Peculiarities of cerebral circulation: 1. Brain and spinal cord is isolated from endothelium by BBB composed of continuous capillaries that limits movement of proteins and electrolytes 2. Fluid movement is primarily determined by osmolar gradient (in contrast to peripheral tissues – transcapillary gradient of large macromolecules) 3. Hence, administration of…
Tag: General Surgery
Clinical Skills and Approaches 
Burn Fluid Resuscitation
A) Clinical endpoints suggesting adequacy of burn fluid resuscitation: B) Pathophysiology of Burn:
Clinical Skills and Approaches 
Perioperative Fluid Management
Author: Sulabh Kumar Shrestha, KISTMCTH A) RELEVANT ANATOMY AND PHYSIOLOGY Details of the body fluid compartments are described here Microvessels for fluid exchange: The Exchange Vessels – capillaries and most proximal part of the venules Sinusoidal capillaries (liver, spleen, bone marrow): freely permeable to all solutes Fenestrated capillaries (glands, glomeruli, GIT):…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Axillary Lymph Node Dissection
A) Indications: Clinical or radiological evidence of involvement of axillary nodes Microscopically positive sentinel node(s) due to metastasis from primary malignant tumor In sentinel node negative: 98 % accurate in predicting that the other nodes are negative In sentinel node positive: possibility of microscopic disease in any of the remaining lymph nodes is 15–30…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
BCG for Urinary Bladder Cancer and BCG sepsis
The objectives of intravesical therapy in bladder cancer is to: avoid post-TURB (Transurethral resection of bladder) implantation of tumor cells eradicate residual disease prevent tumor recurrence delay or reduce tumor progression Indications of BCG in bladder cancer: Intravesical treatment and prophylaxis of bladder CIS Prophylaxis of primary or recurrent stage Ta and/or…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Chest Tube Insertion or Tube Thoracostomy
Indications of chest tube insertion Pneumothorax: In any ventilated patient (positive airway pressure will force air into the pleural cavity and produce tension pneumothorax) Tension pneumothorax after initial needle thoracocentesis Persistent or Recurrent pneumothorax after simple aspiration Large secondary spontaneous pneumothorax in patients >50 years Pleural effusion: Malignant pleural effusion…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
NG tube insertion
Indications Gastric decompression Gavage (feeding) Gastric lavage (irrigation or dilution of gastric contents) Sampling of the gastric contents for analysis Sometimes used to instil air into the stomach to detect a gastric perforation on erect CXR Contraindications Basilar skull fractures (Risk of NG reaching brain) Facial fractures (risk of cribiform…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Aspirin and Clopidegrol : Perioperative Guidelines
The average lifespan of platelets is 7 to 10 days. Aspirin and Clopidegrol inhibits platelets for around 21 days. Hence, when these agents are stopped 7 days before the surgery, it allows 33% regeneration of platelets. Stents and coronary lesions act as unstable plaque until they are completely covered by…