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Transform your greatest weakness into your greatest strength

Weakness to Strength

There was once a 10 year old boy who decided to study judo despite the fact that he had lost his left arm in a devastating car accident. The boy began lessons with an old Japanese judo master. The boy was doing well, so he couldn’t understand why, after three months of training, the master had taught him only one move.

“Sensei,” the boy finally said, “shouldn’t I be learning more moves?”

“This is the only move you know, but this is the only move you’ll ever need to know,” the sensei replied.

Not quite understanding, but believing in his teacher, the boy kept training.
Several months later, the sensei took the boy to his first tournament. Surprising himself, the boy easily won his first two matches. The third match proved to be more difficult, but after some time, his opponent became impatient and charged; the boy deftly used his one move to win the match.
Still amazed by his success, the boy was now in the finals. This time, his opponent was bigger, stronger, and more experienced. For a while, the boy appeared to be overmatched. Concerned that the boy might get hurt, the referee called a timeout. He was about to stop the match when the sensei intervened.

“No,” the sensei insisted, “Let him continue.”

Soon after the match resumed, his opponent made a critical mistake: he dropped his guard. Instantly, the boy used his move to pin him. The boy had won the match and the tournament. He was the champion.

On the way home, the boy and sensei reviewed every move in each and every match. Then the boy summoned the courage to ask what was really on his mind.

“Sensei, how did I win the tournament with only one move?”

“You won for two reasons,” the sensei answered. “First, you’ve almost mastered one of the most difficult throws in all of judo. Second, the only known defense for that move is for your opponent to grab your left arm.”

The boy’s biggest weakness had become his biggest strength.

Gas Gangrene

Gas gangrene is a rapid spreading infective gangrene of the muscles characterized by collection of gas in the muscles and subcutaneous tissue. It is also called "Clostridial myonecrosis".

Gas Gangrene is most likely to develop in wounds where there has been extensive laceration or devitalization of muscle mass with gross contamination of the wound by soil and other foreign bodies.

Clostridial organisms can be divided into two groups - namely Saccharolytic and Proteolytic. Of the Saccharolytic group of anaerobes, Clostridium perfringes (Cl. welchii) plays the main part in gas gangrene.

Other organisms that cause gas gangrene are Clostridium oedematiens, Clostridium septicum, Clostridium histolyticum, and Clostridium bifermentans.

Two important factors necessary for the formation of gas gangrene include :

Entry of Clostridial organisms, particularly Clostridium perfringes (Cl. welchii), and
Anaerobic conditions within the wound

Diabetes and other occlusive arterial diseases predispose to gas gangrene.

The various exotoxins produced by these organisms (particularly Clostridium welchii) are:


Alpha toxin (Lecithinase)	Is hemolytic, and splits lecithin to phosphocholine and diglyceride.
Collagenase	Is a proteinase and breaks down collagen
Hyaluronidase	Breaks down hyaluronic acid
Theta toxin	Is hemolytic, lethal and necrotic
Leucocidin	Kills the leucocytes

Clostridial invasion affects the whole of the involved muscle from origin to insertion producing a foul smelling necrosis of the muscle which becomes dull red to green and ultimately black in appearance.
The muscle becomes green to black due to the action of the sulphurated hydrogen on iron liberated from broken down muscle hemoglobin. The gas is chiefly hydrogen, being odorless in the beginning, but soon it becomes fetid due to the liberation of sulphurated hydrogen (H2S), ammonia and volatile gases.

TYPES OF GAS GANGRENE


Clostridial cellulitis	Crepitant infection involving necrotic tissue, but healthy muscle is not involved and is characterized by foul smelling, seropurulent infection of a wound.
Single muscle type	Limited to one muscle only
Group type	Limited to one group of muscles, eg. extensors of the thigh
Massive type	Involves almost whole muscle mass of one limb
Fulminating type	Spreads very rapidly even beyond the limb, associated with intense toxemia

The most characteristic feature of gas gangrene is profuse discharge of brownish, foul smelling fluid between the sutures and the presence of crepitus due to presence of gas in the muscle and subcutaneous tissue.
The first prophylactic step in the prevention of gas gangrene wound is excision or debridement in which all the devitalized tissues, blood clots, dead and damaged muscles and foreign bodies should be removed.

What is Gastric lavage ?

Gastric lavage, also commonly called stomach pumping or gastric irrigation, is the process of cleaning out the contents of the stomach. It has been used for over 200 years as a means of eliminating poisons from the stomach. Gastric lavage involves the passage of a tube (such as an Ewald tube) via the mouth or nose down into the stomach followed by sequential administration and removal of small volumes of liquid.

- Useful within three hours after ingestion of the poison

PROCEDURE FOR GASTRIC LAVAGE

A stomach tube (Ewald's tube or Boa's tube) or ordinary, soft, noncollapsible rubber tube of length 1.5 meter and diameter 1 cm with a glass funnel attached on one end and a mark at 50 cm from the other end (which should be rounded with lateral openings) is used
Denture must be removed and mouth gag should be placed
Patient should be in left lateral position or head hanging over the edge of the bed and face supported by assistant.
The end is lubricated with olive oil or glycerine and is slowly passed into mouth and through the pharynx and oesophagus into the stomach till the 50 cm marking.
About 1/4th liter of lukewarm water should be passed through the funnel held high above the patient's head
When funnel is empty, compress the tube below the funnel between finger and thumb and lower it below the level of stomach. the contents will be emptied by siphoning action when the pressure is released.
This first stomach contents should be preserved for chemical analysis.

Gastric lavage can be done with:
- water
- 1:5000 Potassium Permanganate (KMnO4)
- 5 % Sodium Bicarbonate (NaHCO3)
- 4 % Tannic acid
- 1 % Sodium or potassium iodide
- 0.9 % saline

Repeat the wash with 1/2 liter suitable solution till clear and odorless fluid comes out.

CONTRAINDICATIONS OF GASTRIC LAVAGE:
Absolute Contraindication:
Corrosive poisoning except for carbolic acid

Relative Contraindication:
i. Convulsant poisoning
ii. Comatose patient
iii. Volatile poison
iv. upper GIT disease
v. Patient with marked hypothermia and hemorrhagic diathesis

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Transform your greatest weakness into your greatest strength

Gas Gangrene

What is Gastric lavage ?

MCQs on Diseases of Salivary Glands and Thyroid Glands - General Surgery MCQs Part 2