The preparation for an urgent intervention outside of an operating room resolves itself into a question of asepsis or antisepsis, and around this point gathers a multitude of details. But it is necessary only to proceed systematically and intelligently to achieve excellent results.
Bonney, of Philadelphia, writes that he has done many major operations in the homes of the poor in the midst of the most unsurgical surroundings; nevertheless, the results have been excellent. Most of these operations were for urgent abdominal, pelvic, or genito-urinary disease, and though such work is often time-consuming and laborious, yet it shows what can be done in the case of necessity.
<Callout type="important" title="Systematic Approach">Every practitioner must feel assured that with decision, knowledge, and system, even under apparently unfavorable circumstances, they can nearly always realize effective antisepsis.</Callout>
Suppose a major emergency, with every detail of the preparation to be supervised; First Step — Have a fire started. Have the available receptacles assembled. Review the stock of linens if you do not have gauze or muslin. Freshly laundered handkerchiefs and napkins (without fringe) furnish material for excellent compresses and coverings for the field of operation.
<Callout type="gear" title="Essential Equipment">For boiling water, secure one or two large kettles—a copper wash-boiler—and three smaller receptacles such as enameled stewing-pans: one for boiling the instrument and sutures; another for brushes, irrigator, nozzles, and tube; the third for compresses and tampons.</Callout>
Second Step. Prepare the Operating Room and Table—If there is any choice, select the best lighted and largest room. If it is at night, arrange for illumination. Do not displace the furniture except to make room for the operating table, two small tables, and room to “tri about.” An extensive ‘clearing for action’ does more harm than good.
Third Step—Everything having boiled sufficiently, carry the vessels into the operating room and empty the contents of each into its special receptacle. If these bowls have not been boiled, now is the time to sterilize them by singeing with burning alcohol. Into each pour two or three spoonfuls of alcohol and set it on fire.
Fourth Step—Direct the assistant to begin anesthesia, and now prepare your hands. They are not to be prepared by a desultory rinsing in soapy water but by patient and systematic scrubbing. Get your sleeves rolled up and pinned. Have before you two wash basins, one with hot and the other with cold sterile water.
Fifth Step—In the meantime the anesthesia has progressed. When it is well under way, prepare the field of operation, which we assume has been previously shaved, by scrubbing with soap and water, followed by alcohol or ether and bichloride solution.
Key Takeaways
- Effective antisepsis is achievable even in non-hospital settings with proper preparation and systematic approach.
- Boiling water for at least half an hour is crucial for sterilizing instruments, sutures, and other materials.
- Proper hand hygiene involves thorough scrubbing with soap and hot water followed by alcohol and bichloride solution.
Practical Tips
- Use freshly laundered linens without fringe as excellent material for compresses and coverings in the field of operation.
- Sterilize bowls and dishes by pouring alcohol into them, setting it on fire to singe the inner surface thoroughly.
Warnings & Risks
- Do not displace furniture unnecessarily when preparing an operating room; this can stir up dust that has accumulated over time.
- Avoid using rubber gloves unless dealing with infective processes, as they are not indispensable but may offer extra protection against infection.
Modern Application
While the chapter emphasizes techniques for emergency surgery in non-hospital settings, many of its principles remain relevant today. The importance of sterilization and antisepsis is unchanged, though modern methods such as autoclaving have replaced boiling water for instrument sterilization. Understanding these historical practices can provide valuable insights into improvising medical care during emergencies.
Frequently Asked Questions
Q: What are the essential steps to prepare for an emergency surgery in a private home?
The essential steps include starting a fire, assembling receptacles and reviewing linens, preparing the operating room, sterilizing instruments and materials by boiling or using hot oil, and ensuring proper hand hygiene.
Q: How can one ensure effective antisepsis in an emergency setting?
Effective antisepsis is achieved through systematic preparation, thorough sterilization of equipment, and meticulous hand hygiene. This includes scrubbing hands with soap and hot water followed by alcohol and bichloride solution.
Q: What materials can be used as compresses in an emergency surgery setting?
Freshly laundered linens such as handkerchiefs and napkins without fringe are excellent materials for compresses and coverings in the field of operation. These provide a sterile environment similar to gauze or muslin.