General Surgery Flashcards
Three events recorded for pt safety
Adverse event
Near miss event
No harm event
Which event gives the most reliable data regarding patient safety mechanism
Near miss event data
Usage of checklist before surgery reduced mortality rate by
From 1.9% to 2%
The written consent should contain complications wrt procedure.
Should we include all known complications in the consent?
Any complications with incidence more than 1% should be included
Color coded IV lines
Orange 14G Grey 16 G Green 18G Pink 20G Blue 22 G Yellow 24G
Pt with dehydration and hypotension requires quick IV fluid which IV Canula should be preffered
Wide bore with fast flow rate
Orange is widest bore
Narrowest bore with least flow rate
Yellow 24 G
Pt after rta brought to er with severe blood loss
Which of following IV lines will be used
16G
18G
20G
22G
Minimum two 18G iv inserted
If available a wider can be used
Here 16G is given in option
Most common complication and mgt of iv lines
Superficial thrombophlebitis
TT change of canula
Total parenteral nutrition is given to pt which iv line should be used
As tpn rich in sugar
Wide bore needle for fast flow rate with short length
I/V canula for burn pt
Dehydration - urgent requirement wide bore needle
Edema with burn long length preferred
Phases of surgical safety checklist
Sign in ward to OT
Time out BEFORE INDUCTION
SIGn out BEFORE SKIN CLOSURE
Site marking is included in which checklist phase
Sign in phase
In which phase surgeon is asked for anticipated blood loss
Time out
Responsibility of scrub nurse is
Sterility Maintainence
Duty of nurse during sign out phase
Nurse does guaze count and equipment count
Actual blood loss during sign out phase is told by
Anaesthetist
Each phase of checklist is signed by
Nurse
Anaesthetist
Surgeon
How is blood loss calculated during surgery
Mops soaked +blood in suction - irrigating fluid
Volume of blood in a completely soaked big mop
100cc blood
Advantage of lines in mop/guaze
These lines are Radiopaque and used in locating missing mop using C arm
A fist full of clot is how much blood
500 cc blood
Zones in an OT
Protective zone
Clean zone
Aseptic zone
Disposal zone
Zone connecting protective to aseptic zone
Clean zone
It has equipment storeroom
Maintenance workshop
Most common position used for abdominal breast surgery
Supine
Neutral OT position is
The head end and foot end of table are at same level
Position used in pelvic surgery
Trendelenburg
The foot end of table is raised
Reverse trendelenburg position is
And used in
Head end is raised and foot end is lowered
Laparoscopy cholecystectomy
Use of prone position
Spinal surgery
Pilonidal sinus surgery
Lithotomy position uses stirrups to abduct lower limb
Most common complication due to it
Improper padding or over abduction leads to common peroneal nerve injury
Kidney position is used for
Over abduction of arm can lead to
Thoracotomy
Nephrolithotomy
Nephrectomy
Injury to brachial plexus
Position for cranial surgery especially posterior cranial fossa
Fowler’s position
Advantage and disadvantage of fowlers position
Adv relatively bloodless surgery
Disad increase risk of air embolism
Prevention by ligation of vein before cutting
Rose position is achieved by
30 degree head elevation
Towel roll placed below shoulder blades
Increase risk of air embolism
Position used in thyroid surgery
Rose position
Mgt of air embolism during surgery
Durants recovery position
It is left lateral decibitus
And air aspirated through central line
Most common complication of laparoscopy cholecystectomy
Right shoulder tip pain
Because co2 used in surgery enters beneath right dome of diaphragm and irritates diaphragm
Why is jack knife position no longer used
It causes positional asphyxia
Lloyd David position is and used for
Trendelenburg+ lithotomy position
Used in Abd perineal resection and low anterior resection
Instrument used to hold surgical blade
Bard parker handle
No 12 blade is used for
Suture removal
Stab blade is used for
No 11 blade for I &D
Blade used to make incision
No 10,15,20,21,22,23
Imp things to make sure while handling blades
Belly is the sharpest portion
Blade should be always passed in kidney tray with pointes end towards one self
Blade should always be perpendicular to skin
Cautery pad is used in which type of cautery
Monopolar cautery
Why bipolar doesn’t require cautery pad
Because current travels from one paddle toother paddle and completes the circuit
Cautery tip in monopolar is aka
Use of 2 buttons
Bovie tip
Yellow for cutting
Blue for coagulation
Advantage of bipolar over monopolar cautery
Bipolar is safe when used near vital nerves,
Monopolar cautery should be avoided in
Pt with pacemaker Thyroid surgery Parotid surgery Penile surgery Surgery involving end arteries
Waves produxed in cutting mode
Low Voltage
Continuous current
Less thermal spread
Waves produced coagulation mode
AC
High voltage
More thermal spread
Disadvantage of monopolar cautery
Interference with cardiac conduction
Lateral spread causes thermal damage to nearby nerves
Preferred site for cautery pad
When cautery doesn’t work
A well vascular wide hairless area of contact
When cautery pad is not attached
Small cautery pad leads to burns
Ligasure energy source
It is used for
Heat and pressure
Sealing vessel upto 7mm diameter in 2-4 sec
Ligasure energy source
It is used for
Heat and pressure
Sealing vessel upto 7mm diameter in 2-4 sec
Harmonic scalpel works on the principle of
Advantage?
Ultrasonic waves Heat is not produced Used close to vital structure Precise Can cut through scar tissue
Instrument used in area with low collagen tissue like non cirrhotic liver
Cusa
Cavitron ultrasonic surgical aspirator
T/F
Dist between two sutures should be 2 times depth of wound
True
Mattress suture should be used if simple sutures are unable to cause eversion of skin edge
T/F
True
Round body needles should be preferred for skin suturing
T/F
False
It cannot cross skin
Monocryl is one of the best suture msterial for subcuticular suturing
T/ F
True
CBD repair suture material used?
Polydiaxone
Round body needle
5-0
Vascular anastomosis suture material and needle
Prolene
Round body needle
Rectus sheath suture material used
Prolene
Cutting needle
Nerve repair suture material used
Nylon
Round body needle
Best suture material for sub cuticular suturing
Knot used
Monocryl 3-0
Cutting needle
Tied by aberdeen knot
10-1 sutures are finer than no1 sutures
T/F
True
Number 1 suture is easier to handle as compared to 10-0
T/F
True
Because itis thicker
No 1 suture are likely to fracture more commonly as compared to 10-0 ?
False
They are thicker
Drains used after Modified radical mastectomy
Indicated when?
Romovac suction drain
Usedwhen output is more than 40 cc for 2 consecutive days
Use of minivac suction drain
Used after sentinel LN biopsy
Chest tube drainage system is aka
Underwater seal system
T/F
Lscs is clean contaminted type of wound?
True
Ilieal perforation is dirty wound?
True
Right hemicolectomy is pt with prepared bowel?
Clean /clean contaminated/dirty?
Clean contaminated
Lap chole in acute cholecystitis? Type of wound
contaminated
Knee replacement is clean surgery?
T/F?
True
Early case of duodenal perforation is a ____ type of wound
Clean contaminated
All of the following are risk factor for increase risk of wound infection except OBESITY HYPERTENSION JAUNDICE CANCER
Htn
34 yr old pt underwent laprotomy for ileal perforation and was in recovery when multiple episodes of loose stools which composes of mainly mucus with spikes of fever. Most probable cause of her condition
Pelvis diarrhea due to pus in pelvis
Most common surgical site infection on post op say 1
Atelectasis
Most common cause of post op fever in a surgical pt
Surgical site infection
Most common cause of post of fever overall
UTI
SSI is any wound infection within 15 days of surgery?
False, 30 days of surgery
Burst abdomen following abdominal surgery usually develops around day 6
True
Most common site of intra abdominal collection in pt of bowel surgery
Puch of douglas
Hypothermia during surgery reduces risk of infection?
No it increases
For a female pt undergoing abdominal surgery with part should be cleaned
From inframammary fold to mid thigh
In a prolonged surgery prophylactic antibiotics should be repeated after
4 hrs
A dual ring abd wound protector is superior to single ring protector
T/F?
True
Washing the wound cavity with antibiotics after surgery reduces wound infection rate?
False
In transparenteral nutrition, sudden glucose intolerance is an early sign of sepsis
T/F
True
Central line for TPN should be changed every 2 weeks to prevent infection
T/F
No central line is not changed unless infection is suspected
In TPN, electrolytes should be checked every 2-3 days?
True
TPN is best delivered through?
Central line
Subclavian central lines have higher rate of pneumothorax as compared to IJV central line
T/F?
True
Subclavian central lines are easier to insert as compared to IJV central line
T/F
False
Best nutrition regimen in a pt with esrd
Low volume high calories
Following TPN, one expect wt gain after how much time?
5-7 days
Femoral lines have the highest infection rate
T/F
True
Nasogastric tube cam be used for feeding upto 2-3 wks
T/F
True
Nasojejunal tube should be used if there is?
Bad gastric emptying
Most common complication of enteral nutrition
Tube related - migration of tube, blockade
Most common complication related to feeding regimen
Osmotic diarrhea
Tube feed should be withheld is aspiration is–
More than 200 cc in 2 hr period
Method for feeding gastrostomy
Stam method
Witzel method
Percutaneous endoscopic gastrostomy
Why is surgeon knot secure knot
Because it has 2 throws followed by one throw
Purse string suture used for
Bury tha base of appendix
Stapler haemorrhoidopexy
Edges preferred for skin suture
What to do when simple suture fails to cause it
Everted edges
Mattress suturing
Far near near far suture is used for
Better obliteration of cavity
Shoe string method is used for
It is used for delayed closure of wound
Healing by tertiary intention is achieved
Where to hold needle
At junc of 2/3 from pointed end and 1/3 from swaged end
Use of round body and cutting needle
Round body -splits tissue, atraumatic, delicate structure like blood vessel, cbd
Cutting needle - cuts through tissue, traumatic, used for tough structure skin fascia
Jenkins rule of mass closure
Minimum length of prolene used to close rectus sheath wound is 4times length of rectus sheath wound
Catgut is derived from
Its tensile strength
Submucosa of sheep gut
Undergoes degradation by 7-10 days
Strongest layer of bowel
Suture edges for bowel Suturing
Submucosa
Inverted edges
Technique for bowel anastomoses
Single layer - stitch at extramucosal single layer applied
Two layer outer and inner layer
Two layer repair technique in bowel Anastomosis
First layer - albert layer closed by Round body vicryl
Second layer lembert layer is a seromucosal layer
RB silk
Salmon fluid sign is seen in
Burst abdomen
Large quantities of reddish fluid escapes from main wound
