1. Basic Principles
    2. 1. Metabolic response to injury
    2. Shock, haemorrhage and transfusion
    3. Wound healing and tissue repair
    4. Tissue engineering and regenerative therapies
    5. Surgical infection
    6. Tropical infections and infestations
    7. Basic surgical skills
    8. Diagnostic imaging
    9. Gastrointestinal endoscopy
    10. Principles of minimal access surgery
    11. Tissue and molecular diagnosis
    12. Principles of oncology
    13. Surgical audit and research
    14. Ethics and law in surgical practice
    15. Human factors, patient safety and quality improvement
    16. Surgical Instruments
  2. General Paediatrics
    3. 17. Paediatric surgery
    18. Neonatal surgery
    19. Trauma in children
    20. Paediatric urology
  3. Perioperative care
    4. 21. Preoperative care including the high-risk surgical patient
    22. Day case surgery
    23. Anaesthesia and pain relief
    24. Postoperative care including perioperative optimization
    25. Nutrition and fluid therapy
  4. Trauma
    5. 26. Introduction to trauma
    27. Early assessment and management of severe trauma
    28. Traumatic brain injury
    29. Torso and pelvic trauma
    30. The neck and spine
    31. Maxillofacial trauma
    32. Extremity trauma
    33. Diaster surgery
    34. Conflict surgery
  5. Elective Orthopaedics
    6. 35. History taking and clinical examination in musculoskeletal
    36. Sports medicine and sports injuries
    37. The spine
    38. The upper limb
    39. The hip
    40. The knee
    41. The foot and ankle
    42. Musculoskeletal tumours
    43. Infection of the bones and joints
    44. Paediatric orthopaedics
  6. Skin, Plastic and Reconstructive
    7. 45. Skin and subcutaneous tissue
    46. Burns
    47. Plastic and reconstrutive surgery
  7. Head and Neck
    8. 48. Cranial neurosurgery
    49. The eye and orbit
    50. Developmental abnormalities of the face, mouth and jaws: cleft lip and palate
    51. The ear, nose and sinuses
    52. The pharynx, larynx and neck
    53. Oral cavity cancer
    54. Disorders of the salivary glands
  8. Endocrine and Breast
    9. 55. The thyroid gland
    56. The parathyroid glands
    57. The adrenal glands and other abdominal endocrine glands
    58. The breast
  9. Cardiothoracic
    10. 59. Cardiac surgery
    60. The thorax
  10. Vascular
    11. 61. Arterial disorders
    62. Venous disorders
  11. Abdominal
    12. 63. History and examination of the abdomen
    64. The abdominal wall, hernia and umbilicus
    65. The peritoneum, mesentery, greater omentum and retroperitoneal space
    66. The oesophagus
    67. The stomach and duodenum
    68. Bariatric and metabolic surgery
    69. The liver
    70. The spleen
    71. The gallbladder and bile ducts
    72. The pancreas
    73. Functional disorders of the intestine
    74. The small intestine
    75. Inflammatory bowel disease
    76. The vermiform appendix
    77. The large intestine
    78. Intestinal obstruction
    79. The rectum
    80. The anus and anal canal
  12. Genitourinary
    13. 81. Urinary symptoms and investigations
    82. The kidney and ureter
    83. The urinary bladder
    84. The prostate and seminal vesicles
    85. The urethra and penis
    86. The testis and scrotum
    87. Gynaecology
  13. Transplantation
    14. 88. Kidney transplantation and the principles of transplantation
    89. Liver transplantation
    90. Pancreas transplantation
    91. Intestinal and multivisceral transplantation
    92. Heart and lung transplantation
Basic Principles
2. Shock, haemorrhage and transfusion
INTRODUCTION
SHOCK
HAEMORRHAGE
Introduction
▢ Definition:
  • •
    Haemorrhage is the excess loss of blood due to rupture of blood vessels.
  • •
    Haemorrhage means the loss of blood from the vascular system associated with an absolute reduction in the circulating blood volume.
Pathophysiology
Classification
Arterial, Capillary and Venous haemorrhage
Based on vessel involved
▢ Arterial haemorrhage:
▢ Capillary haemorrhage:
▢ Venous haemorrhage:
Revealed and concealed haemorrhage
Based on view
▢ Revealed haemorrhage:
  • •
    External haemorrhage
  • •
    Examples
    1. Exsanguination from an open arterial wound.
    2. Massive haematemesis from a duodenal ulcer.
▢ Concealed haemorrhage:
  • •
    Contained within the body cavity
    • ◉ Traumatic concealed haemorrhage:
    ◉ Non-traumatic concealed haemorrhage:
    1. Occult gastrointestinal bleeding
    2. Ruptured aortic aneurysm
Primary, reactionary and secondary haemorrhage
Based on time of haemorrhage
▢ Primary haemorrhage:
  • •
    Primary haemorrhage is haemorrhage occurring immediately as a result of an injury (or surgery).
▢ Reactionary haemorrhage:
  • •
    Reactionary haemorrhage is due to dislodgement of a clot by resuscitation, normalisation of blood pressure and vasodilation.
  • •
    It is delayed hemorrhage (within 24 hours).
  • •
    It may be caused due to technical failure, such as slippage of a ligature.
▢ Secondary haemorrhage:
  • •
    Secondary haemorrhage is due to sloughing of the wall of a vessel.
  • •
    Occurs 7-14 days after injury.
  • •
    Precepitation factors
    1. Infection
    2. Pressure necrosis (such as from a drain)
    3. Malignancy
Surgical and non-surgical haemorrhage
Based on treatment modality
▢ Surgical haemorrhage:
  • •
    It is amenable to surgical control(e.g. suture ligation) or other technique such as angioembolisation.
▢ Non-surgical haemorrhage:
  • •
    It isn't amenable to surgical control.
  • •
    Treatment requires correction of the coagulation abnormalities.
  • •
    It is general bleeding from raw surfaces and mucous membranes due to coagulopathy.
Class I, II, III and IV
Based o degree of haemorrhage
Class 1
Class 2
Class 3
Class 4
Volume of
blood loss
<15%
15-30%
30-40%
>40%
Degree of haemorrhage
Haemorrhagic resuscitation
Identify haemorrhage
Damage control resuscitation (DCR)
▢ Rapid haemorrhage control:
▢ Permissive hypotension:
▢ Avoid dilutional coagulopathy:
▢ Treat existing coagulation deficits:
After haemorrhage control