetes played a role. Patient’s with diabetes are at risk for necrotizing frasciitis.

After the operation, we still wondered, what took him so long to get to the hospital? After all, he had noticed a small amount of abscess in his groin. And 2 3 days later, he is in the hospital intubated, sick, with most of his abdominal wall (down to the aponeuroses), is gone, with a naken (fascia-less) penis and testes.

So the question is, when did he notice his balls were black ? And why didn’t he come to the hopital sooner?

Lesson here? If there is something wrong with your private parts, expecially something that looks like an infection, go see the doctor immediately.

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The little boy that died in the corn field

Children should not die. A month ago, a little boy died. He was 10 years old. He was playing in the corn fields. A pile of corn was piled on him by accident. He suffocated under the corn. A few minutes to 30 minutes later, they pulled him out of the stash of corn. By then, he was unresponsive. He was brought to our hospital intubated, with fixed pupils. It was too late. He was brain dead.

I understand that in some parts of the country, farming accidents happen. These tend to happen in harvest season, and then later during hunting season.

I just can’t imagine the grief that his parents must be experiencing right now.

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http://www.brianthemountainram.com/2010/03/04/neoplasia-multiple-choice-questions/

Great review with neoplasia multiple choice questions

http://www.brianthemountainram.com/2010/03/04/neoplasia-multiple-choice-questions/.

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Kaplan for MCAT Test Preparation

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