Chapter 1 - Introduction Flashcards
What do you do if you have to sneeze in the OR?
Back up STRAIGHT; do not turn your head
What do you do if you feel faint in the OR?
Say you feel faint and ask to sit down
N.B. Always a good idea to eat before going into the OR
What should you say when you first enter the OR?
Introduce yourself as the student, state that you’ve been invited to scrub, ask if you need to get out your gloves/gown
Should you wear your I.D. into the OR?
Yes
Can you wear nail polish in the OR?
Yes, as long as it isn’t chipped
Can you wear rings or a watch when scrubbed in to the OR?
No
Can you wear earrings in the OR?
No
When scrubbed, are your back or underarms sterile?
No; do not put your hands under your arms or behind your back
How far down the gown is considered part of the sterile field?
Just to the waist
How far up the gown in considered sterile?
Up to the nipples
How do you stand while waiting for the case to start?
Hands together in the front, above your waist
Can I button up a surgical gown (when not scrubbed) with bare hands?
Yes (remember: the back of the gown is not sterile)
How many layers of gloves should you wear when scrubbed?
2 layers
What is the normal order of sizes of gloves?
Larger size pair with the smaller pair on top
What items compromise the sterile field in the OR?
Instrument table, Mayo tray, and anterior drapes on the patient
What is the tray with the instruments in the OR called?
Mayo tray
Can you grab things off the Mayo tray?
No, ask the scrub nurse/tech for permission
How do you remove blood with a laparotomy (lap) pad?
Dab; don’t wipe because it will remove the platelet plugs
Can you grab the skin with DeBakey pickups?
No, pickups for the skin must have teeth (e.g. Adson, rat-tooth); it’s better to cut the skin than crush it
How should you cut the sutures after tying a knot?
- Rest cutting hand on non-cutting hand
2. Slip scissors down to the knot and cant scissors at a 45 degree angle so you don’t cut the knot itself
What should you do when you are scrubbed and someone is tying a suture?
Ask the scrub nurse for a pair of suture scissors so you are ready if you’re asked to cut the suture
What is Allen’s test?
Test for patency of ulnar artery prior to placing a radial arterial line or performing an ABG
Examiner concludes both ulnar and radial arteries with fingers as patient makes a fist; patient opens fist while examiner releases ulnar artery occlusion to assess blood flow to hand
(20% of population have complete radial artery dominance)
Ballance’s sign
Constant dullness to percussion in the left flank/LUQ and resonance to percussion in right flank seen with splenic rupture/hematoma
Battle’s sign
Ecchymosis over the mastoid process in patients with basilar skull fractures
Beck’s triad
Seen in patients with cardiac tamponade
- JVD
- Decreased or muffled heart sounds
- Decreased blood pressure
Blumer’s shelf
Metastatic disease to the rectouterine pouch (of Douglas) or rectovesical pouch creating a “shelf” that is palpable on rectal examination
Carcinoid triad
Seen with carcinoid syndrome (think FDR)
- Flushing
- Diarrhea
- Right-sided heart failure
Charcot’s triad
Seen with cholangitis
- Fever (chills)
- Jaundice
- Right upper quadrant pain
Chvostek’s sign
Twitching of facial muscles upon tapping the facial nerve in patients with hypocalcemia
Courvoisier’s law
Enlarged, non-tender gallbladder seen with obstruction of common bile duct, most commonly with pancreatic cancer
N.B.: Not seen with gallstone obstruction because gallbladder is scarred secondary to chronic cholelithiasis
Cullen’s sign
Bluish discoloration of periumbilical area due to retroperitoneal hemorrhage tracking around to the anterior abdominal wall through fascial planes (e.g. acute hemorrhagic pancreatitis)
Cushing’s triad
Signs of increased intracranial pressure
- Hypertension
- Bradycardia
- Irregular respirations
Goodsall’s rule
Anal fistulae course in a straight path anteriorly and a curved path posteriorly from midline
Think of a dog with a straight anterior nose and curved posterior tail
Hamman’s sign/crunch
Crunching sound on auscultation of the heart resulting from emphysematous mediastinum; seen with Boerhaave’s syndrome, pneumomediastinum, etc.
Howship-Romberg sign
Pain along the inner aspect of the thigh
Seen with obturator hernia as the result of nerve compression
McBurney’s point
One third the distance from the anterior iliac spine to the umbilicus on a line connecting the two
Meckel’s diverticulum rule of 2’s
2% of the population, 2% are symptomatic, occur within 2 feet from the ileocecal valve
Murphy’s sign
Cessation of inspiration while palpating under the right costal margin; patient cannot continue to inspire deeply because it brings an inflamed gallbladder under pressure (seen in acute cholecystitis)
Obturator sign
Pain upon internal rotation of the leg with the hip and knee flexed
Seen in patients with appendicitis/pelvic abscesses
Pheochromocytoma symptoms triad
- Palpitations
- Headache
- Episodic diaphoresis
Think of the “PHE” in pheochromocytoma
Psoas sign
Pain elicited by extending the hip with the knee in full extension
Seen with appendicitis and psoas inflammation
Raccoon eyes
Bilateral black eyes as a result of basilar skull fracture
Reynold’s Pentax
- Fever
- Jaundice
- Right upper quadrant pain
- Mental status changes
- Shock/sepsis
Thus, Charcot’s triad plus #4 and #5; seen in patients with suppurative cholangitis
Rovsing’s sign
Palpation of LLQ resulting in pain in the RLQ
Seen in appendicitis
Virchow’s node
Metastatic tumor to the left supraclavicular node (classically due to gastric cancer)
Virchow’s triad
Risk factors for thrombosis:
- Stasis
- Abnormal endothelium
- Hypercoagulability
Trousseau’s sign
Carpal spasm after occlusion of blood to forearm with a BP cuff in patients with hypocalcemia
Valentino’s sign
Right lower quadrant pain from a perforated peptic ulcer due to succus/pus draining into the RLQ
Whipple’s triad
Evidence for insulin a
- Hypoglycemia (<50)
- CNS and vasomotor symptoms (e.g. syncope, diaphoresis)
- Relief of symptoms with administration of glucose
