November 9, 2011

10 things I learned in surgery

1. the enemy of good is better (otherwise known as, doing more isn't always the right move)
2. the art of being a surgeon is first knowing when NOT to do surgery
3. when asked a question that you don't know the answer to, first: say you don't know, then say what you do know (as in, we don't know if she's going to recover fully but we do know that her kidney function has returned to normal more quickly than we would have expected).
4.  the surgeon is the head of the team, act like it. thank your team for what they do, and most importantly, tell your team what's going on so they can do their jobs the best they can.
5. how you do one thing is how you do everything, so make sure your values are reflected in all you do.
6. from one of my vascular attendings to a diabetic man who had already had one below-the-knee amputation due to low blood flow from his arteries not working well due to his extensive smoking behavior and diabetes "hey man, you're smoking your leg off" - (aka surgery isn't always the end of a problem).
7. bad news should always be hard to deliver, no matter how much experience you have.
8. the major causes of fever after surgery all start with W:
1) wind (atelectasis, pulmonary embolism), 2) water (UTIs), 3) walking (DVTs), 4) wound (infections), 5) wires (foleys, NG tubes, J tubes, ventilators), 6) wonder drugs (lots of drugs can cause fever)
9. a pulse is more important than breathing.  CPR guidelines just changed to focus on pulse first, then airway, then breathing.  so #1: feel for a pulse, if it's not there, start chest compressions
10. set yourself up for success - in surgery, 90% of the success of the surgery is deciding the approach.  If you don't feel comfortable - adjust something.

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