Protocol for General Surgery (HAN)

General

• Names/details of every admission under General Surgery by H@N team must be written on the admissions board on Ward 7 doctors office
• Any intra-hospital referrals to on-call middle grade surgeon should be from on call Registrar or equivalent for the speciality
  Any referral from A&E with surgical problems such as head injury or abdominal pain should be seen and reviewed by A&E or HaN team initially and if required referral to on-call Middle grade surgeon can be made
  according to action plans ( see below )
• All the GP referrals will be directed to the HaN team. If appropriate they can consult with the on-call middle  grade surgeon carrying bleep 6008
• Any Paediatric Surgical patients (younger than 16 years) should be discussed with on-call Paediatricians/ Paediatric Practitioner. Middle grade surgeon on call should be involved if felt necessary by the on-call  paediatric team.
• In case of A&E stand-by of any possible surgical emergencies of any age group, on-call middle grade surgeon shall be call upon.

Disease specific

1. Abdominal pain:
   1. Adequate analgesia should be administered to all patients
   2. Urine dip must be performed for all patients
   3. All patients should have FBC, CRP, Urea & Electrolytes, Liver Function Tests and Amylase levels.
   4. All female patients (reproductive age group) must have urinary and/or serum β HCG test.
   5. Appropriate erect chest(CXR) & abdominal (AXR) should be arranged
   6. Clinical examination of all patients
      • Must comment on:
        • Abdominal consistency
        • Abdominal tenderness
        • Bowel sounds
        • Hernia orifices
      • Should include a Digital Rectal Examination as appropriate
      • Please note: All new admissions with (fresh or altered) PR bleeding are admitted under medical (not surgical) team at BGH
      • Should comment on relevant clinical signs: Murphy’s, Rovsing’s, rebound tenderness…etc
        
        
2. Head injury; Secondary Survey in accordance to ATLS must be performed on all patients. Indications^ψ for discussion with on-call middle grade surgeon:
   i. GCS less than 13.
   ii. Signs of fracture of base of skull.
   iii. Skull vault fracture on plain skull radiogram.
   iv. More than one episode of vomiting.
   v. Any convulsions.
   vi. Any (new) focal neurological deficit.
   vii. Any visual disturbances.
   viii. Any patients on anticoagulantsΩ or Aspirin

Action plans

ψ They are the NICE/SIGN guidelines for performing CT brain scan for head injury patients.
Ω All these patients must have coagulation profile check.
∑ If patient has two or more severity markers or SIRS, she/he must be reviewed by on-call middle grade
surgeon