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Surgical Careat the District Hospital
2002 , 512 pages [E] ISBN 92 4 154575 5CHF/US$ 50.00In developing countries: CHF/US$ 25.00Order no.1150522
Many patients who present to district (first-referral) level hospitalsrequire surgical treatment for trauma, obstetric, abdominal ororthopaedic emergencies. Often surgery cannot be safelypostponed to allow their transfer to a secondary or tertiary-levelhospital, but many district hospitals in developing countries haveno specialist surgical teams and are staffed by medical, nursing andparamedical personnel who perform a wide range of surgicalprocedures, often with inadequate training. The quality of surgicaland acute care is often further constrained by poor facilities,inadequate low-technology apparatus and limited supplies ofdrugs, materials and other essentials.
The mission of the team responsible for Clinical Procedures in theWorld Health Organization Department of Essential HealthTechnologies (EHT) is to promote the quality of clinical carethrough the identification, promotion and standardization ofappropriate procedures, equipment and materials, particularly atdistrict hospital level. The Departement has identified educationand training as a particular priority, especially for non-specialistpractitioners who practise surgery and anaesthesia. It has thereforedeveloped Surgical Care at the District Hospital as a practicalresource for individual practitioners and for use in undergraduateand postgraduate programmes, in-service training and continuingmedical education programmes.
The manual is a successor of three earlier publications that arewidely used throughout the world and that remain importantreference texts: General Surgery at the District Hospital (WHO,1988), Surgery at the District Hospital: Obstetrics Gynaecology,Orthopaedics and Traumatology (WHO, 1991), Anaesthesia at the District Hospital (WHO, 1988; second edition 2000).
This new manual draws together material from these threepublications into a single volume which includes new and updatedmaterial, as well as material from Managing Complications inPregnancy and Childbirth: A Guide for Midwives and Doctors(WHO, 2000).
"...Indispensable manualfor outlying
health centres."- International Federation
of Surgical Colleges
"... While the generalreader is most likely
enjoying all theadvantages of
sophisticated surgery,much of the world's
population has no accessto even simpler
procedures and traumacare. This worthwhile
manual goes a long wayto closing that gap."
- Annals of Burns and Fire Disasters
Surgical service
• Organization and management of the district surgical service
• The district hospital • Leadership, team skills and
management • Ethics • Education • Record keeping • Evaluation • Disaster and trauma planning • The surgical domain: creating
the environment for surgery• Infection control and asepsis • Equipment • Operating room • Cleaning, sterilization and
disinfection • Waste disposal
Fundamentals of surgical practice
• Approach to the surgical patient• The paediatric patient • Surgical techniques• Tissue handling • Suture and suture technique • Prophylaxis • Basic Surgical Procedures• Wound and lacerations
management • Burns • Foreign bodies • Cellulitis and abscess• Excision and biopsies
The abdomen
• Laparotomy and abdominal trauma
• Assessment and diagnosis of acute abdominal conditions
• Intestinal obstruction • Peritonitis • Stomach and duodenum • Gallbladder • Appendix • Abdominal wall hernia
and groin hernias • Surgical repair of inguinal hernia • Surgical repair of femoral hernia • Surgical treatment
of strangulated groin hernia • Surgical repair of umbilical
and para-umbilical hernia • Surgical repair of epigastric
hernia • Incisional hernia • Urinary tract and perineum• Urinary bladder, male urethra,
male circumcision
Resuscitation andpractical anaesthesia
• Management of emergencies and cardiopulmonary resuscitation
• Intravenous access and fluids • Drugs in resuscitation • Preoperative assessment
and investigations • Anaesthetic issues
in the emergency situation • Important medical conditions
for the anaesthetist • General anaesthesia • Anaesthesia during pregnancy
and for operative delivery • Paediatric anaesthesia • Conduction anaesthesia • Specimen anaesthetic techniques • Monitoring the anaesthetized
patient • Postoperative management • Anaesthetic equipment and
supplies for different level hospitals
• Anaesthesia and oxygen • Fires, explosions and other risks • Care and maintenance
of equipment
Traumatology and orthopaedics
• Acute trauma management• Principles of Primary Trauma Care • Six phases of Primary Trauma Care • Orthopaedic techniques• Traction • Casts and splints • Application of external fixation • Diagnostic imaging • Physical therapy • Cranial burr holes • Orthopaedic trauma• Upper extremity injuries • Fractures of the pelvis and hip • Injuries of the lower extremity • Spine injuries • Fractures in children • Amputations • Complications • War related trauma • General orthopaedics• Congenital and developmental
problems • Bone tumours • Infection • Degenerative conditions
Emergency obstetric care
• Hypertension in pregnancy• Assessment and management • Delivery • Postpartum care • Chronic hypertension • Complications • Management of slow progress
of labour• Slow progress of labour • Progress of labour • Operative procedures • Bleeding in pregnancy
and childbirth• Diagnosis and initial
management • Specific management • Procedures • Aftercare and follow-up
Organizing the district hospital
WHP.DIV 522Order form
• "Surgical Care at the District Hospital"at the price of CHF/US$ 50.00;
In developing countries: CHF/US$ 25.00 (Order no. 1150522)___ Please add CHF 12.00/US$10.80 for postal mail charges___ Please add CHF 34.00/US$ 30.60 for courier servicescharges
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Return to: WHO • WHO PressCH-1211 Geneva 27 • SwitzerlandTel +41 22 791 32 64 • Fax +41 22 791 48 57 E-mail: bookorders@who.int
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