Resident Readiness General Surgery

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This book is dedicated to all my friends, family, co-workers and colleagues who have enriched my life and allowed me to follow my passion. Special thanks to my husband Phil who encouraged me, and to my mom Bonnie Klamen and late father Sam Klamen who raised me to try.—Debra L. Klamen

To the surgical residents in the UCSF-East Bay Department of Surgery whose dedication to their patients and professional commitment to continued learning are an inspirational indicator of the great good health of American Surgery.—Alden H. Harken

For Autumn.—Brian C. George

CONTENTS

Contributors

Acknowledgments

I. Introduction

1. Welcome
(
Brian C. George, MD, Alden H. Harken, MD, and Debra A. DaRosa, PhD
)

2. How to Read this Book
(
Brian C. George, MD, Alden H. Harken, MD, and Debra A. DaRosa, PhD
)

3. General Advice
(
Brian C. George, MD and Alden H. Harken, MD
)

4. A 28-year-old Female Incoming Surgery Resident
(
Amanda V. Hayman, MD, MPH
)

5. How to Write a Note—Fast!
(
Teresa S. Kim, MD
)

II. Handling Patients in the ED

6. Admissions
(
Anthony Visioni, MD and Roy Phitayakorn, MD, MHPE (MEd)
)

7. A 56-year-old Female Status Post Motor Vehicle Accident
(
Ashley Hardy, MD and Marie Crandall, MD, MPH
)

8. A 40-year-old Female With Abdominal Pain
(
Aisha Shaheen, MD, MHA and Marie Crandall, MD, MPH
)

9. A 42-year-old Man With Severe Right Upper Quadrant Pain
(
Brian C. George, MD
)

10. A 23-year-old Student With Periumbilical Pain That Has Migrated to Her RLQ
(
Brian C. George, MD and Alden H. Harken, MD
)

11. A 65-year-old Female in Severe Abdominal Pain
(
Aisha Shaheen, MD, MHA and Marie Crandall, MD, MPH
)

12. A Patient in the ER With a Blood Pressure of 60/– and a Heart Rate of 140
(
Alden H. Harken, MD and Brian C. George, MD
)

13. A 67-year-old Man With Mental Status Changes and a Suspected Diverticular Abscess
(
Alexander T. Hawkins, MD, MPH
)

14. A 57-year-old Man With a Chief Complaint of Nausea and Vomiting
(
Alexander T. Hawkins, MD, MPH
)

15. A 65-year-old Man Status Post Surgery With a HCT of 24%
(
Alden H. Harken, MD and Brian C. George, MD
)

16. A 70-year-old Man With “Bad Blood”
(
Emily Miraflor, MD, Louise Y. Yeung, MD, Brian C. George, MD, and Alden H. Harken, MD
)

17. A 37-year-old Man With a Painful Bulge Over His Left Forearm
(
Eric N. Feins, MD
)

18. Three Patients All Present With Issues Related to Laboratory Tests
(
Abigail K. Tarbox, MD and Mamta Swaroop, MD, FACS
)

19. A 73-year-old Man With Acute Right Lower Extremity Pain
(
Joel T. Adler, MD and Virendra I. Patel, MD, MPH
)

20. A 36-year-old Woman Status Post Motor Vehicle Accident While Intoxicated
(
Shamim H. Nejad, MD and Nadia Quijije, MD
)

21. A 50-year-old Man Presenting With Extensive Burns
(
Jeremy Goverman, MD, FACS and Shawn P. Fagan, MD, FACS
)

22. A 56-year-old Man 6 Days Status Post Colectomy With New Pelvic Discomfort
(
Michael F. McGee, MD and Brian C. George, MD
)

III. Handling Inpatients

23. A 75-year-old Man With Postoperative Pain
(
Ezra N. Teitelbaum, MD
)

24. A 72-year-old Man With Acute Confusion Postoperatively
(
Shamim H. Nejad, MD and Justin B. Smith, MD
)

25. You (the Intern) Are Asked to Read a Chest X-ray
(
Alexander T. Hawkins, MD, MPH and Amy Robin Deipolyi, MD, PhD
)

26. A 65-year-old Woman in Respiratory Distress
(
Alden H. Harken, MD and Brian C. George, MD
)

27. A Patient Who Is Postoperative Day 2 With New-onset Chest Pain
(
Alden H. Harken, MD and Brian C. George, MD
)

28. A 65-year-old Woman With a New-onset Cardiac Arrhythmia
(
Alden H. Harken, MD
)

29. A 60-year-old Man in the PACU With New-onset PVCs
(
Alden H. Harken, MD
)

30. A 65-year-old Man With Bradycardia
(
Alden H. Harken, MD and Brian C. George, MD
)

31. A 65-year-old Man With a Pacemaker Who Needs Surgery
(
Alden H. Harken, MD and Brian C. George, MD
)

32. A Patient With Pulseless Electrical Activity
(
Alden H. Harken, MD and Brian C. George, MD
)

33. A 55-year-old Man Who May Require Perioperative β-blockade
(
Alden H. Harken, MD and Brian C. George, MD
)

34. A 65-year-old Man Who Is in Respiratory Distress 3 Days Postoperatively
(
Jahan Mohebali, MD
)

35. A 68-year-old Man With Postoperative Hypotension
(
Allan B. Peetz, MD and Marie Crandall, MD, MPH
)

36. A 57-year-old Man Who Is Postoperative With a Blood Pressure of 210/95
(
Eric N. Feins, MD
)

37. A 65-year-old Female Who Is 4 Days Postoperative With Nausea, Vomiting, and a Distended Abdomen
(
Ashley Hardy, MD and Marie Crandall, MD, MPH
)

38. A 30-year-old Woman With Postoperative Nausea and Vomiting
(
Abigail K. Tarbox, MD and Mamta Swaroop, MD, FACS
)

39. A 79-year-old Man, Postoperative Day 3, Who has Not had a Bowel Movement in 4 Days
(
Anne-Marie Boller, MD and Joel M. Sternbach, MD, MBA
)

40. A 70-year-old Postoperative Colectomy Patient Who Is Not Putting Out Much Urine
(
Brian C. George, MD and Alden H. Harken, MD
)

41. A 55-year-old Male With Postoperative Urinary Retention
(
Selma Marie Siddiqui, MD and Marie Crandall, MD, MPH
)

42. A 52-year-old Female Who Is Dehydrated Postoperative Day #1
(
Aisha Shaheen, MD, MHA and Marie Crandall, MD, MPH
)

43. A 68-year-old Woman With Electrolyte Abnormalities
(
Molly A. Wasserman, MD and Mamta Swaroop, MD, FACS
)

44. A 58-year-old Man With a Postoperative Fever
(
Jahan Mohebali, MD
)

45. A 42-year-old Woman 4 Hours Postoperative With a Fever and Extreme Pain
(
Michael W. Wandling, MD and Mamta Swaroop, MD, FACS
)

46. A 35-year-old Man With Crohn Disease Who Needs Postoperative Orders
(
Roy Phitayakorn, MD, MHPE (MEd)
)

47. A 65-year-old Man With Diabetes Needing Postoperative Orders
(
Roy Phitayakorn, MD, MHPE (MEd)
)