Allied Surgical Specialties
Urology
Haematuria needs upper and lower tract evaluation. Renal colic: CT of the kidneys, ureters and bladder is first-line; obstruction with sepsis needs urgent decompression by nephrostomy or stent. Testicular torsion is a clinical diagnosis; explore within 6 hours. Benign prostatic hyperplasia presents with lower urinary tract symptoms; assess with symptom score, flow rate and PSA. Urethral injury presents with blood at the meatus - do not catheterise; perform a retrograde urethrogram.
Neurosurgery
Glasgow Coma Scale (eye, verbal, motor; 3–15) is the core assessment. Head injury: prevent secondary injury by avoiding hypoxia and hypotension; extradural haematoma has a lucid interval and biconvex shape, subdural is crescentic. Raised intracranial pressure presents with headache, vomiting, papilloedema and Cushing's triad. Spinal cord injury needs immobilisation and early specialist referral.
Orthopaedics and plastics
Open fractures need antibiotics within one hour, tetanus cover, debridement and stabilisation. Compartment syndrome is a clinical diagnosis; fasciotomy is definitive. Hip fracture is common in the elderly and needs early surgery. Plastic surgery principles: reconstruct like with like, use a graft for an avascular bed and a flap for exposed bone, tendon or hardware. Burns and skin cover follow the same reconstructive ladder.
Transplantation
Brain death is certified by neurological criteria. Grafts are matched by ABO and HLA; immunosuppression is induction plus maintenance. Hyperacute rejection is antibody-mediated and occurs minutes to hours; acute rejection is cellular at days to weeks; chronic rejection is late. Living donation requires independent donor advocacy.
Rule of thumb
In any injured limb, pain out of proportion and pain on passive stretch mean compartment syndrome until measured otherwise - do not wait for pulselessness.