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

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

MEDICAL STUDENT WEBSITE

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.

MEDICAL STUDENT WEBSITE

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.

MEDICAL STUDENT WEBSITE

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

I used Kaplan for my MCAT test prep and I am so glad I did.  Kaplan is a great resource for students interested in getting high scores on standardized exams, particularly on the MCAT.

Here’s a list of Kaplan resources: you can click on the link to read reviews.

Kaplan MCAT online course
Kaplan MCAT live course

Kaplan MCAT 2009-2010 Premier Program (Kaplan Mcat Premier Program)
Kaplan MCAT in a Box
Kaplan MCAT Complete 5 Book Subject Review 2009-2010 (Kaplan MCAT Complete Subject Review (5v))
Kaplan MCAT Practice Tests
Kaplan MCAT Advanced: Your Only Guide to a 45 (Kaplan Mcat 45)
Kaplan MCAT Verbal Reasoning & Writing 2009-2010
Kaplan MCAT 2008-2009 Premier Program (w/ CD-ROM) (Kaplan Mcat Premier Program)
Kaplan MCAT Practice Tests
Kaplan MCAT Biology 2009-2010
Kaplan MCAT Physics 2009-2010

Kaplan MCAT Advanced 2009 Edition: Intensive Prep for Top Students (Kaplan Mcat 45)
Kaplan MCAT General Chemistry 2009-2010
Kaplan MCAT Organic Chemistry 2009-2010

Good luck on your MCAT!

I used Examkrackers to study for the MCAT when I took it. It was the best resource for MCAT prep. Their verbal reasoning books are amongst the best. You can’t go wrong with these.

Here is the list of Examkrackers books:

Examkrackers Mcat Complete Study Package.
Examkrackers MCAT101 Passages in MCAT Verbal Reasoning.
Examkrackers: 1001 Questions in MCAT in Physics .
Examkrackers 1001 Questions in MCAT Chemistry .
Examkrackers 1001 McAt Biology Questions .
Examkrackers: 1001 Questions in MCAT, Organic Chemistry .

Examkrackers MCAT Audio Osmosis with Jordan and Jon .
Examkrackers MCAT Biology .
Examkrackers MCAT Verbal Reasoning & Mathematical Techniques .
Examkrackers MCAT Organic Chemistry .
Examkrackers Mcat Inorganic Chemistry.
Examkrackers MCAT Physics .
Examkrackers 16 Mini Mcat’s (Examkrackers MCAT Manuals) . . . . . .  . ..

The Amazon Kindle is now selling for $279, a far cheaper price than the over $300 it used to sell for when it first came out. This is great pricing in time for the holliday season. Good thing Sony came into the picture. Now we can all get a great deal for this e-reader.

The Amazon Kindle will be shipped this coming Monday and will work in 100 countries. Unfortunately, this amazing reader will not work in Canada. However, if you live in any of the countries where it will sell, you should definitely take advantage of it.