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Flashcards in Surgery overview Deck (35)
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1
Q

What are the three problems of early surgery?

A

> Pain
Blood loss
Infections

2
Q

What was Robert Liston famous for?

A

Fast amputation speed

3
Q

Why would surgeons operate so fast?

A

> To reduce the risk of the patient dying of shock

>Minimize pain

4
Q

What was discovered in 1799?

A

Nitrous Oxide by Humphrey Davy

5
Q

Name the positives (1) and negatives (2) about Nitrous Oxide

A

+Makes patients less aware

  • Doesn’t make you unconscious-just less aware
  • Doesn’t work on everyone
6
Q

What new anesthetic was developed in 1846?

A

In 1846 William Morton (a dentist) started used Ether.

7
Q

What was Ether the first anesthetic to do?

A

+Ether was the first anesthetic to make people unconscious

8
Q

What did Horace Wells use in a dental operation in 1845

A

Nitrous Oxide-left patient in agony

9
Q

What was wrong with Ether (5)?

A
  • It irritated patients lungs (and surgeons) making them cough even when unconscious
  • It caused vomiting
  • Put people in a deep sleep that could last for days
  • Was highly flammable-surgeons operated by candle light
  • Contained in heavy glass bottles that were easy to smash and awkward to carry
10
Q

What did Robert Liston use in an amputation in 1846?

John Collin Warren used ** to remove a tumor in America the same year

A

Ether

11
Q

When was Chloroform discovered?

A

1847 by James Simpson, he wanted to ease the pain of childbirth

12
Q

Who famously died in 1848

A

Hannah Greener during an operation using chloroform, she was the first recorded death.

13
Q

What were the problems when using chloroform in surgery?

A
  • It was difficult to get the dosage right;
  • Too little meant patients felt pain
  • Too much killed them (affected the heart)
14
Q

What were the positives of Chloroform

A

+Induced a state of unconsciousness without the side effects of Ether
+Meant surgery could be slower, and more careful
+Reduced death by shock

15
Q

Why did the Church oppose Chloroform/anesthetics (4) ?

A

> They thought pain was sent by god. In 1849 a letter was published in the Lancet protesting use of anesthetics.
People were against use of anesthetics in childbirth, thought the pain was penance for Eve’s sins.
Fear it would make women unladylike
Fear it would make men wimpy-spill their deepest secrets (army)

16
Q

Why did surgeons oppose Chloroform? (4)

A

> The fastest surgeons had the best demand-so made more money. Anesthetics got rid of the need for this skill-patient was unconscious.
Chloroform was a new development and people were wary.
Felt it was easier to die unconscious than awake and struggling.
Couldn’t explain rise in death rate (black period of surgery) and were put off. (Hannah Greener)

17
Q

Who solved the problem of dosage?

A

In 1848 John Snow developed an inhaler which made administering doses more precise

18
Q

Who helped normalize the use of Chloroform?

A

Queen Victoria, she used chloroform in the birth of her 8th child in in 1853. (Charles Dickens wrote about his wife using it also)

19
Q

When was the black period of surgery

A

1847 to 1877. Whilst patients were unconscious surgeons could try out more complicated operations, this lead to more people getting infections, losing blood and dying.
(discovery of chloroform-use of antiseptics)

20
Q

Give 3 reasons why Simpson didn’t help solve the problem of pain relief…

A

> Snow made Chloroform safe and usable (inhaler) Simpson’s chloroform had fatal side effects
Without Queen Victoria’s endorsement it would’ve been forgotten; opposition to chloroform meant it wasn’t used
Simpson wasn’t the first to develop pain relief (N.O and Ether)

21
Q

The Germ Theory was published in ** by *** ***. What did it say?

A

The Germ Theory was published in 1861 by Louis Pasteur. The germ theory stated that ‘infections’ (moldiness in wine) was caused by microbes also known as ‘germs’. The germs could be killed by heat.

22
Q

Who linked microbes to septicemia (infection). How did he originally propose to stop septicemia?

A

Joseph Lister. Started the use of antiseptics-used carbolic acid to soak wound and dressing (first used on a boy that had a compound fracture)

23
Q

After originally using carbolic acid as an antiseptic how did Joseph Lister change his methods?

A

Moved from antiseptics to aseptic. To prevent microbes from getting into the wounds he said the ‘surgery’ needed to be sterile and free from the microbes. Used a donkey pump to spray carbolic acid everywhere)

24
Q

Why did people oppose Lister himself and his theory? (6) (not the use of carbolic acid)

A

> Lister was viewed as a fanatic.
Didn’t believe in microbes or that they caused infections-Lister was a common joke.
Felt Lister was blaming them for their patients’ deaths.
Surgeons copied the method wrong which meant it didn’t work successfully-said it didn’t work at all.
Some surgeons had good success rates without carbolic acid.
Lister constantly changed methods-making improvements-made him seem unsure that they worked.

25
Q

Why did surgeons oppose the use of carbolic acid? (7)

A

> Believed antiseptics would compromise body defense system.
Carbolic spray was messy and went everywhere.
It was very expensive.
The donkey pump was awkward to use.
Carbolic acid damaged their hands.
Using carbolic acid slowed the operation down lots-had to spray everything.
Carbolic acid was originally used to treat sewage-made people unsure (was what gave Lister the idea)

26
Q

What else (equipment) helped promote the ‘aseptic’ environment?

A

Robert Koch invented the steam sterilizer in 1878; instruments were free of germs
Invention of rubber gloves; prevent microbes being introduced to wound by surgeons hands
People wore gowns and face masks

27
Q

How had people originally tried to stop blood loss?

A

Metal clips; tie arteries
Ligatures; tie blood vessels-still bleed if not tied properly
Cauterization (burning); hot oil/iron was poured on wound
Tourniquets
Blood Transfusion; banned-mortality rate was so high

28
Q

Who discovered blood groups?

A

Karl Landsteiner 1901. He also discovers that blood groups need to match for a transfusion to be successful

29
Q

Why did research into preventing blood loss suddenly increase in the early 20th century?

A

WW1… 1914-1918. Soldiers were dying of blood loss even if their wounds weren’t fatal.

30
Q

What three three things (name dates please) helped towards making transfusions a ‘thing’ (blood storage)

A

1914; Richard Lewisohn discovers Sodium Citrate stops blood clotting (still deteriorates)
1916; Richard Weil shows blood lasts longer when refrigerated
1916; Rous and Turner discover adding sodium glucose makes blood last even longer outside the body.
These developments mean the donor no longer has to be present during a transfusion -> blood depots!

31
Q

What was the first of its kind in the ‘Battle of Cambrai’

A

Blood depot-1917

32
Q

What made blood transfusions easier? (technology)

A

Hypodermic Needle

33
Q

Who was Harold Gillies?

A

Harold Gillies-father of plastic surgery. 2.1m men were injured in WW1-the use of bombs left many with shrapnel wounds. Harold Gillies set up a plastic surgery unit at Aldershot to treat those injured. He used pedicle grafts.

34
Q

What else was set up in WW1 to treat the injured?

A

> Triage system-prioritized cases (is still used)
Petite Curies-portable X-ray machines
Medical cards and records used ton communicate

35
Q

What new anesthetic was used in 1905?

A

Novocaine