Surgery Clerkship
Surgical Skills Verification: ACUTE ABDOMEN
Goals:
To familiarize the student with the acute abdomen patient
Objective:
After the completion of the rotation the student will be able know:
1)
2)
3)
The most common conditions associated with an acute abdomen
The diagnostic tests that can help to make the diagnosis
The proper preparation of the patient for surgical exploration.
Acute abdomen is a clinical syndrome “for any acute condition within the abdomen demanding immediate
operation” (Dorlan). “The acute abdomen is one that requires an acute decision”.
DIAGNOSIS: Diagnosis is made by a combination of good and precise clinical history, physical examination and
imaging.
PAIN: Cramping (
)
Localized ( )
Radiating (
)
Intensity ( )
Length __________
VOMITING: Yes ____ No ____
Bilious (
)
Explosive ( )
Blood ( ) Frequency ______
Gas (
) or Stool ( ) per rectum
ABDOMINAL DISTENTION: Yes ___ No ____
Tender: Yes ____ No ____ Rebound: Yes ____ No ____
Localized tenderness: Yes ____ No ____
PAST MEDICAL HISTORY:
Abdominal Surgery: Yes ___ No ____
Appendectomy ( ) Cholecystectomy (
) Hysterectomy (
CO- MORBID CONDITIONS
Coronary artery disease: Yes ____ No ____
CABG (
Diabetes ( ) Renal Failure ( )
COPD ( )
)
Other __________________
)
PHYSICAL EXAMINATION:
Does the patient look ill? Yes ____ No ____
VITAL SIGNS:
Temp _______ Pulse ________ BP _______ Resp _______ Pain _______
Heart and Lung:
Rectal: ( ) Mass in rectum? Yes ____ No ____
Vaginal: ( ) Pain on mobilization cervix? Yes ____ No _____
LABORATORY:
CBC ( )
WBC ( )
Differential ( )
Platelets ( )
Urinary: Blood: Y / N
CAST: Y / N
Chest X-ray: Pneumonia: Y / N
Free Air: Y / N
KUB: Small bowel obstruction: Y / N
Ileus: Y / N
CAT Scan: Appendix: Y / N
Sigmoid: Y / N
Observing Physician’s Signature:
Pregnancy test: Y / N
Thumb Printing: Y / N
Bowel obstruction: Y / N
____________________________________ Date: ____________
Student’s Signature: _______________________________________________ Date: ____________
Surgery Clerkship
Surgical Skills Verification: TRAUMA
Goal:
To familiarize the student with the acute resuscitation of the trauma patient
Objectives:
After completion of the rotation the student will be able to:
1)
2)
3)
4)
Checklist:
ABC’s
Define the ABCDE of a trauma resuscitation
Define shock and the common causes of shock in the trauma patient
Discuss the clearance of the cervical spine
Discuss the location of bleeding in blunt trauma patients
Airway- secure or established
Intubate
Breathing- apply oxygen and chest exam
Place a chest tube
Circulation- stop the hemorrhage
Disability- discuss Glasgow Coma Score
Eye opening, Verbal and Motor response
Yes_____ No _____
Yes _____No _____
Yes _____No _____
Yes_____ No _____
Yes_____ No _____
Yes_____ No _____
Exposure- undress the patient/hypothermia
Yes_____ No _____
Shock:
Yes_____ No _____
Shock is inadequate tissue perfusion
Markers of tissue perfusion
Capillary refill, skin color/temperature
Base deficit and lactate
______________ Describe
______________ Value
Hemorrhage as a cause of shock
Cardiac tamponade as a cause of shock
Tension pneumothorax as a cause of shock
Level of consciousness
Yes_____ No _____
Yes_____ No _____
Yes_____ No _____
_________________
Cervical Spine Clearance
Elements of clinical clearance
Yes_____ No _____
Pain
_______Palpable ________Motion ________Distracting Pain
Types of radiographic clearance
_______________List Study
Location and work up of bleeding in blunt trauma patients
Chest
Hemothorax
Abdomen
Spleen_____ Liver_____
Retroperitoneum/pelvis
Thighs
External sources (lacerations, open fractures, amputations)
Observing Physician’s Signature:
Yes_____ No _____
Yes_____ No _____
Yes_____ No _____
Yes_____ No _____
Yes_____ No _____
____________________________________ Date: ____________
Student’s Signature: _______________________________________________ Date: ____________
Observer’s Initials ____________________
Date Observed __________
Surgery Clerkship
Surgical Skills Verification: RADIOLOGY
Goal:
To familiarize students with the most common imaging modalities.
Objectives:
After completion of the rotation the student will be able to: Recognize surgical
radiographic findings and correlate with intraoperative & pathological findings.
Plain Films:
Patient Initials
Ultrasound:
__________________________
Patient Initials ___________________________
Type of X-ray
__________________________
(Chest, Abdominal)
Type of Ultrasound _______________________
(Breast, Abdominal, Thyroid)
Pertinent Findings _________________________
(Free Air, Hemo, SBO)
Pertinent Findings _________________________
Procedure Performed _________________________
Procedure Performed _______________________
Intraoperative Findings ________________________
Intraoperative Findings__ ____________________
Attending ____________________ Date _________
Attending ______________________ Date __________
CT:
Mammography:
Patient Initials
___________________________
Patient Initials __________________________
Type of CT ________________________________
(Head, Abdominal)
Pertinent Findings ________________________
(Calcifications, Mass, Cyst)
BiRADS_________
Pertinent Findings ___________________________
(Tumor, Obstruction, Trauma)
Procedure Performed ______________________
(Biopsy, Mastectomy)
Procedure Performed
Intraoperative Findings _______________________
Intraoperative Findings_____________________
(Specimen, Mammography, Palpable Mass)
Pathology _______________________________
Attending ____________________ Date _________
Attending ______________________ Date __________
_____________________
FAST:
Patient Initials
___________________________
Pertinent Findings ___________________________
(+ or -)
Procedure Performed _________________________
Intraoperative Findings ________________________
Attending ____________________ Date __________
Surgery Clerkship
Surgical Skills Verification: BREAST
Goals:
1)
2)
Accurately view a mammogram with normal/abnormal findings.
Know how to take a history and perform an exam on a patient with breast disease.
Objectives:
Upon completion of the rotation the student will be able to read a mammography or other
radiographic views, know the various stages and types of breast problems and be able to do a
breast exam.
Workshop:
1)
Mammo with benign findings:
Views _____
CC _____
MLO _____
Cyst _____ Fibroadenoma _____
2)
Compression _____
Other _____
Location _____
(i.e. 9:00, 2:00)
BiRADS _____
Mammo with abnormal findings:
Views _____
3)
4)
CC _____
Size of Mass _____
Spiculation _____
Breast Ultrasound
Findings: Cyst _____
Mass _____
Ca++
Views:
Compression _____
Location _____
(i.e. 9:00, 2:00)
CA++ _____
Size _____
Location _____
Well Circumscribed_____
Spiculated _____
Cc _______
Compression _______ Location _______
Mlo _______
Punctate or coarse __________
5)
MLO _____
Exam:
Mass _______
Clustered or single ___________
Nipple Discharge _______
Adenopathy _______
BiRADS _____
BiRADS ___________
Nipple Retraction _______
Skin Changes _______ Symmetry _______
Observer’s Initials ______________________________
Date Observed _______________
Clinical:
1)
Br Ca Sp Hx:
G_____P_____ Age at Menarche _____
OCP/HRT _____
Prior bx __________
2)
Family Hx _____
Age of Menopause _____
First Childbirth _____ BF _____
Skin ∆ __________ Lump __________
Preformed a supervised breast exam on a patient.
Observer’s Initials ______________________________
Yes _____
Discharge __________
No _____
Date Observed _______________
Surgery Clerkship
Surgical Skills Verification: Suture Skills
GOAL:
To familiarize the student with the management of common wounds encountered in
medical practice.
Objectives:
Upon completion of the rotation, the student will be able to:
1)
2)
3)
4)
Discuss the management of open wounds encountered in emergency situations.
Understand when to refer a patient to a specialist for specific lacerations.
Understand indications for operating room closure of specific lacerations and wounds.
Be able to demonstrate technique of closure of various lacerations.
Checklist:
Student was able to understand indications for and perform closure of a laceration using:
1)
Vertical mattress technique
Yes _____
No _____
2)
Simple interrupted suture technique
Yes _____
No _____
3)
Closure of a deep wound using buried absorbable suture.
Yes _____
No _____
Skin closure using subcuticular technique.
No _____
4)
Yes _____