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Final year Medicine > Images and instruments > Flashcards

Images and instruments Flashcards

1
Q

Central venous access complications

A 
Immediate: Haemorrhage
Pneumothorax
Arterial puncture
Arrythmias
Cardiac tamponade
Air embolism
Delayed
Venous stasis
THrombosis
Erosion of vessel
Line fracture
Catheter colonisation
Line related sepsis.
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2
Q

Triangle of safety

A

Lateral edge of pec major
Lateral edge of latissimus dorsi
5th intercostal space
APex of axilla

Insert above rib to avoid neurovascular bundle
Position confirmed with CXR

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3
Q

Chest drain complications

A

Insertion related
- damage to nearby structures- intercostal artery, solid organ. LT nerve damage -> winged scapula.
Subcutaneous emphysema
Pneumothorax

Position related
-Obstruction
-kinking
-dislodged 
Reexpansion pul oedema.

Infection
wound
pneumonia
empyema

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4
Q

port a cath

A

For - long term chemo/abx
Centrally placed - SC port silicon.
HUBER point needle.
Low infection risk.

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5
Q

Epidural insertion pack

A

Touhy - clear depth marking for accurate
Short/long term anaesthetic
adaptor
can cause low pressure headache.

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6
Q

Chest drain

A

Indications - PTx, haemothorax, symptomatic malignant pleural effusion, empyema.

Remove when no longer swinging bubbling and CXR confirms resolution.
in forced expiration.
close wound with mattress suture.

.

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7
Q

Surgical drains

A

Indications:
Drainage of a potential space post surgery
Removal of harmful fluid e.g. blood, pus, bile
Detection of bleeding or leakage - e.g. anastomosis

Open vs closed
Open - corugated rubber connect to external env - superficial wounds - risk of infection

Closed - connect via tubing to bottle.

Active - neg presure - impreoved wound closure
Passive - gravity - abdomen - less perforation.

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8
Q

Complications of surgical drains

A 
Ascending infection
Foreign body reaction (fibrosis, granulation)
Migration
Obstruction/kinkinh
Fistulation.
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9
Q

Breast implants

A

Breast augmentation, reconstruction post mastectomy, Gender reassignment.

10-15 years.

Very rare risk of anaplastic large cell lymphoma.
Rupture, infection, capsular contracture, erosion, migration.

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10
Q

Disposable rigid sigmoidoscope

A

left lateral position, knees flexed
Inspection of anus, rectum, lower sigmoid colon.

DRE before.
visual inspection.
15-20cm.
biospies e.g UC.

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11
Q

Proctoscope

A

visualise anal canal and lower rectum.
Also injecting/banding haemorrhoids.

Left lateral position, DRE, light source, lubricated.

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12
Q

Laporoscopic trochar

A

Veress needle, Hasson technique
CO2 gas - cleared by expiration, soluble in tissues, inert.
Complications; Visceral perforation
BMI

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13
Q

Absorbable Sutures

A

Vicryl, monocryl, PDS

For deep, rapid healing tissues (bowel, biliary, urinary anastomoses)

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14
Q

Non absorbable sutures

A

Steel, silk, nylon, prolene

Permanent support and slower healing tissues (vascular, tendon, fascia)

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15
Q

Monofilament

A

Superficial wound closure (less tissue reaction)

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16
Q

Complications of Hip prosthesis

A 
Dislocation
Osteolysis
Metal sensitivity
Nerve injury
Chronic pain.
17
Q

Oropharyngeal airway

A

FIrst line airway adjunct

risk of vomiting and aspiration if gag reflex is present.

18
Q

Nasopharyngeal airway

A 
Decreased Conc , intact gag reflex.
horizontally inserted.
pt height - 
Can casue ulcers, nosebleeds. 
Severe head or max fax trauma/basal skull fracture.
19
Q

LMA

A

Bridge to intubation
<2h surgeries
no protection v aspiration.
Avoid if reduced chest compliance

20
Q

ET Tube

A

Definitive airway
laryngoscope
above carina
inflate cuff - prevent gastric aspiration
check w symmetrica lexpansion, breath sounds, CXR

21
Q

Tracheostomy

A

Below glottis
reduced deadspace, improved oral hygiene, reduced sedation.

Indication - weaning off mechanical ventilation. severe max fax trauma.

22
Q

Complications of intubation

A 
Early - cant 
truama
bleeding
cuff perforation
endobronchial intubation

Delayed - tracheal necrosis/stenosis

23
Q

Indications of intubation

A

Decreased consciousness and loss of airway reflexes (GCS <8)
Failure to oxygenate (T1RF)
Failure to ventilate (T2RF)
Failure to maintain airway patency (obstruction, angioedema, facial/upperairway trauma)

24
Q

NG tube

A

ci if basal skull fracture
Short-med term enteral nutriion (max 4-6 w)
check position aspirate pH <4. CXR
2 ports for TPN/Drugs

Indication

  • Short/med term feeding - w functional GIT
  • Admin drugs/contrast in unsafe swallow.

Complications: NGT - nasal trauma, malposition , blockage
Feeding - refeeding syndrome, electrolyte imbalance, intolerance -diarrhoea.

25
Q

Ryles tube

A

Wide bore 16-18Fr
Prevent tube collapse during aspiration

Indication: Gastric decompression (bowel obstruction, ileus, post surgical)

Complications:
Pulmonary - aspiration pneumonia, ptx

GI - malposition, obstruction, reflux oesophagitis, gastritis, visceral perforation.

26
Q

Stool sample pot

A 
Bristol 5,6,7 warrant samples.
Tests - MCS - 4days
Rotavirus, adenovirus, norovirus - same day
GDH - Cdiff
Cdiff toxin - 2 weeks
Ova cysts, parasites - 4 days
helicobacter antigen - 1 wk
27
Q

urinary catheters

A

Types ;
Foley - <28days latex
Long term - silicone
3 way - haematuria- washout/irrigation.

indications

  • Diagnostic: UO measure, sterile sample, renal tract imaging.
  • Therapeutic - retention, immobility, bladder irrigation

Complications
- Early - create false tract, urethral rupture, paraphimosis, haematuria
Late - infection, blockage, stricture, stones.

CI
-Blood at meatus
-high prostate
scrotal haematoma
pelvic fracture
28
Q

Shouldered syringe

A

used to inject haemorrhoids, above dentate line.
5% phenol in almond oil.
Pain, damage, bleeding
Late - prostatitis, imptotence.

29
Q

Cannula colours

A

Orange = 14 G - blood tx, surgery, trauma

Grey = 16G rapid fluids, trauma, blood tx

Green = 18G rapid fluids, trauma, rapid blood

Pink: 20G most infusions. rapid fluids, trauma. routine blood transfusion

Blue: 22G Most infusions. paeds, older adults
routine blood transfusion

Yellow: 24G neonate, paeds, blood transfusion.

Purple 26G paeds, neonate

30
Q

Complications of cannulae

A 
Extravasation
Haematoma
Phlebitis
Thrombosis
Systemic infection

Final year Medicine (18 decks)

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