Surgery: Resuscitation, Operative Indications, and Source Control
Surgery: resuscitation, decision, and source control
Surgical questions reward a disciplined sequence: stabilize, diagnose, decide whether the patient needs the operating room, and control the source. High-yield topics include trauma, shock, acute abdomen, bowel obstruction, appendicitis, cholecystitis, pancreatitis, hernia, wound care, perioperative risk, and antibiotic prophylaxis. In trauma, follow airway, breathing, circulation, disability, and exposure; obtain FAST in unstable patients with suspected abdominal bleeding. In bowel obstruction, distinguish small from large bowel and look for strangulation signs such as fever, tachycardia, metabolic acidosis, and severe pain. In pancreatitis, early management is fluids, analgesia, and nutrition; antibiotics are not routine unless infected necrosis is suspected.
Traps
Do not send an unstable patient to CT before resuscitation or operative control. Do not assume pain out of proportion to exam is benign; mesenteric ischemia is a classic trap. In biliary disease, distinguish cholecystitis from cholangitis; cholangitis needs antibiotics and biliary drainage. Avoid routine perioperative antibiotics beyond the indicated window.
Worked rule
An unstable trauma patient with hypotension and a positive FAST goes to the operating room for hemorrhage control. A stable patient with concerning findings can undergo CT for characterization. This rule prevents the common error of over-imaging an unstable patient.