Fundamentals Of Perioperative Practice Flashcards
What are surgeries classified from?
Urgency
Risk
Purpose
What are the types of urgency in a surgery?
Elective
Urgent
Emergency
What are the 6 surgery purposes?
Diagnostic , reconstructive
Ablative , transplantation
Palliative , constructive
What are the 6 indicators of surgery?
Vital , cosmetic
Absolute , prophylactic
Relative , diagnostic
What are the 4 types of instrument cleaning?
Cleaning
Decontamination
Sterilisation
Disinfection
Define cleaning surgical tools
Removal of all bio-burden or soil from the instrument or objects surface
Define decontamination of instruments
Removal of all pathogenic microorganisms from the instrument
Define sterilisation of an instrument
Total destruction of all microbial life including viruses and spores
Define disinfection of an instrument
Destruction of all vegetative microbial life, but not spores
Define surgery
Structurally altering the human body by incision or destruction of tissues for diagnostic or therapeutic treatment of conditions or diseases
List the types of anaesthesia (5)
General
Spinal
Epidural
Regional
Local
What does the triad of anaesthesia consist of?
Amnesia
Analgesia
Muscular relaxation
How can anaesthesia be introduced?
Intravenous
Inhalation
What is stage 1 of anaesthesia?
INDUCTION
Loss of consciousness
Progress to analgesia with amnesia
What is stage 2 of anaesthesia?
EXCITEMENT
Excited activity
Respiration and heart rate may become irregular
What is stage 3 of anaesthesia?
SURGICAL ANAESTHESIA
Respiratory depression
Skeletal muscles relax
What is stage 4 of anaesthesia?
OVERDOSE
Too much medication resulting in severe brain stem and/ or medullary depression
What is plane 1 of anaesthesia?
Eyes initially roll then become fixed
Eyelid reflex is lost
Swallowing reflex is lost
What is plane 2 of anaesthesia?
Loss of corneal and laryngeal reflexes
Secretion of tears
What is plane 3 of anaesthesia?
Pupils dilate and loss of light reflex
Intercostal paralysis
What is plane 4 of anaesthesia?
Diaphragmatic respiration only
Assisted ventilation is required
What is purple waste and how should it be disposed?
Hazardous
Incineration
What is yellow waste and how should it be disposed?
Clinical / highly infectious
Incineration
What is red waste and how should it be disposed of?
Hazardous / non hazardous anatomical waste
Incineration
What is orange waste and how should it be disposed of?
Clinical / infectious waste
Treated then disposed or incinerated
What is black and yellow waste and how should it be disposed?
Non hazardous and non infectious
Incinerated or landfill
What is black waste and how should it be disposed of?
Various
Landfill
Define MAC
Minimum alveolar concentration
The concentration of volatile anaesthetic agent at 1 atmosphere which produces immobility in 50% of patients exposed to a noxious stimulus.
What does the airway assessment acronym LEMON mean?
Look for external difficulty
Evaluate using 3=3=2 rule
Mallampati (class 1 & 2)
Obstruction
Neck mobility
What does the airway assessment acronym BONES mean?
Beard
Obese
No teeth
Elderly
Snores (sleep apnea)
What does the airway assessment acronym SHORT mean?
Surgery (head neck jaw)
Haematoma
Obese
Radiation
Tumour
What is spinal anaesthesia?
An injection of local anaesthetic into the cerebrospinal fluid
What is Boyle’s law?
At a constant temperature the volume and pressure of a gas are inversely proportional to each other
What is Gay-Lussac’s law?
At a constant volume, pressure is directly proportional to temperature
What is Charles’ law?
At a constant pressure, the volume is directly proportional to the temperature
What is Dalton’s law?
The total pressure exerted by a gaseous mixture is equal to the sum of all the partial pressures of each individual component in a gas mixture
What is Henry’s law?
At a constant temperature the amount of a given gas that dissolves in a given type of volume of liquid is directly proportional to the partial pressure of that gas in equilibrium with that liquid.
What are the 4 types of theatre cleaning?
Damp dusting
Patient turnover cleaning
Terminal cleaning
Scheduled cleaning
Name 3 amnesia drugs
Propofol
Ketamine
Thiopentane
Name 3 analgesia drugs
Fentanyl
Remifentanil
Alfentanil
Name 5 paralysis drugs
Pancuronium
Atracurium
Rocuronium
Vecuronium
Suxamethonium
What drug reverses rocuronium and vecuronium?
Sugammadex
What drug can reverse non depolarising blockage in anaesthesia and what should it be given with?
Neostigmine
Given with glycopyrrolate
What are 7 advantages for spinal anaesthesia?
Good for patients with respiratory problems
Good for patients with diabetes
Less chance of post op DVT
Bleed less
Cost is cheaper
Patient uses own airway
Muscle relaxation
What are 6 disadvantages of spinal anaesthesia?
Can cause hypotension
Lasts 2 hours max
Causes urinary retention
Can cause infection of subarachnoid space
Requires the patient to be cooperative
Requires experienced anaesthetist
Name 5 complications of spinal anaesthesia?
Bleeding in patients with hemorrhagic tendencies
Infection of skin or subarachnoid space
Shock
Total or high spinal shock
Headaches
What drugs are used in spinal anaesthesia?
Lignocaine / lidocaine for the skin
0.5% bupivacaine (marcain) in 8% dextrose (hyperbaric)
What does epidural anaesthesia do?
Gives intraoperative and postoperative pain management
What is an epidural needle called?
Tuohy needle
What drugs are involved in epidural anaesthesia?
Bupivacaine or Levobupivacaine 0.5 to 0.75%
And ropivacaine 0.75 - 1%
What are 3 complications of epidural anaesthesia?
Bleeding
Shock
Infection
What is a regional block?
When the transmission of impulses from the nerves are blocked by injection of local anaesthetic around the nerve.
What is a local anaesthetic?
Used to numb the skin either by injection or topical application
What can a local anaesthetic be used with and why?
Adrenaline
Causes vasoconstriction and creates a slower rate of absorption. Can’t be used on digits
What should everybody wear in a theatre?
Scrubs, hat, face mask
What are 4 extra theatre PPE?
Eye protection
Cuts covered
Correct sized gown
Correct glove size
What are the 4 main properties of surgical antiseptic?
Antimicrobial activity
Persistent activity
Safety
Acceptance
What is an indicator glove and why is it used?
To increase awareness of perforations
What are the 10 ideals for volatile anaesthetic agents?
Smooth & reliable induction and maintenance
Minimal affect on other organ systems
Safe for all ages and pregnancy
Not metabolised
Odourless, pleasant to inhale
Rapid onset and offset
Potential
Cheap
Non inflammable
Environmentally friendly
5 factors that increase MAC
Hyperthermia
Youth
Alcoholism
Hypernatremia
Thyrotoxicosis
6 factors that decrease MAC
Hypothermia
Old age
Hypotension
Pregnancy
Hypercarbia
Hypoxia
Define latent heat of vaporisation?
The amount of energy required to convert 1g of liquid into vapour with constant temperature.
What are the 6C’s?
Care
Compassion
Competence
Communication
Courage
Commitment
What does the pin index system do?
Ensures the correct cylinder is attached to the correct yoke
What is a Bodox seal?
Made of metal and neoprene so there is no leak from the cylinder
What does the pressure gauge of O2 show on an anaesthetic machine?
The contents of the oxygen remaining in the cylinder
What does the pressure gauge of N2O show on an anaesthetic machine?
The gauge will remain constant until all the liquid has evaporated. Then it will start to decrease fairly rapidly.
What is emergency oxygen flow?
Delivers 35L/min of O2. It bypasses flow meters and vaporisers joining common gas outlet
How is an oxygen failure alarm powered?
By the fall in oxygen pressure
Why do we do a surgical count?
To reduce the risk of leaving something in the patient that can lead to growths and infections.
What are the names of something that has been left inside a patient after surgery and it has formed a shell? (3)
Gossypiboma
Textiloma
Cottonoid
How do we do a surgical count? (6)
2 practitioners counting aloud
Items counted separately
Counting sequence should be in a logical order
Swabs and packs counted in 5
The new packs number should be verified before use
Needles counted as a total amount and added individually
When do we do a surgical count? (5)
At set up (initial)
During procedure (new items)
Prior to closure of a potential cavity (second count)
At skin closure (final/third)
Bin count
What is the calculation to work out blood loss?
Weight of wet swab - weight of dry swab = approximate EBL
Dry weight of a 4x3 swab
4g
Dry weight of a 22x22 swab
13g
Dry weight of a 30x30 swab
25g
Dry weight of a 45x45 swab
50g
What is wound healing?
The physiological process by which the body replaces and restores itself
What are 5 symptoms a wound is healing?
Heat
Pain
Redness
Swelling
Loss of function
What are the 3 categories of wound closure?
Primary, secondary and tertiary
What is a primary wound closure?
The closure of a wound within hours of its creation
What is a secondary wound closure?
Healing involves no formal wound closure. The wound closes spontaneously by contraction and re-epithelialisation
What is a tertiary wound closure?
AKA delayed primary closure
Involves initial debridement of the wound left open for a specific period then formally closed later.
What is the infection rate of a clean surgical wound?
1-3%
What is the infection rate of a clean/contaminated surgical wound?
5-6%
What is the infection rate of a contaminated surgical wound?
20-25%
What is the infection rate of a dirty surgical wound?
30-40%
What are 8 local factors that affect wound healing?
Bacterial colonisation
Necrosis
Wound infection
Poor wound hygiene
Poor blood supply
Low O2 saturation
Debris
Pressure
What are 8 systematic factors that affect wound healing?
Cardiovascular disease
Diabetes
Metabolic disease
Malnutrition
Medications (steroids)
Immuno suppression
Age
Smoking
What are 10 complications of wound healing?
Dehiscence
Haemorrhage
Adhesions
Infection
Herniation
Fistula & sinus formation
Hypertrophic scar
Heloid scaring
Contractive
Evisceration
What are resident microorganisms?
Normally found on the skin. Termed as normal flora. Found in the deeper layers of the skin and do not readily cause infection.
What are transient microorganisms
Transferred through contact with an external source. Found on the top surface of the skin and can be picked up and transferred easily.
How does povidone iodine work?
Creates a biofilm on the patients skin which prevents regrowth of organisms for 2-4 hours.
How does chlorhexidine gulconate with 70% alcohol work?
The alcohol mixes with the air and evaporates off the skin and killing microorganisms. This reduces regrowth for 24-48 hours.
What is laryngospasm?
A primitive protective airway reflex to protect against aspiration. It is triggered by stimulation of the vocal cords and peri glottic region
When can laryngospasm occur?
When the patient is awake or semi conscious (more prone in semi and takes longer to go)
When are patients most at risk of laryngospasm? (3)
During the induction of anaesthesia,
Emergence of anaesthesia
During stage 2 of anaesthesia
When will laryngospasm usually break?
When patient awakes
When hypoxia or hypercapnia develops.
This is not always the case
What can laryngospasm lead to?
Laryngospasm
Hypoxia
Bradycardia
Cardiopulmonary arrest
What are 10 risk factors to laryngospasm?
Light anaesthesia
Irritant volatile anaesthetic
Blood/secretions
Pre existing airway abnormalities
Gastroesophageal reflux
Instrumentation during light planes
LMA and inexperienced anaesthetist
Young children
Certain types of surgery
Smoking
How can we pharmacologically prevent laryngospasm?
Magnesium
Lidocaine
Atropine
How to recognise laryngospasm? (4)
Stridor
Tracheal tug
Paradoxical respiratory effort (see saw breathing)
Oxygen desaturation
How to treat laryngospasm? (9)
Prompt regain of oxygenation
Remove stimulation
Direct laryngoscope and gentle suction
Consider further help
CPAP- 100% O2, tight fit mask, 4 hands
Vigorous jaw thrust
Pressure on laryngospasm notch
Rapidly deepen anaesthesia with propofol
Paralyse with suxamethonium or rocuronium
What are 4 anecdotal ways to treat laryngospasm?
Larsons manoeuvre
Superior laryngeal nerve block
Nitroglycerin
Gentle chest compressions
What is in view for mallampati classification 1?
Soft palate
Faucets
Entire uvula
Tonsillar pillars
What is in view for mallampati classification 2?
Soft palate
Faucets
Base of uvula
What is in view for mallampati classification 3?
Soft palate
Base of uvula
What is in view for mallampati classification 4?
Soft palate only
What does a Murphy’s eye do?
A side hole in an ET tube to enable ventilation if the bevel becomes occluded
What should the temperature be in theatre?
18.5 to 22.5
What is a histology specimen?
Diagnosis of ‘lumps’ tissue abnormalities, organs and body tissue/ cellular abnormalities
What is a microbiology specimen?
Looking at microorganisms and their disease causing potential. Eg bacteria, viruses and fungi
What is a haematology specimen?
Bloods and blood grouping- finding abnormalities
What is a biochemistry specimen?
Body fluid, fluid balance and abnormalities in fluid balance physiological and blood gases
What is specimen fixation and what are the types?
Aims to render tissue in as lifelike conditions as possible for examination by hardening for easier manipulation, solidification, optical differentiation and staining mordant.
Heat, perfusion and immersion
What is a pneumatic tourniquet?
A mechanical device that uses pressure to prevent blood flow to a limb to allow a bloodless field for the surgeon.
Describe supine position
Flat on back
Describe trendelenburg position
Supine and head down
Describe reverse trendelenburg position
Supine head up
Describe prone position
On tummy
Describe lithotomy position
Supine, knees bent at 90 degrees
(Like sitting on your back)
Describe Lloyd Davis position
Supine, knees bent at less than 90 degrees
(Like sitting on your back)
Describe lateral lying position
Lying on side
Describe jack knife position
On side, head and feet below abdomin.
Like an upside down u shape
What is pressure damage?
Localised damage to skin and underlying tissue caused by pressure, shear or friction
What is a friction injury?
2 surfaces rub across one another
What is a shear injury?
Pulling of the skeleton while the skin adheres to the surface
What is a moisture injury?
Caused by exposure of the skin to excessive moisture
What is compartment syndrome?
Occurs when perfusion falls below tissue pressure in a closed anatomical space
Symbol for a round bodied needle?
Circle/ dot
Symbol for cutting needle?
Triangle
Symbol for taper cut needle?
Peace sign
Name 5 absorbable synthetic sutures
Vicryl
Monocryl
Coated vicryl
Coated vicryl plus
PDS ii
Name a non absorbable biological suture
Mersilk
Name 7 non absorbable synthetic sutures
Mersilene
Ethibond
Prolene
Pronova
Ethilon
Nurolon
Stainless steel
What are the 6 suturing methods?
Deep, purse string, subcuticular, interrupted, continuous, and ligation
What 3 thing are necessary for an infection?
Source, susceptible person and transmission
What are the 2 shockable rhythms?
Pulseless ventricular tachycardia
Ventricular fibrillation
What is rapid sequence induction?
For patients at risk from gastric regurgitation
Involves cricoid pressure.
What are the 4 settings on a diathermy machine
Coagulation
Fulguration
Cutting
Blend
What are the pre requisities for surgery?
Proper patient
Proper time
Proper circumstances
