Surgery is no longer reserved to the elect few. That its beneficence shall be denied a place in every practitioner’s art is repugnant to the spirit of the times. Modern life is complex: every profession and every calling has its specific duty to perform. Whether the medical profession shall continue to play nobly its large part in the social drama depends upon the general practitioner. The hope of the profession rests in him. But there is a price to pay the age for high respect. That price to the medical profession is nothing less than the fulfillment of its therapeutic promise and the realization of its surgical opportunity. The opportunity is golden; for, with the wonderful improvements in surgical technic, the field of emergency surgery, that is to say, the indication for immediate intervention, -has been remarkably broadened and the time finds the public singularly favorable to that form of relief.
The general practitioner must be prepared to act quickly. Every doctor should have an emergency bag supplied with materials: hand brush fountain syringe, hypodermic syringe, catheters, flasks of alcohol, ether, chloroform and carbolic acid, bi-chloride tablets, a package of sterile compresses, sutures, bandages, a box of plaster of Paris, and certain instruments. Hand Brushes. -These are almost indispensable for emergency surgery. They should be kept well wrapped and should be cleansed with soap and hot water and sterilized by boiling for 1 minute before using. New brushes should be boiled in soda solution for five to ten minutes.
Fountain Syringe or Irrigator—One may use the full rubber outfit or, what is better, a porcelain container and a long rubber tube with glass noseles. It is absolutely essential that the whole be sterilized by boiling. The glass nozzles are likely to be broken if plunged directly into boiling water or if cooled too rapidly. If the porcelain container is used, it may be boiled and then singed with burning alcohol. It takes up but little room in the bag, and the tube and nozzles may be wrapped up and packed in it and the whole wrapped and kept clean and dry. This outfit is almost indispensable, for in many emergencies the only adequate treatment is by hypodermoclysis or intravenous infusion.
The Antiseptics -The alcohol must be kept in a well stopped flask and the carbolic acid or lysol, also. The bichloride may be in the form of tablets, so that the strength of a solution may be readily calculated. The most commonly employed is the formula containing mercury bi-chloride 7.3 gr., citric acid 3.8 gr. This tablet in one quart of water makes a 1 to 2000 solution, which is as strong as need be used. One to three pints makes a 1 to 3000 solution, and soon. Instead of the tablets, one may keep a concentrated solution of bichloride in alcohol.
Many English operators prefer a solution, 1-000 biniodide of mercury. A one-half ounce bottle of Tr. iodine should be carried and will be found excellent for emergency sterilizations of the skin.
Anesthetics -One should keep on hand at least one pint of ether and four to six ounces of chloroform. Cocaine for local anesthesia is best kept in tablet form and the solutions made extemporaneously. For example, 2 1/2-grain tablets of cocaine to 1 teaspoonful of sterile water makes a 2 per cent. solution; 4 1/2-grain tablets to a teaspoonful of water makes a 4 per cent. solution; 10 1/2-grain tablet 40 per cent. solution. This is not exact, of course, but it serves as a good working rule for the emergency. Ethyt chloride for local freezing is put up in small containers convenient for the emergency bag.
Sterile Gauze -Too frequently the practitioner commits the error of depending upon absorbent cotton for his sponges and compresses. Absorbent cotton, as found on the market, is scarcely ever aseptic. Even if it is, it is almost certain to be contaminated in getting it out of the package. A supply of sterile gauze is one of the best means of promoting an aseptic operation. It should be kept in a hermetically sealed package of metal or glass.
In lieu of the gauze compresses readily sterilized, one may carry a supply of ordinary gauze which can be cut into appropriate sizes and sterilized at the time of operation. It is a good idea to cut two sizes; a small for compresses and wipers, a larger to cover the field of operation. All these pieces should be folded once and the borders hemmed. A ball of cotton may be hemmed in between the layers, which makes a still better sponge.
Swires and Ligatures -If these materials are not already sterilized and in a special package or container, such as a sealed tube of alcohol, catgut must be ruled out, for its preparation takes too much time. One should take care to have several sizes of silk, especially the 0 and 10 for these are the sizes required in intestinal work. Silk and silk worm-gut may be sterilized as needed.
Catheters and bougies should be kept in a metallic box. Rubber and metal catheters arc always readily sterilized by boiling. Rubber catheters deteriorate rapidly unless properly cared for. They may break unexpectedly, the result of an unnoticed change in quality, and a piece be left in the bladder.
Drainage Tubes -These should be preserved in a box or bottle which may be boiled thoroughly before opening.
Plaster should be kept in a tin box with tight cover and may be loose or already rolled. A supply of roller bandages is, of course, always kept on hand, from which the plaster bandages may be made. What might be enumerated must, of course, be subject to the widest variation. But the feeling of greatest contentence goes with the consciousness of having the necessary things with which to act. On the whole, the doctor should pride himself upon the completeness of his outfit, rather than upon his ability to improvise.
Cleaning instruments and preserving them from rust is a matter of no small importance. After each operation they should be taken apart, scrubbed with soap and warm water, wiped with gauze saturated with alcohol, and dried thoroughly. If the cleansing has been delayed, it may be necessary to immerse them for a short time in a solution of potash, and finally cleanse in the manner described. If any stains still persist they should be polished with chamois skin.
Formaldehyde, certain acids, and iodine in too close proximity, tarnish and spoil instruments in spite of care.
A dish or two of calcium chloride in the instrument case will absorb moisture and tend to prevent rusting. Too often the practitioner neglects his instruments because, perhaps, not often used; and, in the emergency, he finds himself with knives rusty and without an edge, scissors that will not cut, and forceps that have no grip. He will certainly gain time by spending a little time in carrying out these small details.
<Callout type="tip" title="Pro Technique">Always keep your emergency bag organized to ensure quick access during critical moments.</Callout>
<Callout type="warning" title="Safety Hazard">Avoid using broken or rusty instruments, as they can cause severe injuries and infections.</Callout>
Key Takeaways
- General practitioners must carry an emergency bag with essential surgical materials.
- Proper sterilization of instruments is crucial to prevent infections.
- A well-organized and complete emergency kit can save lives in critical situations.
Practical Tips
- Always keep your emergency bag organized to ensure quick access during critical moments.
- Regularly check the expiration dates on anesthetics like ether and chloroform to avoid using outdated supplies.
- Use sterile gauze instead of absorbent cotton for better aseptic operations.
Warnings & Risks
- Avoid using broken or rusty instruments, as they can cause severe injuries and infections.
- Do not neglect the sterilization process; improper sterilization can lead to serious complications.
- Be aware that some materials like rubber catheters may deteriorate over time and require regular replacement.
Modern Application
While many of the specific tools and techniques described in this chapter are outdated, the principle of preparedness remains crucial for modern survival scenarios. Understanding basic emergency surgery can help in situations where immediate medical care is unavailable. Modern first aid kits should include some of these items, such as sterile gauze, antiseptics, and basic surgical instruments.
Frequently Asked Questions
Q: What are the most important items to include in an emergency surgeon's kit?
The most critical items include a hand brush fountain syringe, hypodermic syringe, flasks of alcohol, ether, chloroform, and carbolic acid. Sterile gauze, sutures, bandages, and specific instruments like scalpels are also essential.
Q: How should I sterilize my surgical instruments?
Instruments should be cleaned with soap and hot water, then wiped with alcohol and dried thoroughly. They can be boiled for 1 minute to ensure thorough sterilization.
Q: What are the risks of using outdated anesthetics like ether or chloroform?
Using outdated anesthetics can lead to ineffective anesthesia, which may result in complications during surgery. Always check expiration dates and replace them as needed.