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- •Acknowledgements
- •Foreword
- •Contents
- •Preface
- •Recognition of the Sick Patient
- •Shock and Organ Perfusion
- •Outcomes of Resuscitation
- •Investigations
- •Fluid and Electrolyte Replacement
- •Haematological Therapy
- •Coagulopathy
- •Antibiotics
- •Emergency Laparoscopic Surgery
- •Approach to Traumatic Abdominal Pain
- •Ancillary Investigations in the ED
- •Indications for Referral
- •References
- •Risk Factors for Surgery
- •Postoperative Care
- •Intensive Care/High Dependency
- •Sepsis Syndromes
- •Acute respiratory distress syndrome(ARDS)
- •Blood transfusion and blood component therapy
- •Postoperative Oliguria
- •Renal Replacement Therapy (RRT)
- •Abdominal compartment syndrome (ACS)
- •Nutrition
- •Pros and cons of TPN
- •Introduction
- •Initial Management
- •Rockall score
- •Glasgow–Blatchford score
- •Medical Therapy
- •Endoscopic Therapy
- •Timing of endoscopy
- •Epinephrine injection
- •Thermal therapy
- •Argon plasma coagulation
- •Endoscopic clipping
- •Failure of endoscopic therapy
- •References
- •Introduction
- •Management of Variceal Bleeding
- •Medical Management and Resuscitation
- •Endoscopic Management
- •Variceal band ligation
- •Cyanoacrylate glue
- •Endoscopic sclerotherapy
- •Subsequent endoscopy
- •Portosystemic shunts: TIPS and surgery
- •References
- •Introduction
- •Management Options
- •Catheter Angiography
- •CT Angiography
- •Embolic Agents
- •Complications of Angiography
- •Indirect Bleeding
- •References
- •I. Indications
- •II. Preoperative Preparation
- •B. Over-Sewing a Bleeding Ulcer
- •Pyloroplasty/gastroenterostomy
- •Truncal vagotomy
- •Ensure safe duodenal stump closure
- •Dealing with problems related to the posterior duodenal ulcer penetratinginto the pancreas
- •Mobilisation of distal stomach
- •Billroth II gastroenteral anastomosis
- •Surgical Techniques for BleedingGastric Ulcer
- •F. Local Excision of Gastric Ulcer
- •Key Points in Billroth I Gastrectomyfor Bleeding Gastric Ulcer
- •Incisional wound closure
- •Postoperative care
- •References
- •Indications
- •Preoperative Preparation
- •Operative Treatment
- •A. Benign Duodenal Ulcer Perforation
- •B. Benign Gastric Ulcer Perforations
- •References
- •2. Preoperative Preparation
- •3. Surgery
- •Open Appendectomy
- •Introduction
- •General Complications
- •Thromboembolism
- •Atelectasis
- •Nausea and Vomiting
- •Wound Complications
- •Acute Abdominal Complications
- •1. Bleeding
- •2. Leaks
- •Treatment options for GJ leak
- •Managing sleeve leak
- •3. Stenosis and Stricture
- •4. Gastric Band Slippage and IntestinalObstruction
- •5. Other Complications
- •Gastric banding
- •Gastric bypass
- •Nutritional problems
- •1. Indications
- •Operative Strategy of Acute Appendicitis
- •Laparoscopic Appendectomy
- •4. Postoperative care
- •Special Situations
- •Introduction
- •Management of Acute Sigmoid Colonic Diverticulitis
- •A. Preoperative Management
- •B. Indications for Surgery
- •C. Options of Surgical Procedure
- •Two-stage approach
- •Single-stage approach
- •Role of laparoscopic surgery in acute perforative sigmoid colonic diverticulitis
- •E. Position of Patient for Surgery
- •Intra-Operative Surgical Techniques
- •A. Incision and Laparotomy
- •Tips and tricks to help locate the ‘difficult’ left ureter
- •Common sites of left ureteric injury during anterior resection
- •D. Splenic Flexure Take Down
- •Tips and tricks to tackle difficultsplenic flexure
- •E. Vascular Control
- •Ligation of the inferior mesenteric artery (IMA)
- •How to identify the IMA?
- •On-table colonic lavage
- •When is it not safe to anastomose?
- •J. Completion of Surgery
- •K. Postoperation Care
- •References
- •Introduction
- •I. Preoperative Management
- •II. Management Options
- •III. Endoscopic Colonic Stenting
- •Indications
- •IV. Defunctioning Stoma
- •Indications
- •Postoperative Considerations
- •References
- •Definition
- •Risk Factors for DifficultLaparoscopic Cholecystectomyin Acute Cholecystitis
- •Preoperative preparation
- •Surgical Treatment
- •Laparoscopic approach
- •References
- •Pre- ERCP Preparation
- •ERCP for Choledocholithiasis
- •ERCP in Bile Duct Injuries
- •Difficult Biliary Cannulation
- •Post- ERCP Care
- •References
- •A) Acute Cholangitis
- •C) Bile Duct Injuries During Surgery
- •D) Pancreatic Trauma
- •E) ERCP Perforation
- •I. Introduction
- •IV. Postoperative Management
- •Special situations
- •Final Note
- •Introduction
- •Disadvantages of Radiological Drainage
- •Radiological Evaluation of the Abscess
- •1) Diagnosis of Abscess
- •2) Identify a Potential Cause for an Abscess
- •3) Determine Drainability of an Abscess
- •4) Identifying the Complications from an Abscess
- •5) Aid Drainage Planning
- •Role of RadiologicalIntervention
- •Contraindications
- •Technique
- •Imaging Guidance
- •Insertion of the Drain
- •Drainage Catheter
- •Site Specific Comments on Radiological Drainage of Intra-Abdominal Abscess
- •Liver Abscess
- •Subphrenic and Lesser Sac Abscess
- •Percutaneous Cholecystostomy
- •Pancreatic Collection/Abscess
- •Pelvic Abscess
- •Enteric Abscess
- •Others
- •Conclusion
- •References
- •I. Ectopic Pregnancy
- •Operative procedures
- •II. Ruptured Tubo-Ovarian Abscess
- •Preoperative
- •Operative procedures
- •Postoperative
- •III. Haemorrhage or LeakingOvarian Cyst and Adnexal Torsion
- •A. Adnexal torsion
- •Preoperative — Benign Ovarian Cyst
- •Laparoscopic intervention
- •2. Laparoscopic ovarian oophorectomy
- •3. Open Cystectomy
- •Introduction
- •Repair of Bladder Injuries
- •Boari Flap
- •Other Manoeuvres
- •Post-Operative Care
- •Conclusion
- •II. Perioperative Care
- •IV. Mycotic Aneurysms
- •VI. Post-Surgery Follow-up
- •I. Introduction and Indications
- •II. Preoperative Management
- •III. OT Preparation
- •IV. Operative Procedure
- •Damage Control Mode
- •Splenic Injuries
- •Bowel Injuries
- •Kidney Injuries
- •Pancreatic Injuries
- •Liver Injuries
- •VI. Postoperative Care
- •V. Wound Closure
- •Introduction
- •Preoperative Planning
- •Choice of Surgical Technique
- •Operative Procedure
- •1. Component Separation Technique
- •3. Bilateral Skin Flap Advancement
- •5. Use of Alloplastic Materials
- •Postoperative Management
- •References
- •Laparotomy
- •Laparoscopy
- •Interventional Radiology
- •Air Enema
- •Neonatal Intestinal Obstruction
- •Duodenal Atresia
- •Duodenoduodenostomy
- •Malrotation with Volvulus
- •Intestinal Atresia
- •Hirschsprung’s Disease (HD)
- •Anorectal Malformations
- •Inguinal Hernia in Children
- •References
- •Introduction
- •Benefits of Laparoscopy in Emergency
- •Indications of Emergency Laparoscopy
- •Instrumentation
- •Instruments for Removal of Specimen
- •Instruments for Port Closure
- •Patient Position and O.T. Setup
- •Suggested Reading
- •Index
- •Uploaded by [StormRG]
- •Contents

in the 1990s. Subsequent studies have confirmed the potential health
damage with the plastic degrading slowly and remaining in the
lungs to accumulate in volume. Wuhan researchers used a machine
simulating human breathing to establish that masks shed up to
nearly 4,000 microplastic fibres in a month with reused masks
producing more. Scientists said some masks are laced with toxic
chemicals and a variety of compounds seriously restricted for both
health and environmental reasons. They include cobalt (used in blue
dye) and formaldehyde known to cause watery eyes, burning
sensations in the eyes, nose, and throat, plus coughing, wheezing
and nausea. No – that must be ‘Covid-19’.
Mask ‘worms’
There is another and potentially even more sinister content of masks.
Mostly new masks of different makes filmed under a microscope
around the world have been found to contain strange black fibres or
‘worms’ that appear to move or ‘crawl’ by themselves and react to
heat and water. The nearest I have seen to them are the selfreplicating fibres that are pulled out through the skin of those
suffering from Morgellons disease which has been connected to the
phenomena of ‘chemtrails’ which I will bring into the story later on.
Morgellons fibres continue to grow outside the body and have a
form of artificial intelligence. Black ‘worm’ fibres in masks have that
kind of feel to them and there is a nanotechnology technique called
‘worm micelles’ which carry and release drugs or anything else you
want to deliver to the body. For sure the suppression of humanity by
mind altering drugs is the Cult agenda big time and the more
excuses they can find to gain access to the body the more
opportunities there are to make that happen whether through
‘vaccines’ or masks pushed against the mouth and nose for hours on
end.
So let us summarise the pros and cons of masks:

Against masks: Breathing in your own carbon dioxide; depriving the
body and brain of sufficient oxygen; build-up of toxins in the mask
that can be breathed into the lungs and cause rashes on the face and
‘mask-mouth’; breathing microplastic fibres and toxic chemicals into
the lungs; dehumanisation and deleting individualisation by literally
making people faceless; destroying human emotional interaction
through facial expression and deleting parental connection with
their babies which look for guidance to their facial expression.
For masks: They don’t protect you from a ‘virus’ that doesn’t exist
and even if it did ‘viral’ particles are so minute they are smaller than
the holes in the mask.
Governments, police, supermarkets, businesses, transport
companies, and all the rest who seek to impose masks have done no
risk assessment on their consequences for health and psychology
and are now open to group lawsuits when the impact becomes clear
with a cumulative epidemic of respiratory and other disease.
Authorities will try to exploit these effects and hide the real cause by
dubbing them ‘Covid-19’. Can you imagine seing out to force the
population to wear health-destroying masks without doing any
assessment of the risks? It is criminal and it is evil, but then how
many people targeted in this way, who see their children told to
wear them all day at school, have asked for a risk assessment?
Billions can’t be imposed upon by the few unless the billions allow it.
Oh, yes, with just a tinge of irony, 85 percent of all masks made
worldwide come from China.
Wash your hands in toxic shite
‘Covid’ rules include the use of toxic sanitisers and again the health
consequences of constantly applying toxins to be absorbed through
the skin is obvious to any level of Renegade Mind. America’s Food
and Drug Administration (FDA) said that sanitisers are drugs and
issued a warning about 75 dangerous brands which contain

methanol used in antifreeze and can cause death, kidney damage
and blindness. The FDA circulated the following warning even for
those brands that it claims to be safe:
Store hand sanitizer out of the reach of pets and children, and children should use it only with
adult supervision. Do not drink hand sanitizer. This is particularly important for young
children, especially toddlers, who may be attracted by the pleasant smell or brightly colored
bottles of hand sanitizer.
Drinking even a small amount of hand sanitizer can cause alcohol poisoning in children.
(However, there is no need to be concerned if your children eat with or lick their hands after
using hand sanitizer.) During this coronavirus pandemic, poison control centers have had an
increase in calls about accidental ingestion of hand sanitizer, so it is important that adults
monitor young children’s use.
Do not allow pets to swallow hand sanitizer. If you think your pet has eaten something
potentially dangerous, call your veterinarian or a pet poison control center right away. Hand
sanitizer is flammable and should be stored away from heat and flames. When using hand
sanitizer, rub your hands until they feel completely dry before performing activities that may
involve heat, sparks, static electricity, or open flames.
There you go, perfectly safe, then, and that’s without even a mention
of the toxins absorbed through the skin. Come on kids – sanitise
your hands everywhere you go. It will save you from the ‘virus’. Put
all these elements together of the ‘Covid’ normal and see how much
health and psychology is being cumulatively damaged, even
devastated, to ‘protect your health’. Makes sense, right? They are
only imposing these things because they care, right? Right?
Submitting to insanity
Psychological reframing of the population goes very deep and is
done in many less obvious ways. I hear people say how
contradictory and crazy ‘Covid’ rules are and how they are ever
changing. This is explained away by dismissing those involved as
idiots. It is a big mistake. The Cult is delighted if its cold calculation
is perceived as incompetence and idiocy when it is anything but. Oh,
yes, there are idiots within the system – lots of them – but they are
administering the Cult agenda, mostly unknowingly. They are not
deciding and dictating it. The bulwark against tyranny is self-

respect, always has been, always will be. It is self-respect that has
broken every tyranny in history. By its very nature self-respect will
not bow to oppression and its perpetrators. There is so lile selfrespect that it’s always the few that overturn dictators. Many may
eventually follow, but the few with the iron spines (self-respect) kick
it off and generate the momentum. The Cult targets self-respect in
the knowledge that once this has gone only submission remains.
Crazy, contradictory, ever-changing ‘Covid’ rules are systematically
applied by psychologists to delete self-respect. They want you to see
that the rules make no sense. It is one thing to decide to do
something when you have made the choice based on evidence and
logic. You still retain your self-respect. It is quite another when you
can see what you are being told to do is insane, ridiculous and
makes no sense, and yet you still do it. Your self-respect is
extinguished and this has been happening as ever more obviously
stupid and nonsensical things have been demanded and the great
majority have complied even when they can see they are stupid and
nonsensical.
People walk around in face-nappies knowing they are damaging
their health and make no difference to a ‘virus’. They do it in fear of
not doing it. I know it’s da, but I’ll do it anyway. When that
happens something dies inside of you and submissive reframing has
begun. Next there’s a need to hide from yourself that you have
conceded your self-respect and you convince yourself that you have
not really submied to fear and intimidation. You begin to believe
that you are complying with craziness because it’s the right thing to
do. When first you concede your self-respect of 2+2 = 4 to 2+2 = 5 you
know you are compromising your self-respect. Gradually to avoid
facing that fact you begin to believe that 2+2=5. You have been
reframed and I have been watching this process happening in the
human psyche on an industrial scale. The Cult is working to break
your spirit and one of its major tools in that war is humiliation. I
read how former American soldier Bradley Manning (later Chelsea
Manning aer a sex-change) was treated aer being jailed for
supplying WikiLeaks with documents exposing the enormity of

government and elite mendacity. Manning was isolated in solitary
confinement for eight months, put under 24-hour surveillance,
forced to hand over clothing before going to bed, and stand naked
for every roll call. This is systematic humiliation. The introduction of
anal swab ‘Covid’ tests in China has been done for the same reason
to delete self-respect and induce compliant submission. Anal swabs
are mandatory for incoming passengers in parts of China and
American diplomats have said they were forced to undergo the
indignity which would have been calculated humiliation by the
Cult-owned Chinese government that has America in its sights.
Government-people: An abusive relationship
Spirit-breaking psychological techniques include giving people hope
and apparent respite from tyranny only to take it away again. This
happened in the UK during Christmas, 2020, when the psychopsychologists and their political lackeys announced an easing of
restrictions over the holiday only to reimpose them almost
immediately on the basis of yet another lie. There is a big
psychological difference between geing used to oppression and
being given hope of relief only to have that dashed. Psychologists
know this and we have seen the technique used repeatedly. Then
there is traumatising people before you introduce more extreme
regulations that require compliance. A perfect case was the
announcement by the dark and sinister Whiy and Vallance in the
UK that ‘new data’ predicted that 4,000 could die every day over the
winter of 2020/2021 if we did not lockdown again. I think they call it
lying and aer traumatising people with that claim out came
Jackboot Johnson the next day with new curbs on human freedom.
Psychologists know that a frightened and traumatised mind
becomes suggestable to submission and behaviour reframing.
Underpinning all this has been to make people fearful and
suspicious of each other and see themselves as a potential danger to
others. In league with deleted self-respect you have the perfect
psychological recipe for self-loathing. The relationship between
authority and public is now demonstrably the same as that of

subservience to an abusive partner. These are signs of an abusive
relationship explained by psychologist Leslie Becker-Phelps:
Psychological and emotional abuse:
Undermining a partner’s
self-worth with verbal aacks, name-calling, and beliling.
Humiliating the partner in public, unjustly accusing them of having
an affair, or interrogating them about their every behavior. Keeping
partner confused or off balance by saying they were just kidding or
blaming the partner for ‘making’ them act this way … Feigning in
public that they care while turning against them in private. This
leads to victims frequently feeling confused, incompetent, unworthy,
hopeless, and chronically self-doubting. [Apply these techniques to
how governments have treated the population since New Year, 2020,
and the parallels are obvious.]
Physical abuse:
The abuser might physically harm their partner in
a range of ways, such as grabbing, hiing, punching, or shoving
them. They might throw objects at them or harm them with a
weapon. [Observe the physical harm imposed by masks, lockdown,
and so on.]
Threats and intimidation:
One way abusers keep their partners in
line is by instilling fear. They might be verbally threatening, or give
threatening looks or gestures. Abusers oen make it known that
they are tracking their partner’s every move. They might destroy
their partner’s possessions, threaten to harm them, or threaten to
harm their family members. Not surprisingly, victims of this abuse
oen feel anxiety, fear, and panic. [No words necessary.]
Isolation:
Abusers oen limit their partner’s activities, forbidding
them to talk or interact with friends or family. They might limit
access to a car or even turn off their phone. All of this might be done
by physically holding them against their will, but is oen
more isolated a person feels, the fewer resources they have to help
gain perspective on their situation and to escape from it. [No words
necessary.]

Economic abuse:
Abusers oen make their partners beholden to
them for money by controlling access to funds of any kind. They
might prevent their partner from geing a job or withhold access to
money they earn from a job. This creates financial dependency that
makes leaving the relationship very difficult. [See destruction of
livelihoods and the proposed meagre ‘guaranteed income’ so long as
you do whatever you are told.]
Using children:
An abuser might disparage their partner’s
parenting skills, tell their children lies about their partner, threaten
to take custody of their children, or threaten to harm their children.
These tactics instil fear and oen elicit compliance. [See reframed
social service mafia and how children are being mercilessly abused
by the state over ‘Covid’ while their parents look on too frightened
to do anything.]
A further recurring trait in an abusive relationship is the abused
blaming themselves for their abuse and making excuses for the
abuser. We have the public blaming each other for lockdown abuse
by government and many making excuses for the government while
aacking those who challenge the government. How oen we have
heard authorities say that rules are being imposed or reimposed only
because people have refused to ‘behave’ and follow the rules. We
don’t want to do it – it’s you.
Renegade Minds are an antidote to all of these things. They will
never concede their self-respect no maer what the circumstances.
Even when apparent humiliation is heaped upon them they laugh in
its face and reflect back the humiliation on the abuser where it
belongs. Renegade Minds will never wear masks they know are only
imposed to humiliate, suppress and damage both physically and
psychologically. Consequences will take care of themselves and they
will never break their spirit or cause them to concede to tyranny. UK
newspaper columnist Peter Hitchens was one of the few in the
mainstream media to speak out against lockdowns and forced
vaccinations. He then announced he had taken the jab. He wanted to
see family members abroad and he believed vaccine passports were
inevitable even though they had not yet been introduced. Hitchens

has a questioning and critical mind, but not a Renegade one. If he
had no amount of pressure would have made him concede. Hitchens
excused his action by saying that the bale has been lost. Renegade
Minds never accept defeat when freedom is at stake and even if they
are the last one standing the self-respect of not submiing to tyranny
is more important than any outcome or any consequence.
That’s why Renegade Minds are the only minds that ever changed
anything worth changing.

‘
R
CHAPTER EIGHT
‘Reframing’ insanity
Insanity is relative. It depends on who has who locked in what cage
Ray Bradbury
eframing’ a mind means simply to change its perception and
behaviour. This can be done subconsciously to such an extent
that subjects have no idea they have been ‘reframed’ while to any
observer changes in behaviour and aitudes are obvious.
Human society is being reframed on a ginormous scale since the
start of 2020 and here we have the reason why psychologists rather
than doctors have been calling the shots. Ask most people who have
succumbed to ‘Covid’ reframing if they have changed and most will
say ‘no’; but they have and fundamentally. The Cult’s long-game has
been preparing for these times since way back and crucial to that has
been to prepare both population and officialdom mentally and
emotionally. To use the mind-control parlance they had to reframe
the population with a mentality that would submit to fascism and
reframe those in government and law enforcement to impose
fascism or at least go along with it. The result has been the factdeleted mindlessness of ‘Wokeness’ and officialdom that has either
enthusiastically or unquestioningly imposed global tyranny
demanded by reframed politicians on behalf of psychopathic and
deeply evil cultists. ‘Cognitive reframing’ identifies and challenges
the way someone sees the world in the form of situations,
experiences and emotions and then restructures those perceptions to
view the same set of circumstances in a different way. This can have

benefits if the aitudes are personally destructive while on the other
side it has the potential for individual and collective mind control
which the subject has no idea has even happened.
Cognitive therapy was developed in the 1960s by Aaron T. Beck
who was born in Rhode Island in 1921 as the son of Jewish
immigrants from the Ukraine. He became interested in the
techniques as a treatment for depression. Beck’s daughter Judith S.
Beck is prominent in the same field and they founded the Beck
Institute for Cognitive Behavior Therapy in Philadelphia in 1994.
Cognitive reframing, however, began to be used worldwide by those
with a very dark agenda. The Cult reframes politicians to change
their aitudes and actions until they are completely at odds with
what they once appeared to stand for. The same has been happening
to government administrators at all levels, law enforcement, military
and the human population. Cultists love mind control for two main
reasons: It allows them to control what people think, do and say to
secure agenda advancement and, by definition, it calms their
legendary insecurity and fear of the unexpected. I have studied mind
control since the time I travelled America in 1996. I may have been
talking to next to no one in terms of an audience in those years, but
my goodness did I gather a phenomenal amount of information and
knowledge about so many things including the techniques of mind
control. I have described this in detail in other books going back to
The Biggest Secret in 1998. I met a very large number of people
recovering from MKUltra and its offshoots and successors and I
began to see how these same techniques were being used on the
population in general. This was never more obvious than since the
‘Covid’ hoax began.
Reframing the enforcers
I have observed over the last two decades and more the very clear
transformation in the dynamic between the police, officialdom and
the public. I tracked this in the books as the relationship mutated
from one of serving the public to seeing them as almost the enemy
and certainly a lower caste. There has always been a class divide
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