Care In The Operating Room

Question 1

What number should infectious patients be on the list

Answer 1

Last to avoid contamination

Question 2

WHO surgical safety checklist

Answer 2

1- prelist briefing 
2- sign in 
3- time out 
4- sign out 
5- post list briefing

Question 3

Sign in

Answer 3

Should be done prior to induction of anesthesia
1- has patient confirmed their identity and surgery
2- is the surgical site marked?
3- is the anesthesia machine and medication check list complete?
4- does patient have any allergies?
5- is there airway obstruction or aspiration risk?
6- is there risk of >500 ml blood loss(>7ml/kg in children)
7- antibiotics 8- venous thromboembolism prophylaxis
9- monitoring
Also removal of dentures and jewellery and confirmation of any implanted metal

Question 4

Antibiotics

Answer 4

To be given less than an hour before surgery.
Discontinued within 24 hours.
Not used in clean non-prosthetic surgery

Question 5

VTE prophylaxis

Answer 5

Mechanical via graduated compression stockings. Pneumatic compression devices and foot impulse devices.
Also by medications

Question 6

Risk of vte greater in which type of anesthesia

Answer 6

General

Question 7

Ventilation in OT

Answer 7

Atleast 20 air changes per hour.

In laminar flow it is 100-200

Question 8

Temperation in ot

Answer 8

20-24 degree Celsius

Question 9

Humidity in Ot

Answer 9

50 to 60 percent

Question 10

Who oversees patient transfer and positioning

Answer 10

Surgeon and anesthetist

Question 11

Transfer is aided through

Answer 11

Sliding boards

Friction free sliding sheets

Question 12

Pressure areas to be given special care during positioning of patient

Answer 12

1- skin over bony prominences
2- superficial nerves like common peroneal nerve
3- stretchable nerves like brachial plexus
4- areas at risk of developing compartment syndrome
5- eye protection

Question 13

Intraoperative radiological imaging requires

Answer 13

Lead shielding of patient and radiolucent table

Question 14

Where should monopolar diathermy dispersal electrode be applied

Answer 14

Clean dry hairless skin. Situated over well perfused muscle. Away from scars. Bony prominences. Areas distal to tourniquet. Implanted metals

Question 15

Implanted devices that may be affected by diathermy

Answer 15

Cochlear implants
Spinal cord stimulation
Pacemakers
Implanted defibrillators

Question 16

Complications of tourniquet use

Answer 16

Neurovascular compression
Direct skin compression
Chemical burns by fluids that leak under the tourniquet
Distal ischemia and reperfusion injury

Question 17

Tourniquets are avoided in which patients

Answer 17

Those of sickle cell disease
And
Peripheral vascular disease

Question 18

Max pressure of tourniquet

Answer 18

Above 100 mmHg in upper limb surgery

And above 150 in Lower limb

Question 19

Principles of application of tourniquet

Answer 19

Apply it as proximally as possible.
Exsanguinate Limb prior to inflation.
By elevation. Esmarch bandage. Roll cylinder.
Note time of application and removal of tourniquet.
Always apply padding.

Question 20

Max time of tourniquet usage

Answer 20

1.5 hours

Question 21

Time out

Answer 21

Prior to surgery. 
Verbal confirmation of patients identity. 
Confirmation of antibiotic prophylaxis. 
Temperature control.
Hair removal. 
Glycaemic control. 
Infection control.

Question 22

Temperature control

Answer 22

Use warm IV fluids. Warm blankets. Change OT ambient temperature. Avoid excessive patient exposure.

Question 23

Glycaemic control

Answer 23

Hyperglycaemia perioperatively increases risk of postoperative infections

Question 24

Scrubbing up

Answer 24

Jewellery removed prior to scrubbing.
Nails and deep skin creases cleaned with brush.
Hands and firearms cleaned atleast 3 times.
Dried from distal to proximal with sterile towel.
Hands should remain inside gown till gloves are applied either by one person or two person technique. Hands should remain above waist level this point forward

Question 25

Scrub solutions

Answer 25

1- 2 percent chlorhexidine
2- 7.5 percent povidine iodine
3- alcohol

Question 26

Chlorhexidine

Answer 26

Lasts for 4 hours.

Poor against tubercle bacilli

Question 27

Povidine iodine

Answer 27

Shorter duration of action

Question 28

Alcohol

Answer 28

Ineffective against spores

Question 29

Movement of scrubbed personnel in OT

Answer 29

Hands at Operating table at all times.
Keep hands away from faces.
Not lean over unsterile areas.
Pass each other back to back or front to front.

Question 30

Pre-prep

Answer 30

Required in visible debris.
Cleaned first with soapy detergent.
Then water.
Then with surgical detergent.

Question 31

Prepping

Answer 31

Done with same solutions. 
At surgical site and area adjacent. 
Use 2 coats. 
Avoid excessive use to prevent chemical burns. 
Groin. Perineum. Axilla are cleaned last

Question 32

Draping

Answer 32

Drapes held only by sterile personnel
Once put in place shouldn’t be removed
Diathermy and suction equipment can be held in place over the drapes.

Question 33

Sign out

Answer 33

Record operation.
Count the number of instruments and swabs used.
Note that there have been no equipment problems that require fixing.
Note the key concerns for the post-op care of the patient.

Question 34

Operation Note

Answer 34

Should include 
Time and date of operation. 
Type of operation. 
Type of anesthesia. 
Patient positioning. 
Surgeon name. 
Anesthetist names 
Use of diathermy. 
Tourniquet application. 
Antibiotics given. 
Skin prep and draping. 
Incision.
Findings. 
Operation details. 
Any implants used. 
Closure and suture material. 
Complications. 
Postoperative instructions. 
Time line for normal recovery as in when to mobilise patient. Start oral feed.  Dressing changes. 
Discharge and follow up details.