General Surgery & Traumatology

Syllabus Unit: Clinical Medicine & Surgery

Why it matters

Chapter overview

General surgery in AIIMS PG spans the full operative journey — preoperative risk assessment and consent, the biology of how a wound actually heals, the rigid ABCDE sequence that saves trauma patients, and the staging principles that govern oncologic resection — each tested through precise definitions, named scoring systems and exact protocol steps rather than operative technique alone.

Postgraduate Medical Exam Syllabus Clinical Medicine & Surgery 50% weightage

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Time Out — before skin incision

Sign Out — before the patient leaves the operating room

1Principles of Surgical Management

Safe surgery begins before the incision — risk stratification, the WHO checklist and sterile technique determine outcomes as much as operative skill does.

Learning Objectives

Apply the ASA physical status classification (I-V) to grade preoperative anaesthetic risk.
List the three phases of the WHO Surgical Safety Checklist and when each is performed.
Differentiate sterilisation from disinfection and describe standard autoclave parameters.
State the requirements for valid informed consent before a surgical procedure.

Key Terms

ASA ClassificationA five-grade (I-V, plus VI for brain-dead organ donors) system grading preoperative physical status, used to predict anaesthetic and perioperative risk.

WHO Surgical Safety ChecklistA three-phase checklist (Sign In before anaesthesia, Time Out before incision, Sign Out before leaving the OR) shown to reduce surgical mortality and complications.

SterilisationComplete destruction of all microorganisms including spores (e.g. autoclaving at 121°C, 15 psi, for 15 minutes), distinct from disinfection which reduces but does not eliminate all pathogens.

Informed ConsentVoluntary, informed, competent patient agreement to a specific procedure after disclosure of risks, benefits and alternatives; written consent is mandatory for surgery under Indian medical law.

Every operation is preceded by three separate safety layers: a risk grade for the patient (ASA), a procedural checklist for the team (WHO Surgical Safety Checklist), and a sterility standard for the instruments and environment — each is independently examinable.

ASA physical status classification

ASA I — a normal, healthy patient.
ASA II — mild systemic disease without functional limitation (e.g. controlled hypertension, obesity).
ASA III — severe systemic disease with functional limitation (e.g. poorly controlled diabetes with end-organ effects).
ASA IV — severe systemic disease that is a constant threat to life.
ASA V — a moribund patient not expected to survive without the operation.

The WHO Surgical Safety Checklist

Three checkpoints are performed by the whole team out loud: Sign In (before induction of anaesthesia — confirms patient identity, site, consent), Time Out (before skin incision — confirms team introductions, procedure, antibiotic timing), and Sign Out (before the patient leaves the OR — confirms instrument/swab counts and specimen labelling).

Sterilisation and asepsis

Autoclaving (121°C, 15 psi, 15 minutes) is the standard for surgical instruments, destroying even bacterial spores; ethylene oxide is used for heat-sensitive equipment. This is distinct from disinfection (e.g. glutaraldehyde), which lowers the microbial load but does not reliably kill spores.

Key PointThe Spaulding classification links the required disinfection level to how an item contacts the patient: critical items (enter sterile tissue) need sterilisation, semicritical items (touch mucosa) need high-level disinfection, and noncritical items (touch intact skin) need only low-level disinfection.

Informed consent

Valid consent requires the patient to be competent, to receive adequate disclosure of risks/benefits/alternatives, and to agree voluntarily without coercion; it must be procedure-specific and, for surgery in India, must be in writing.