Inadequate fluid resuscitation of the surgical patient with severe sepsis – A survey of junior doctors

Abstract

s / International Journal of Surgery 11 (2013) 686e745 696 ABSTRACTS Conclusion: Pre-course materials, particularly demonstration videos, are a valuable adjunct to suturing tutorials and can promote self-directed learning. 0785: INADEQUATE FLUID RESUSCITATION OF THE SURGICAL PATIENT WITH SEVERE SEPSIS e A SURVEY OF JUNIOR DOCTORS Michael Courtney, Bussa Gopinath, Matthew Toward, Rajesh Jain, Milind Rao. University Hospital of North Tees, Stockton-on-Tees, UK. Aim: The initial management of unwell surgical patients is commonly performed by junior doctors. Guidelines for severe sepsis recommend a minimum fluid challenge of 20ml/kg. This study aims to evaluate the volume of fluid challenge that junior doctors would give a severely septic surgical patient. Method: 3 scenarios were created involving a surgical patient with severe sepsis; weight differed in each (75kg, 100kg and 50kg), none had comorbidities, and the fluid was crystalloid. A questionnaire was produced asking the volume of fluid challenge that the doctor would give each patient, with multiple-choice answers of 250ml-2000ml. The questionnaire was distributed to junior doctors in a district general hospital for anonymous completion. Results: 77 questionnaires were completed, 40 by F1s, and 37 by SHOs (F2/ CT/Trust grade). All respondents are involved in management of surgical patients during their rotations. Of 231 answers, 12 were 20ml/kg. The median chosen volume in every scenario was 500ml, equating to 6.7ml/kg, 5.0ml/kg, and 10ml/kg respectively. Conclusions: Junior doctors give inadequate fluid challenges to severely septic surgical patients. They do not adjust the fluid volume according to body mass, and consequently heavier patients are more affected. More teaching/training, along with re-audit, is required to ensure improved patient care. 0787: DOES BELONGING TO AN UNDERGRADUATE SURGICAL SOCIETY REALLY IMPROVE STUDENTS' SURGICAL SKILLS? Matthew Smith , Lyudmila Kishikova , Jessica Bewick , Joseph Norris . Brighton and Sussex Medical School, Brighton, UK; Brighton and Sussex University Hospitals Trust, Brighton, UK. Aim: Undergraduate surgical societies provide an excellent opportunity to develop the surgical skills required of graduating doctors. However, the extent of this benefit is difficult to ascertain. Our project aimed to investigate the confidence of active surgical society members in performing basic surgical skills in comparison to a group of students only undergoing compulsory skills session during the undergraduate curriculum. Method: Surgical society members (n 1⁄4 82) and medical students in compulsory teaching (control, n 1⁄4 32) completed an anonymous questionnaire assessing their confidence in performing suturing, knot-tying, handwashing, gowning and assisting during laparoscopy. Student suturing and knot-tying ability was objectively assessed by a surgical registrar and scored on a five-point-scale. Results: The results of the questionnaire demonstrated that active surgical society members felt more confident performing the range of assessed surgical skills than the control group. Furthermore, surgical society members had significantly higher suturing and knot-tying scores than the control group (3 versus 2.6, respectively; p 1⁄4 0.0305). Conclusion: Our results suggest that active surgical society participation increases student confidence in performing basic surgical skills that are often neglected by official undergraduate medical curricula. 0822: APPENDICECTOMY: IS IT STILL AN SHO PROCEDURE? Christopher Emmett, Paul O'Loughlin, Poonam Valand, Claire Millins, John Martin, Venkatesh Shanmugam. Darlington Memorial Hospital,