Blunt Abdominal Trauma

In this post, I would like to be more direct on my medical knowledge. I have posted about everyday topics, which are important, but I am first and foremost a surgeon, willing to share my advice and knowledge on various topics!

Today’s topic is on Blunt Abdominal Trauma.

Blunt abdominal trauma represents a real emergency and requires immediate surgical attention. It is important to get the diagnosis right and to manage the patient from the very beginning in the correct manner so that the outcome is satisfactory. An experienced surgeon is required, especially as unnecessary complications, disabilities and even death can often be avoided if the right treatment regime is initiated.

Noting down the patient’s history, observations and using clinical skills during examinations are of great importance in order to progress efficiently with diagnostic and treatment efforts. Imaging techniques can be a significant part of determining the true extent of the patient’s condition. Some of these include sonography, radiological examinations and CT scans and need to be available without delay.  It is wise to then begin with close monitoring in an intensive care setting, in order to register any abnormalities and changes within the patient’s condition. In addition to monitoring your patient, laboratory facilities, infusion fluids and blood transfusions must be available and accessible.

The most common traumata are haematomata within the abdominal wall or retroperitoneal haematomas and bleedings. Intra-abdominal injuries must always be considered, as splenic, liver injuries or tears to the bowel, mesentery, omentum, bladder, diaphragm, pancreas or other abdominal structures. Significant blood loss of more than 1 liter always requires immediate compensation by fluid resuscitation via an efficient venous access or by uncross-matched or cross-matched blood, if there is enough time. Ongoing and life threatening bleeds require immediate intervention either by compression or endovascular occlusion or surgical intervention. In an ideal setting the trauma surgeon should have an inter-ventional radiologist or vascular surgeon on standby. Not only will the quality of the surgical skill and management be a lot higher, as the likelihood of various difficulties and issues increases, the need for more staff is imminent. An emergency theatre and anaesthetic staff also need to be available for treatment without significant delay once an indication for surgical intervention is made. This can happen within the initial phase of the patient’s assessment or at a later stage (ranging from hours – days). Sometimes it can be extremely difficult to diagnose dangerous and life threatening bowel injuries, which might not be picked up by imaging techniques including ultrasound or CT scans. But  if these injuries are missed, patients can develop sepsis and even die.

Blunt abdominal trauma therefore requires extra resources personal, equipment and facilities as well as specially trained and experienced surgeons to achieve a good outcome. When the right decision is made and the process is followed, the results can be very awarding, as it can mean the difference between life and death. A good outcome without disabilities is caused by excellent and active interference of manageable complications.

And with that, enjoy your weekend young surgeons!

– Clemens

Travelling on the job

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It’s been a while since I last posted something and yet, I have already been asked for more content, so thank you for your kind feedback!

This week, I want to talk about travelling on the job, as for me, it is an important part of being a doctor. If you’re like me and need to travel between home and work, there are a lot of things to watch out for:

  1. Time Management

-> if you can’t manage your time well, you can’t travel, it’s as simple as that. You have to work out how much sleep you need (after a long shift), how long it will take for you to get home and back to work  and how long it would take you to get to the hospital if you are on-call and an emergency arises.

If you need help on managing your travelling time and you do not know the area you’re working in too well, set a timer on your phone from start to finish and drive calmly to your workplace. By doing this, in an emergency case, you know you will be able to get to work in at least that time.

If you have done a long shift and are tired, please don’t drive. I have been in many situations where I haven’t been given an on-call room and have had to find other ways to sleep. The cafeteria or staff room are good places just to take a break after your shift, so make sure you take your time. I am lucky, that I have family who can collect me if I am tired, but sometimes I can’t avoid having to travel straight after my shift has ended.

If you know you have to travel then,

2. Pace Yourself.

If you do not pace yourself in a race, you will tire quickly and barely reach the end of the race. Try and prepare to travel, by not stressing too much, running around the place and taking over everybodys jobs. Rather take your time to work on each patient, but try not to overwork yourself! In a hospital environment, depending on the country and department you are in, this can be a difficult thing to do…but you will get used to working in such an environment and learn to pace yourself.

Preparation for travelling is definitely a key part of pacing yourself, as if you are prepared for after your shift, it will be less stress. Make sure your tank has enough fuel, you maybe take a snack or two (if it’s a longer journey) and that your car is parked in an accessible spot, for you to leave work promptly.

3. Travelling with work

There may be times when your workplace needs you to travel to emergency situations, either by ambulance, car or helicopter. Stay calm, there are other people with you, just note that being a doctor is a full-time job, which means that travelling with work (like any other emergency situation) can cause your shift to lengthen. First and foremost is patient care, so don’t work yourself up about travelling, just focus on getting to the patient to help them. Make sure you know the equipment in order to stabilize the patient and stay up-to-date with new procedures and technology. Also I think it wise to note, that ambulances drive extremely fast, so be mentally prepared before you set off!

There are travel opportunities within medicine and you will most likely have to deal with some, at least during your training. Note, that preparation is key and practice makes perfect! Soon travelling will be part of the norm, if you’re as busy as I am!

Bye for now

-Clemens

 

Infographic on: Appendectomies

infographic-appendectomy

Over the span of my career, I Dr. Clemens Gerstenkorn, have performed a large number of appendectomies. In this short Infographic, I have summarised three main points which I feel are important to explain, when viewing the surgical aspect of this procedure. Even though I am focussing on the surgery, I have simplified the terms I have used in order not to confuse matters.

However, if any of these points are unclear, please feel free to write and ask, or even comment and I may even post a longer and more detailed explanation on how I perform an appendectomy.

That’s it for now!

-Clemens

Getting to grips with the internet

I, Clemens Gerstenkorn (51), unlike many people in my age, cannot seem to get to grips with the internet. One minute it is so simple, the next it’s exploding with new content, including all the verbal jargon which comes with the territory. Who has the time to remember the difference between Memes and Gifs or Smileys and Emoticons? Are there really people out there learning every meaning behind a semicolon and a bracket symbol, rather than the classical ways of expressing your true feelings using words? I can, however, write E-mails and work with text documents and receive a little help now and again to get things up and running.

I may not be gifted in using the internet, I am however good at my job. I am a full-time doctor and surgeon, or in other words, a human plumber. I fix what nature cannot and try my best to keep up-to-date with all the newest techniques, which the medical world is faced with.

Although this seems far from the media world, they are actually closely connected. Many people use the internet as a way of checking their symptoms and seeing if something is wrong with them. Other times, it can be used as a reassurance for families facing a crisis. However, when talking to people who are not associated with the medical world, I find that they are faced with medical phrases, which are either not properly explained or just not understood by the parties.

So now I get to state one of my main goals for this website. What I would like to do, is share my knowledge with the world and explain the difficult medical ‘slang’, without all the complicated stress of personalizing it. In doing so, I hope to ease patient’s and their friend’s and family’s worries and allow them to focus on what matters.

My second goal is to discuss papers, research and different surgical techniques in depth, whether my own, or written by others. This will be more detailed than just explaining medical terminology and once in a while will be followed by another ‘blog’ type article, referring to my thought processes.

Until next time

– Clemens