Circumcision: Kursus Sunathon

30.10.2016

Ahad

Sedikit daripada apa yang saya belajar dari kursus Sunathon di UIA kuantan pada sabtu dan ahad ini. Sengaja saya kongsikan agar ilmu tak dibiar terampai dan terus tersalur tak beralur. Oh ye, kursus Sunathon ini adalah suatu kursus yang mengajar setiap lapisan pengamal perubatan sama ada pelajar mahupun yang sudah bergelar doktor cara cara untuk mengkhatankan kanak kanak (bahasa mudah).

First, introducing the surgical equipments;
   • Kidney dish
   • Needle Holder
   • Scissors
   • 3 Artery Forceps
   • Forceps

* nak differentiate;
   - Needle holder has lock but no curve at the     tip
   - Artery forcep either tooth or untooth and has lock
   - Scissor has no lock

Other tools;
    • Catgut (needle, surgical thread)
    • Alcohol swab
    • Sharp bin (for sharp things; needle, catgut)
    • Syringe
    • Needles
    • Underpad
    • Disposable gloves

PRE OPERATION
    √ Introduce and build a good rapport with the parents and also the patients (history taking and consent).
    √ Seek if there is any medical conditions that may disqualify the patients from proceeding with Sunathon.
    √ Calm the patient.
    √ Explain the procedures and please do not lie especially for the painful part (local anesthesia).
    √ Re-check the consent form.

CIRCUMCISION FLOW

LOCAL ANESTHESIA
    √ Loosen the syringe
    √ Use needle 23g (long and large to easier the withdrawal of drugs)
    √ Withdraw 2ml of marcaine (long acting) and 2ml of lignocaine (short acting).
    √ Recap the needle and expel bubble (to prevent air emboli).
    √ Change the needle to 27g (short and tiny to reduce pain during injection).
    √ Alcohol swab (at the area of injection).
    √ Palpate to find the deep dorsal nerve (at the apex of symphysis pubis).
    √ Whole needle are in, aspirate to ensure that the needle is not going in to the vein (can cause ventricular tachycardia; increase in heart rate, and numbness of tongue).
    √ Inject 2ml of drugs.
    √ Inject subcutaneously into the left and right lateral pudendal nerves (only at the superficial, or else that part will swell).
    √ Wait for 1 minute and test the penis with the forceps.

*Precaution: Prevent needle prick injury!

CLEAN AND DRAPE
    √ Ungloved person open the dressing set.
    √ Gloved person put out all the things from the set except the cotton.
    √ Pour generously the iodine onto the cottons and normal saline into the another big compartment.
    √ Clean the penis using in to out technique (to prevent infection) 3 times using 3 cottons.
    √ Cut the drape (diamond shape at the center, pointing the patient's head; obliquely).

*If there is no iodine, it can be replaced with alcohol.

CIRCUMCISION PROCEDURE
    √ Remove smegma after clean and drape.
    √ Expose fully corona radiata.
    √ Hold the foreskin at three points (2,6,10 o' clock) using 3 artery forceps.
    √ Doctors will perform circumcision to remove foreskin.
    √ The procedure should be done within the time limit of the fast acting local anesthesia (20 mins).

SUTURING PROCEDURE (best part hihu)
    √ 6 sutures (6,12,2,8,4,10 o' clock) in sequence.
    √ Right hand hold the needle holder while the left hand hold the forceps.
    √ Hold the needle 2/3 from the sharp tip.
    √ 2, 1, 1 tying.
    √ Apply Chloramphenicol (CMC) around the site of surgery to finish up.

POST OPERATION
   √ Observe the patient for 30-60 mins for any complication, then follow up for a few days.
   √ Antibiotic-Amoxicillin (250mg/5ml): give 1 teaspoon 3 times daily, after meal. Must finish the medication.
   √ Painkiller-Ponstan (125mg/5ml): give 2 teaspoons PRN (when needed) max 3 times daily, after meal.
   √ Before patient leaves, advice parents and patients regarding care and wound.
      CMC: apply on clean and dry wound.

Notes seorang amatur *some are just taken from the notes given by the CUCMS team and some are my own notes. Moga bermanfaat.