March 2012 (Part 1)
By Flora Chang, OREXer ’11-12
On my OREX day, there was no morning meeting at 7AM. I’m not sure if this is true of every Wednesday, but apparently the meeting was moved to noon?
The first procedure I witnessed was a closed reduction of a nasal fracture. The patient was a young male who appeared to be in his twenties. I later learned from one of the visiting medical students that the patient suffered his injury as a result of being punched by his brother.
Not surprisingly, most nasal fractures result from fist fights, impact from contact sports, or falls. The nose is actually the third most commonly broken bone in the body and the most common broken facial bone. Nasal fractures can affect both bone and cartilage, and they may affect breathing. A septal hematoma, which is essentially a collection of blood, can sometimes form on the nasal septum.
Dr. Park was the main surgeon for this procedure; Dr. Williams and Dr. Isom assisted. The doctors used nasal speculums, nasal pledgets, forceps and another tool called the elevator. They basically realigned the nose, packed the inside with gauze and put a cast over the patient’s nose.
Next, I watched an umbilical hernia repair. Dr. David Boudrealt was the surgeon. Dr. Miller was the anesthesiologist, and a young lady named Lisa was on her anesthesia rotation. She was responsible for manning the entire anesthesia aspect of the surgery.
This patient was a middle-aged Hispanic woman. Umbilical hernias often occur in infants but can also occur in adults. They can occur in patients who have health issues that create pressure in the belly, such as being overweight, pregnant, or having too much fluid in the belly. Other health problems can also cause umbilical hernias, such as chronic cough, constipation, or problems urinating as a result of an oversized prostate gland.
After the patient was intubated and anesthetized, the surgery team began by cleaning the patient’s belly button area from in to out. Dr. Boudrealt then injected a local anesthetic and drew the incision line with a black marker. He drew a short, crescent shaped line about an inch below the patient’s navel. Next, he cut along the line with the scalpel and pushed any bulging tissue back inside the belly. Finally, Dr. Boudrealt closed the wound transversely with stitches.
The final procedure I watched was a colonoscopy with a possible biopsy. Most colonoscopies are actually done in endoscopy rooms at Highland. Every once in a while, however, these procedures are performed in the OR. This particular procedure was done in the OR because the patient was difficult to anesthetize. She was an elderly woman with perhaps some mental issues.
The physician inserted the colonoscope through the rectum and searched through the patient’s colon. The view of the large intestine on the monitor reminded me of an endoscopy or a laproscopic surgery. As he moved the scope around the intestine, he pointed some hemorrhoids and some polyps, a few of which he deemed as “definitely cancerous.”