H&P/ SOAP notes:

History and Physical/ SOAPs – QHC Surgery

Journal Article and Summary:

Suture Versus Mesh Repair in Primary and Incisional Ventral Hernias- A Systematic Review and Meta-Analysis

This study included 1,215 patients and compared patient centered long-term outcomes (recurrence and chronic pain) of suture versus mesh repair. The meta-analysis is based on best available evidence (RCTs) and is therefore a good basis for recommendations in surgical evidence-based clinical practice guidelines. The primary outcomes of this systematic review were recurrence and chronic pain (pain still persists 6 weeks after surgery). The conclusion was that suture repair was associated with more recurrent hernias than mesh repair. It also stated that results of mesh repair might be even better if the implantation is performed laparoscopically. It found that postoperative wound complications (e.g. surgical site infection or seroma) after hernia repair were mostly not statistically significant different between suture versus mesh repair. In regards to pain, outcomes in some studies were different because the position of the mesh (onlay vs. sublay) differed, and chronic pain seemed to be higher in sublay position than onlay position. However they determined more research is needed to analyze the influence of different mesh positions and fixation techniques (e.g. tacks, sutures or fibrin glue) on recurrences and chronic pain.

Site Evaluation Presentation Summary:

For my site visit, I presented an elderly male who presented to the ED with his family after a scald burn to his right lower extremity.  After examination he was found to have 2^nd degree, partial thickness burns to RLE, 8% TBSA, and serous drainage from open blisters and some blisters intact. He was treated with open blister debridement, and the wound cleaned and irrigated. Silver sulfadiazine and dry dressing was applied over the wound and wrapped with kerlix and ace bandage. He was also given IVF resuscitation and tetanus vaccine. Pt was referred to burn center for followup and dressing changes. My site evaluator said that I did a good job overall, but that I had added extra information into my HPI and ROS. He stated that it was a a good focused H&P, and the assessment and plan carried out was optimal. We discussed the Parkland formula and the importance of IVF resuscitation for burns and that patients should be monitored for hyperkalemia especially those with cardiac history.

Typhon Log:

Surgery Typhon Log

Self-Reflection:

Having surgery as my first rotation was nerve wrecking to say the least. I was very anxious because I knew going into surgery first was going to be intense. Everyone I told was like “wow this is your first rotation.” I assumed it was a testament of how the program felt I was ready for the challenge. I had heard the schedule at QHC was very demanding, intense, and mentally stimulating. I was excited and enthusiastic as this is one of those specialties I thought about pursuing and also how surgery is glorified in the medical world. I was eager to learn and go into an operating room and get some hands on experience.

I started with 4 other students, 3 medical students and 1 other PA student, and altogether there were about 7 of us rotating in surgery. My first thought was that’s a lot of students, and that was acknowledged by the preceptor, but everyone was given a schedule and for the most part it worked out. After working for a few days you kind of get to know their personalities, and I quickly found one of the PA students was a “gunner” or a competitive person always trying to scrub into the interesting cases and trying and be friendly with the attendings. This was the first time I had really worked with someone like this, he was confident and he tried to be helpful and hands on any way possible. This proved annoying at first especially since he would also try to take charge over the other students. The other students quickly realized it as well but were fine because surgery was just another rotation for them to get threw. I on the other hand wanted to make to most of this rotation, especially since it was my first. I found that I had to get out of my comfort zone and find ways to open up opportunities for myself. I used my easy going, friendly personality and spoke with other staff such as nurses and scrub technicians who were always helpful during the operation and some nurses alerted me to get blood work or put in IV’s. I befriended the anesthesiologists who allowed me to observe most intubations and they gave me a run through of what their responsibilities were. So I found out that there were plenty of other opportunities to be learned from the rotation and shared it with other students especially how to work with providers.

It was an amazing experience to see first-hand all the different surgeries that we learned about in class and more importantly how it benefited the patients life. What I really enjoyed was that we were able to follow the patient’s post-op care if they were admitted to the surgical floor. It was great to see the continuity of care and made the experience worthwhile.