General sx Flashcards by Yash Patel

Surgical safety checklist

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A soaked mop contain how much blood

100cc

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1fist full of clots contain how much blood

500cc

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5 mops soaked during surgery. 1200 cc in the suction but I litre was irrigation fluid No clots. Total Blood Loss is

Total blood loss is (5X100) + (200-1000) = 700cc of blood loss.

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In lap chole which position is used

Reverse Trendelenburg position.

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Fowler’s / sitting position used for

CNS Fossa (post fossa)
Breast reconstruction

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What to do if we suspect air embolism

Immediately shift patient to left lateral decubitus position with foot end up. This is called as durants or the recovery position

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Rose position used in

Thyroid surgery

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Lloyd davies position is combination of

Trendelenburg and lithotomy position

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What is the best data to check the reliability of safety systems in a hospital?

Number of near miss events.

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Function of Yellow and Blue button in monopolar cautery

Yellow button: Cutting
Blue button : coagulation

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What is cutting current?

Low voltage continuous current.
Principle: Sufficient heat to cause cell water to explode into steam.

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What is coagulation current

High voltage alternating current.
Principle: Cell death by dehydration and protein denaturation. Never applied to skin as it can burn the skin.

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What is Fulgaration mode

Voltage higher than coagulation

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What is Blend mode

Both cutting and Coagulation(combination)

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Most common cause of OT related fire

Cautery Sources

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What is ligasure?

uses heat + pressure to carry out coagulation.
• Can coagulate vessels upto 7 mm in diameter.
• uses body’s collagen and elastin to seal and divide.

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Feedback, mechanism of Ligasure

Energy delivery is in a precise
manner and results in automatic discontinuation of energy once the vessel is completely sealed, then the vessel can be cut.

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1st Generation ligasure only

Coagulation

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2nd Generation ligasure only

Coagulation followed by cutting

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What does harmonic scalpel do?

It works on the ultrasonic principal oscillator blade that oscillate between 20,000 to 50,000 Hz that causes protein denaturation ; coagulation without heat production

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What is Thunderbeat S ?

It has features of ligasure, and harmonic scalpel

What is working principles of CUSA ?

Hepatocytes are particularly susceptible to oscillatory fragmentation due to high water content and low collagen.
It can also aspirate the gas which is produced better in a non-cirrhotic liver.

Which blade is use for Incision and drainage

No. 11 pointed / Stab blade. (Also used for areteriotomy) Incision in the artery.

Which blade is used for suture removal

No 12. Curved Blade

Which blades have belly ?

No 10 , 15, 20, 21, 22,23 Belly of the blade is the sharpest portion of a blade.

What is ABPI

The ankle-brachial pressure index (ABPI) or ankle-brachial index (ABI) is the ratio of the blood pressure at the ankle to the blood pressure in the upper arm (brachium). Compared to the arm, lower blood pressure in the leg suggests blocked arteries due to peripheral artery disease (PAD). The ABPI is calculated by dividing the systolic blood pressure at the ankle by the systolic blood pressure in the arm.[1]

When the drain is removed after mastectomy

When the output is <40cc/day for 2 consecutive day or else seroma can occur

Which drain is used for sentinel lymph node biopsy

Minivac

Which drain is mainly used for abdominal surgery

Jackson pratt drain

Which knot is secure

Square knot ( two square truths, make a square/reef knot) and surgeno’s knot

What are the suturing instrument?

Needle holder , tooth forceps, straight scissors

Describe surgeons knot

This knot consist of two throws followed by one throw

Which suturing are cosmetically better

Subcuticular, suturing(3-0 monocryl needle is used most commonly)

Which suture used in cervical cerclage

Pursestring, suture

Continuous sutures ends with

Aberdeen’s knot/ cobbler’s knot

Shoestring, method is used for

For fasciotomy wound closure in compartment syndrome. This is done for delayed closure to prevent cut through of sutures also known as delayed by tertiary intention.

Round body needles used for

Disney doll is relatively atraumatic. I need to split the tissue and does not cut through it so they use for delicate structures like bowel, blood vessel, bladder, common bile duct

Cutting reverse, cutting needles used for

Skins ; sheath ; fascia

Other needle and their usages

• Half circle needles: Gl Tract. • J Shaped needles: Vaginal surgery. • Quarter circle needles: Eye. • compound curvature: Oral cavity.

Example of natural sutures

Silk ; catgut

Example of synthetic suture

Nylon ; PDS ; prolene

Which sutures are used for facelifts

Barbed vicryl: It has spikes therefore anchors in the tissue and can remain in place without a Knot. This can be used for face lifts. It is very painful.

What is Carrel’s triangle

while repairing a vessel, bulldog clamps are placed on both sides of the vessel. After surgery, the distal clamp is removed first to let the blood fill the air gap retrogradely and then the proximal clamp is released.

Suture removal

• scalp: 5-7 days. • Face: 3-5 days. • Neck: 5-7 days. • Thorax: 10-12 days. • Abdomen: 12-14 days. • Perineum: 10-12 days.

First layer in bowel anastomosis is

Albert layer: The first bite involves all the layers of the bowel using vicryl suture.

Second layer in bowel anastomosis is

Lembert layer: using silk suture and an inversion is created.

Which is the strongest layer in bowel anastomosis

Submucosa

Linear stapler is used for

Sleeve gastrectomy

Circular stapler is used for

Low anterior resection LAR , Steppler hemorrhoidopexy ; esophagojejunostomy

Absorbable suture

Catgut ; Polyglactin(vicryl) ; Polydioxanone ; Poliglecaprone(monocryl)

Non absorbable suture material

Silk ; surgical steel ; Nylon ; Polybutester ; Polyprolene(prolene)

Color, coding of suture material

Catgut : yellow Silk : black Prolene : blue