hamid fallagh @FallaghH

Recomiendo este video de gran contenido práctico para cirujanos jóvenes y no tan jóvenes #BehindTheKnife

BehindTheKnife @BehindTheKnife

8 months ago

Resident 1: This video is the hotness 🌶️ Resident 2: Yeah, it's fire 🔥 See for yourself ➡️ full-length trauma laparotomy video from our Trauma Video Atlas (out this fall), courtesy of @clarkninam @Kniery_Bird @georgoff @mcclellanjm

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Four-gland exploration for primary hyperparathyroidism, part 1 of 3. ⁦@AcademicSurgery⁩ ⁦@SAGES_Updates⁩ ⁦@BehindTheKnife⁩

You’re covering the ICU for the night & your post-op cardiac surgery patient has a low BP 😳 Are they bleeding? Is it ⬇️ cardiac output? Afib? 🤯 Dont worry- we’ve got you covered for all these common post-op cardiac surgery problems in the latest episode of @BehindTheKnife🫀💪

BehindTheKnife @BehindTheKnife

8 months ago

Take a 🎧 to this high-yield, silky smooth episode from our cardiac surgery team @Jess_Millar15 @nickteman @AMWilliamsMD behindtheknife.org

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WELCOME TO 🐅 🐅🐅 COUNTRY! How do you approach a penetrating neck injury? Not so easy, right? Check our our first of its kind video spelling out the approach to neck wounds. High def, high yield, and entirely bad ass. 1 of 24 scenarios with text, original 🖼️, and 📹 out…

In conclusion, some tricks to minimize the effects of a tremor are: - keep elbows close to body - rest forearm/wrist on something - seated position if possible - laparoscopic if possible - common sense: ⬆️sleep⬇️caffeine - just give it time (usually it will stop by itself) ⬛️

Now her wrist is resting on the ring on the Bookwalter. The sewing will now be at least a little bit steadier. You might have to raise the ring a little higher to be able to do this. On one occasion I even set up a Bookwalter I didn't otherwise need just to get this advantage.

Here, a surgeon is sewing down in the pelvis with a long needle holder. Let's say that her hands have a slight tremor at the moment, and are not as steady as she would like. Here we have a Bookwalter set up, but there is another advantage to the device that is not being used.

Whenever you see a microsurgical procedure being done, the surgeons' arms are almost always resting on something. They have to do this...if their arms were up in the air, they would shake too much. There's no reason not to take advantage of this for 'macrosurgical' cases.

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Both of the aforementioned concepts can be seen here: The surgeon on the left is resting her elbows on either the table, and the surgeon on the right is keeping both elbows tucked in, close to the body. Each of these maneuvers will increase the steadiness of the hands.

This photo is blurry, but I picked it because it is the only one I can find of Vivien Thomas operating. This would have been in the lab. Here, Thomas (L) gains an advantage by resting his forearm on the table, whereas Blalock (R) is not doing this, and is at a disadvantage.

You can create a great deal of stability simply by resting your forearm on the patient or table. This helps take the elbow out of the equation. Of course, this isn't always possible to do; the patient may be too small or may not be in a position where it's feasible to do this.

Here we see the first Blalock-Thomas-Taussig shunt being done in 1944. Blalock is keeping his right hand steadier by keeping his elbow close to his body. Note that because the patient is an infant, he can't rest his forearm on the table (we'll get to that next).

One can get a modest degree of stability by keeping one's elbow close to the body, instead of raised and away from the body. This takes the deltoid muscles out of the picture and now you have one less point that you have to try and keep steady.

This position is slightly more stable because the wrist is straight. The forearms and elbows are still up in the air. Most of us probably spend a lot of our time like this. Nonetheless there may be times that one still has some residual tremor, and more steps need to be taken.

The surgeon here is operating with a freely mobile shoulder, arm, and wrist, all of which are currently in a non-neutral position. Most of the time, this is fine. But if this is not providing enough steadiness, then it's time to start keeping parts of one's arm more stationary.

As they say, it isn’t rocket science. Aside from the hand itself, the upper extremity can move about the shoulder, the elbow, and the wrist. If your hand is less steady than it needs to be, then the more you can immobilize these joints, the more advantage you can gain.

There's not much literature about tremor in surgeons, and it is mostly concerned with commonsense causes such as: - caffeine - nervousness - lack of sleep and so on. But often, a tremor is not related to any of these things. This 🧵will look at purely mechanical solutions.

🧵regarding some simple mechanical things that can be done to minimize the impact of the tremor that occurs during surgical cases from time to time. It's something that no one talks about, because people usually just try to conceal it, but it happens to almost everyone. (1/ )

Photo showing one of the reasons why appendicitis does not always present with ‘classic’ pain and tenderness in the RLQ. Here, the inflamed appendiceal tip is way up lateral and superior to the edge of the liver.

The short end of the Army-Navy is not exactly the same as a 'Parker', but the long end is just like a 'Langenbeck'. The name 'Parker-Langenbeck' is recent. As far as I can tell, 'Army retractor' was first, and this was just a name change devised by European manufacturers.