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Yr 6 PACES knowledge > Instruments and images > Flashcards

Instruments and images Flashcards

1
Q

Central venous catheter

Indications

A
  • Central venous pressure measurement
  • Administration of drugs: amiodarone
  • TPN
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2
Q

How is a central venous catheter used

A

Inserted using the seldinger technique under US guidance

Sterile procedure
Under LA
Order CXR afterwards

Common sites: int jugular vein, subclavian vein

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3
Q

Central venous catheter: complications

A

Immediate: pneumothorax, arrhythmia, malposition

Early: infection, haematoma, occlusion

Late: thrombosis, Phrenic nerve damage, sympathetic chain damage (corners)

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4
Q

Indication for central venous catheter vs PICC line vs Hickman line

A

CVC = short term use

Hickman + PICC line = long term central access

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5
Q

Hickman line:

A

Tunneled under skin to enter IJV, and tip lies in the SVC

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6
Q

Tesio catheter: indication and features

A

Indication = haemodialysis

Features = tunnelled subcutaneously
Cuffs promote a tissue reaction –> creates a better seal
Red limb: takes blood TO the machine
Blue limb: takes dialysed blood BACK to patient

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7
Q

Tesio catheter: method

A

Sterile insertion under X-ray guidance

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8
Q

Tesio catheter: complications

A

Early:
Pneumothorax
Arrhythmia
Bleeding

Late:
Infection
Catheter occlusion
Thrombosis

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9
Q 
Blood bottles:
Purple
Yellow
Grey
 - use? what does it contain?
A

Purple - contains EDTA to prevent clotting. use = FBC, X-match

Yellow - contains activated gel. SERUM chemistry

Grey - contains fluoride to inhibit glycolysis. Use = glucose

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10
Q

Endotracheal tube: indications

A

Definitive airway

  • long surgery: eg abdominal surgery
  • head injury –> reduced GCS
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11
Q

Endotracheal tube: features

A

Cuffed = prevents aspiration

Long enough to sit below the vocal cords = definitive

Blue line = radio-opaque

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12
Q

Endotracheal tube: method

A
  • Anaesthetist
  • Pt sedated and muscle relaxant may be used
  • Laryngoscope aids direct vision
  • Tube is secured using tape

Check position: symmetrical chest movements + auscultate for BS, CXR

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13
Q

ET tube: complications

A

Early: misplacement into oesophagus/bronchus
TRAUMA - oropharyngeal/laryngeal

Late: sore throat, tracheal stenosis

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14
Q

Guedel airway: indications

A

Non-definitive airway

Used in its with lowered GCS to maintain a patient airway .e.g. during extubation

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15
Q

Guedell airway: method

A

Measure size: incisors –> angle of mandible

Insert upside down, rotate once inside oral cavity

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16
Q

Guedell airway: complications

A
  • Oropharyngeal trauma

- Gagging –> vomiting –> aspiration

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17
Q

Ryles tube: indications

A

Draining the stomach, and NOT for feeding

Drip + suck in obstruction

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18
Q

Ryles tube: features

A

Wider + stiffer than a feeding NGT

Radio-opaque line –> to visualise on CXR

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19
Q

Ryles tube: insertion method

A

Sizing: tip of patient’s nose, down to epigastrium, going around the ear

Lubricate the tip w gel
Insert tube + ask pt to swallow sips of water when they feel is at back of throat

Secure with tape

Checking location:

  • Aspirate gastric contents + check pH<4
  • CXR
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20
Q

Ryles tube: complciations

A

Nasal trauma
Malposition
Blockage

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21
Q

Feeding NG tube: indications?

A

Provides enteral nutrition:

Reduced GCS/ITU
Malnutrition
Catabolic state: sepsis, burns, major surgery
Dysphagia: stricture, stroke

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22
Q

Feeding NG tube: features and insertion?

A

Soft silicone + guide wire to aid insertion

Sizing: tip of nose to epigastrium, going round the ear

Lubricate tip w gel
Insert via nostril + ask pt to sip water when they feel it at back of throat.

Remove guide wire + secure with dressing

Check location: CXR + aspiration of gastric contents <4

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23
Q

Foley urinary catheter: indications

A
  • Urinary retention - BPH, neuropathic bladder
  • Monitor urine output in acutely unwell pt
  • Immobile
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24
Q

Foley catheter: features

A

2 ports: one for drainage of bladder, one for inflating balloon which keeps catheter in place

Usually latex

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25
Q

Foley catheter: method

A

Obtain consent from patient

ANTT

  • Clean the perineal area
  • Instillagel in the urethra + wait 2 mins
  • Insert catheter
  • Ensure urine is draining before inflating the balloon
  • Replace foreskin to prevent paraphimosis
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26
Q

Foley catheter: complications

A

Early: Paraphimosis
Haematuria
Urethral trauma

Late:
Infection
Blockage

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27
Q

Initial Mx of hip fracture

A

ABC: resus
Analgesia
Assess neurovascular status of limb
IMAGING - orthogonal views

Prep for theatre:
Anaesthetist - inform + book for theatre
Bloods - FBC, clotting, G+S, Xmatch, U+E
CXR
DVT prophylaxis
ECG
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28
Q

Risk factors for hip fracture

A

AGE + osteoporosis!!

Steroids
Early menopause
EtOH + smoking
Low BMI
Hyperthyroidism
Renal/liver failure
Low calcium + Vit D intake/absorption
Pre-existing bone disease (myeloma, RA)
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29
Q

Garden classification

A 
For intracapsular NOF#
1. incomplete, undisplaced
2, complete, undisplaced
3. complete, partially displaced
4. complete, completely displaced
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30
Q

Surgical management of NOF#

A

Extra capsular = DHS or intramedullary

Intracapsular:
1,2: DHS
3,4: THR (if fit), hemiarthroplasty if elderly

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31
Q

Stages of fracture healing

A 
Reactive phase (- 48 hrs)
- bleeding into fracture site + inflammation
Reparative phase (2 days - 2 weeks)
- Callus formation
Remodelling phase (-----7 years)
- Lamellar bone remodels to cope with mechanical forces applied to it "form follows function"
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32
Q

How to describe a fracture

A

Pt details

Pattern: transverse/oblique/comminuted/spiral
Anatomical location: shaft/epiphysis/metaphysis
Intraarticular?
Deformity: translation/angulation
Soft tissues: open/closed?

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33
Q

Suture types

A

Absorbable vs non-absorbable
Monofilament vs braided
Natural vs synthetic

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34
Q

+ves and -ves of monofilament vs braided

A 
Monofilament:
\+ Less friction
- Has more memory
- More slip
- Less tensile strength

Braided:
+ Stronger
+ Easier to handle - less slip and less memory
- increased risk of infection

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35
Q

2 Egs of absorbable sutures?

A 
Monocryl = monofilament
Vicryl = braided
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36
Q

Eg of non-absorbable suture? what is its construction and what is it used for

A

Prolene

monofilament, used for vessel anastomosis _ skin wounds

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37
Q

causes of long QT interval

A

Heart: post MI, post cardiac arrest
Clin chem: low Ca, K, Mg
Congenital
Drugs: amiodarone, citalopram

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38
Q

blood culture bottles: which colours for which bacteria?

A

Red: anaerobic
Blue: aerobic

take BLUE (aerobic) FIRST

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39
Q

Blood culture bottles: method

A

Take blood using ANTT.
REPLACE NEEDLE w a clean one.
Wipe top of bottles with EtOH

Fill AEROBIC (blue) bottle first
Fill in pt details + send to path lab
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40
Q

Indications for blood culture

A

pyrexia, suspected sepsis

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41
Q

Peripheral venous cannula - indications?
method?
complications?

A

Indication; admin of drugs, fluid, taking blood during insertion

Method: into peripheral vein w ANTT

Complications:

  • Malplacement - puncturing an artery, Extravasation
  • Haematoma
  • Blockage
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42
Q

PICC line - where is it inserted?

A

usually brachial vein

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43
Q

Port a Cath - indications? features?

A

Indications: long term chemo or Abx

Centrally placed catheter
Subcutaneous port made of rubber

Accessed at 90 degrees w Huber point needle

V low infection risk as breech is v small

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44
Q

When should blood cultures be taken compared to other blood tests

A

blood cultures FIRST

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45
Q

Laryngoscope: features?

A

Light source + handle

Blade is detachable and comes in diff sizes, and straight vs curved

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46
Q

Complications of a laryngoscope

A

Oropharyngeal trauma
Laryngeal trauma
C-spine injury

47
Q

Tracheostomy - indications? features?

A

Indications:

  • Definitive surgical airway
  • Emergency, in upper airway obstruction
  • Laryngeal surgery
  • Maxfax injuries

Features:

  1. Obturator - used to insert that trache, then removed
  2. Cuff - to prevent aspiration
  3. Flange - to secure to patient’s neck
48
Q

Advantages of tracheostomy tube over ET tube

A
  • no sedation
  • easier to maintain oral hygiene
  • less discomfort
  • less dead space –> reduced work of breathing
49
Q

Complications of tracheostomy

A

Immediate: Haemorrhage, damage to oesophagus/rec laryngeal nerve, pneumothorax

Early:
Obstruction
Displacement
Surgical emphysema

Late
Tracheal stenosis
Tracheomalacia
TOF

50
Q

LMA - indications

A
  1. Emergency, where ET tube cannot be placed

2. Non-definitive airway for short day case surgery

51
Q

LMA - features

A

Inflatable cuff to seal over the larynx

52
Q

LMA - method

A
  • Cuff is deflated + lubricated
  • Open end inserted pointing down towards tongue
  • Sits over the larynx
  • Cuff is inflated + tube secured w tape
  • Position confirmed by equal chest expansion + breath sounds
53
Q

LMA -complications

A

Aspiration - non definitive airway

Dislodgement

54
Q

Guedell airway - indications

A

Emergency setting where ET tube cannot be inserted

Maintaining airway in pt w low GCS!!

55
Q

Guedell - method

A

Initially inserted w open end pointing to roof of mouth, then twisted 180

Measurement - angle of mandible to incisors

56
Q

Guedell - complications

A
  • Oropharyngeal trauma
  • Gagging –> vomiting
  • Aspiration
57
Q

Nasopharyngeal airway - indications

A

Maintaining an airway in low GCS

58
Q

NP airway - method

A 
diameter = little finger
length = tragus of ear --> nostril

Inserted into the nose w a ROTATIONAL action

Safety pin at end prevents tube loss lol

59
Q

NP airway - complications

A

Trauma to nasal mucosa –> epistaxis

Intracranial placement (via cribriform plate in basal skull #)

60
Q

NP airway - contraindications

A

Evidence of basal skull #

  • Racoon eyes
  • mastoid bruising
  • haemotympanum
  • CSF rhinorrhoea/otorrhoea
61
Q

Max rate of O2 delivery through nasal prongs

A

4L

62
Q

Non-rebreather mask: features

A

Enhances oxygen delivery, as long as pt can breathe unassisted

Reservoir bag = 1.5L

One way valve, prevents reinhalation of expired air

63
Q

Indications for ventilation

A

-Respiratory failure that is not improving with less invasive airway management

64
Q

Complications of ventilation

A
  • Pneumothorax
  • Fluid retention
  • pneumonia
  • tracheal stenosis
65
Q

Indications for parenteral nutrition

A
  • Unable to swallow (oesophageal ca)
  • Prolonged obstruction/ileus
  • Severe malnutrition
  • severe Crohns
66
Q

Delivery of parenteral nutrition

A

Must be delivered CENTRALLY as high osmolality –> toxic to vessels

Short term - CVC
Long term - PICC or Hickman

67
Q

Monitoring in parenteral nutrition

A

Fluid balance + electrolytes inc Zn, Mg

FBC, glucose, U+Es, LFTs

68
Q

Complications of parenteral nutrition

A

Line related: infection, thrombosis, pneumothorax, arrhythmia

Feed related:

  • electrolyte imbalance
  • villous atrophy of GIT
  • hyperglycaemia
  • vit and mineral deficiencies
69
Q

Refeeding syndrome - pathophysiology?

what is the main problem and what features does it cause

A

Starvation –> low insulin, low protein + fat metabolism and low intracellular phosphate

Refeeding –> high insulin, rapid uptake of phosphate into cells

Main problem = hypophosphatemia –> rhabdo, seizures, arrhythmia, shock

70
Q

Chemistry in refeeding syndrome

A

LOW PHOSPHATE

and low K and Mg

71
Q

How to prevent a DVT

A

Pre-op:
Stop OCP 4 weeks before
VTE risk assessment
Hydration

Intra-op:
Short length
Minimal access
Intermittent pneumatic compression boots

Post-op:
Analgesia –> mobilisation
Hydration
LMWH

72
Q

Indications for Hartmann’s

A

Trauma, Burns

73
Q

how much Na in 1L 0.9% saline?

A

154mM

74
Q

Two types of open drains?

A

pemrose, tissue drain

75
Q

Suture types- +ves and -ves

A

Monofilament vs braided

Monofilament:
\+ less friction
\+ less infection
- memory
- slippy
76
Q

Egs of diff sutures

A

Monocryl (monofilament + absorbable)
Vicryl (braided + absorbable)

Proline (non-absorbable)

77
Q

Suture used for bowel anastomosis?

For arterial anastomosis?

A

Bowel anastomosis = vicryl

Arterial nastamosis = prolene

78
Q

Name of retractor used for abdo surgery

A

Denver’s retractor

  • can be bent to a suitable shape
79
Q

length of rigid sigmoidoscope vs proctoscope

A

Rigid sig = 25cm

80
Q

length of rigid sigmoidoscope vs proctoscope

A

Rigid sig = 25cm

Proctoscope = 13cm

81
Q

Indications for a disposable proctoscope

A

Investigation of PR bleed (?haemorrhoids, lower rectal ca)

Therapeutic: sclerotherapy, banding

82
Q

Method of proctoscopy? complications

A

Pt in L lateral position, knees bent
Perform DRE
Lubricate + attach light source
Insert

83
Q

What is injected into haemorrhoids for sclerotherapy? how is it injected?

A

5% phenol in almond oil

Inject 2mL above the dentate line

84
Q

Name of syringe used for haemorrhoid sclerotherapy

A

Shouldered/Gabriel syringe

85
Q

Indications/uses for rigid sigmoidoscope

A

? rectal cancer ? diverticular disease ? IBD

can also take a biopsy!

86
Q

Method for rigid sigmoidoscope

A
  • L Lat position + DRE first
  • Lubricate the scope and insert
  • Remove obturator
  • Use light source +
  • INSUFFLATE w air
87
Q

What gas is used to inflate the abdomen in laparoscopic surgery? why?

A

CO2 - cheap +inert

88
Q

Intra-operatively, how is the integrity of an anastomosis checked?

A

Fill pelvic cavity w saline

Insufflate rectum w air + look for bubbles

89
Q

Indications for catheterisation

A

Diagnostic: measure urine output, sterile urine sample

Therapeutic: relieve retention, immobility, bladder irrigation,

90
Q

Urinary catheter - contraindications

A

Urethral trauma!

  • Urethral stricture
  • blood @ urethral meatus
  • Post-op urological pts
91
Q

Causes and Mx of non-draining cathter

A

Blocked? - flush w 20mL saline or consider 3 way catheter

Renal or pre-renal failure???

92
Q

What is TWOc

A

Trial without catheter after acute urinary retention

May be performed as a urology outpatient if retention again is likely

93
Q

Indications for long term cathterisation

A

Chronic obstruction (BPH)
Neurogenic bladder
Complications of incontinence –> pt preference, palliative care

94
Q

Indications for intermittent self cathterisation

A

Neurogenic bladder: DM, MS

Chronic retention

  • an alternative to long term catheterisation
95
Q

Indication for 3 way foley cathter

A

Irrigate bladder in pts @ risk of clot retention

eg after TURP or in pts w haematuria

96
Q

Suprapubic catheter- indications?

A

Urethral obstruction: BPH, rotate ca

Urethral INJURY

97
Q

Method of insertion of suprapubic catheter

A

US guided insertion under LA

98
Q

Complications of suprapubic catheter

A

Haemorrhage
Malignancy SEEDING
Viscus perforation

99
Q

Advantages and disadvantages of suprapubic cathter

A

+ves: Fewer infections, less stricture formation, more comfortable, maintains sexual function

-ves: more complex
serious complications: eg malignancy seeding

100
Q

Contraindications for suprapubic catheter

A

Bladder carcinoma
Undiagnosed suprapubic
Previous lower abdo surgery

101
Q

Mx of acute urinary retention

A
  • Catheterise (3 way if clots)
  • Analgesia
  • hourly UO + replace
  • STAT GENTAMICIN COVER
  • (tamsulosin - reduces risk of recathetrisation after retention)
  • TOWC after 24-72 hours
102
Q

2 different methods of JJ stent insertion

A

Percutaneously

OR retrograde, via cystoscopic guidance

103
Q

3 indications for chest drain

A

Pneumothorax
Pleural effusion
After thoracotomy or oesophagectomy

104
Q

Safe triangle for chest drain

A

Lateral edge of pec major
Anterior edge of Lat dorsi
5th ICS

105
Q

How is incision made for chest drain insertion

A

Infiltrate area with
1cm incision w scalpel
Blunt dissect with SPENCER WELLS FORCEPS
Clear adhesions w finger

106
Q

Indications for fracture plate

A

Internal fixation of fractures

107
Q

How is a fracture plate used? how is it secured?

A

Internal fixation of a fracture

Plate is aligned to the bone + screws fix the plate to the bone!

108
Q

Complications of using a fracture plate

A

Infection
Failure
Malposition of remodelled fracture

109
Q

Name of a hemiarthropalsty prosthesis? Indications?

Feature?

A

Austin Moore
Intracapsular NOF #, Garden 3/4 where pt is immobile

Has fenestrated stem - promotes bone growth around it

110
Q

Complications of hip replacement

A

Early: deep infection, dislocation, DVT

Late: loosening (septic or aseptic)
Failure –> stem #
Revision - most replacements last 10-15 years

111
Q

Cemented vs uncemented

A

Cement = acts as glue to attach the prosthesis to the existing bone

Uncemented = promotes the new bone to grow around it. but longer recovery period

112
Q

Indications for intramedullary nail

A

Internal fixation for long bone #s:

tibia, femur, humerus

113
Q

Principle behind a DYNAMIC hip screw

A

Allows collapse of the femoral head onto the neck –> increased loading of fracture site –> quicker union

114
Q

How does fat embolism syndrome often arise?

Key Fx?

A

Embolisation of bone marrow fat in circulation, often due to intramedullary nailing or THR/TKR

Key features:

Hypoxaemia
Petechial rash
CNS depression
Pulmonary oedema

Yr 6 PACES knowledge (14 decks)

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