Genral Surgery Rotation Day 4 (June 16, 2011)

June 16, 2011

Today we attended the journal reading meeting of surgery department. Dr. Xiao, a resident physician in the department, gave us a presentation of an article about the use of extracorporeal membrane oxygenation (ECMO) vs. interventional lung assist membrane ventilator (iLA) on ARDS patients. She made a comparison between these two techniques. For example, unlike ECMO that can remove CO2 and add O2, iLA can only remove CO2 from the blood passing through it. Even though iLA has less distance of circuit, they both have anticoagulation complications as result of using heparin. Dr. Chen, the cardiovascular surgeon in the hospital, gave his comment after the article presentation. He mentioned that more and more hospitals in Taiwan will perform ECMO because it’s covered by the National Health Insurance. He also pointed out that even though no scientific evidence supports ECMO as treatment for ARDS, it’s logical to use this technique to buy patients more time so that other treatments can work out. This idea will be important for me when I deal with the patients with lung or/and heart failure.

Since Mickey’s preceptor would be pretty busy whole day, Mickey came to Dr. Kuo’s lecture with me. His first topic for today is hemorrhoid, a pathological change of anal cushions that can lead to bleeding, swelling, or/and pain. It’s associated with not only constipation but also diarrhea and pregnancy. It’s classified to external or internal depending on if it’s outside of dentate line. He also introduced different treatments (e.g. rubber band ligation, hemorrhoidectomy, and procedure for prolapse hemorrhoid) for different stages. Then he switched the topic to talk about inguinal hernia. We learned the different etiologies between children and elders and two types of operations, tissue repair and tension-free repair, used to treat it. Dr. Kuo ended his lecture by talking about soft tissue infections such as cellulitis and necrotizing fasciitis. The symptoms include redness, swelling, tenderness, and local heat. But he also pointed out that the symptoms can vary depending how deep the infection is. For example, the infection of deep soft tissue like fascia and muscles usually show no redness and swelling until advanced stage. The treatment for soft tissue infections usually starts with antibiotic therapy, and drainage and debridement operations are used when the symptoms persist. After the lecture, Dr. Kuo checked the gauzes I used to practice suture yesterday and said that we can get more suture lines from the operating room to practice. We later got more suture lines from the OR and practiced to improve our suture skill.