Instruments and images Flashcards
1
Q
Central venous catheter
Indications
A
- Central venous pressure measurement
- Administration of drugs: amiodarone
- TPN
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
3
Q
Central venous catheter: complications
A
Immediate: pneumothorax, arrhythmia, malposition
Early: infection, haematoma, occlusion
Late: thrombosis, Phrenic nerve damage, sympathetic chain damage (corners)
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
5
Q
Hickman line:
A
Tunneled under skin to enter IJV, and tip lies in the SVC
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
7
Q
Tesio catheter: method
A
Sterile insertion under X-ray guidance
8
Q
Tesio catheter: complications
A
Early:
Pneumothorax
Arrhythmia
Bleeding
Late:
Infection
Catheter occlusion
Thrombosis
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
10
Q
Endotracheal tube: indications
A
Definitive airway
- long surgery: eg abdominal surgery
- head injury –> reduced GCS
11
Q
Endotracheal tube: features
A
Cuffed = prevents aspiration
Long enough to sit below the vocal cords = definitive
Blue line = radio-opaque
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
13
Q
ET tube: complications
A
Early: misplacement into oesophagus/bronchus
TRAUMA - oropharyngeal/laryngeal
Late: sore throat, tracheal stenosis
14
Q
Guedel airway: indications
A
Non-definitive airway
Used in its with lowered GCS to maintain a patient airway .e.g. during extubation
15
Q
Guedell airway: method
A
Measure size: incisors –> angle of mandible
Insert upside down, rotate once inside oral cavity
16
Q
Guedell airway: complications
A
- Oropharyngeal trauma
- Gagging –> vomiting –> aspiration
17
Q
Ryles tube: indications
A
Draining the stomach, and NOT for feeding
Drip + suck in obstruction
18
Q
Ryles tube: features
A
Wider + stiffer than a feeding NGT
Radio-opaque line –> to visualise on CXR
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
20
Q
Ryles tube: complciations
A
Nasal trauma
Malposition
Blockage
21
Q
Feeding NG tube: indications?
A
Provides enteral nutrition:
Reduced GCS/ITU
Malnutrition
Catabolic state: sepsis, burns, major surgery
Dysphagia: stricture, stroke
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
23
Q
Foley urinary catheter: indications
A
- Urinary retention - BPH, neuropathic bladder
- Monitor urine output in acutely unwell pt
- Immobile
24
Q
Foley catheter: features
A
2 ports: one for drainage of bladder, one for inflating balloon which keeps catheter in place
Usually latex
25
Foley catheter: method
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
26
Foley catheter: complications
Early: Paraphimosis
Haematuria
Urethral trauma
Late:
Infection
Blockage
27
Initial Mx of hip fracture
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
```
28
Risk factors for hip fracture
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)
```
29
Garden classification
```
For intracapsular NOF#
1. incomplete, undisplaced
2, complete, undisplaced
3. complete, partially displaced
4. complete, completely displaced
```
30
Surgical management of NOF#
Extra capsular = DHS or intramedullary
Intracapsular:
1,2: DHS
3,4: THR (if fit), hemiarthroplasty if elderly
31
Stages of fracture healing
```
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"
```
32
How to describe a fracture
Pt details
Pattern: transverse/oblique/comminuted/spiral
Anatomical location: shaft/epiphysis/metaphysis
Intraarticular?
Deformity: translation/angulation
Soft tissues: open/closed?
33
Suture types
Absorbable vs non-absorbable
Monofilament vs braided
Natural vs synthetic
34
+ves and -ves of monofilament vs braided
```
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
35
2 Egs of absorbable sutures?
```
Monocryl = monofilament
Vicryl = braided
```
36
Eg of non-absorbable suture? what is its construction and what is it used for
Prolene
monofilament, used for vessel anastomosis _ skin wounds
37
causes of long QT interval
Heart: post MI, post cardiac arrest
Clin chem: low Ca, K, Mg
Congenital
Drugs: amiodarone, citalopram
38
blood culture bottles: which colours for which bacteria?
Red: anaerobic
Blue: aerobic
take BLUE (aerobic) FIRST
39
Blood culture bottles: method
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
```
40
Indications for blood culture
pyrexia, suspected sepsis
41
Peripheral venous cannula - indications?
method?
complications?
Indication; admin of drugs, fluid, taking blood during insertion
Method: into peripheral vein w ANTT
Complications:
- Malplacement - puncturing an artery, Extravasation
- Haematoma
- Blockage
42
PICC line - where is it inserted?
usually brachial vein
43
Port a Cath - indications? features?
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
44
When should blood cultures be taken compared to other blood tests
blood cultures FIRST
45
Laryngoscope: features?
Light source + handle
| Blade is detachable and comes in diff sizes, and straight vs curved
46
Complications of a laryngoscope
Oropharyngeal trauma
Laryngeal trauma
C-spine injury
47
Tracheostomy - indications? features?
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
Advantages of tracheostomy tube over ET tube
- no sedation
- easier to maintain oral hygiene
- less discomfort
- less dead space --> reduced work of breathing
49
Complications of tracheostomy
Immediate: Haemorrhage, damage to oesophagus/rec laryngeal nerve, pneumothorax
Early:
Obstruction
Displacement
Surgical emphysema
Late
Tracheal stenosis
Tracheomalacia
TOF
50
LMA - indications
1. Emergency, where ET tube cannot be placed
| 2. Non-definitive airway for short day case surgery
51
LMA - features
Inflatable cuff to seal over the larynx
52
LMA - method
- 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
LMA -complications
Aspiration - non definitive airway
| Dislodgement
54
Guedell airway - indications
Emergency setting where ET tube cannot be inserted
Maintaining airway in pt w low GCS!!
55
Guedell - method
Initially inserted w open end pointing to roof of mouth, then twisted 180
Measurement - angle of mandible to incisors
56
Guedell - complications
- Oropharyngeal trauma
- Gagging --> vomiting
- Aspiration
57
Nasopharyngeal airway - indications
Maintaining an airway in low GCS
58
NP airway - method
```
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
NP airway - complications
Trauma to nasal mucosa --> epistaxis
Intracranial placement (via cribriform plate in basal skull #)
60
NP airway - contraindications
Evidence of basal skull #
- Racoon eyes
- mastoid bruising
- haemotympanum
- CSF rhinorrhoea/otorrhoea
61
Max rate of O2 delivery through nasal prongs
4L
62
Non-rebreather mask: features
Enhances oxygen delivery, as long as pt can breathe unassisted
Reservoir bag = 1.5L
One way valve, prevents reinhalation of expired air
63
Indications for ventilation
-Respiratory failure that is not improving with less invasive airway management
64
Complications of ventilation
- Pneumothorax
- Fluid retention
- pneumonia
- tracheal stenosis
65
Indications for parenteral nutrition
- Unable to swallow (oesophageal ca)
- Prolonged obstruction/ileus
- Severe malnutrition
- severe Crohns
66
Delivery of parenteral nutrition
Must be delivered CENTRALLY as high osmolality --> toxic to vessels
Short term - CVC
Long term - PICC or Hickman
67
Monitoring in parenteral nutrition
Fluid balance + electrolytes inc Zn, Mg
FBC, glucose, U+Es, LFTs
68
Complications of parenteral nutrition
Line related: infection, thrombosis, pneumothorax, arrhythmia
Feed related:
- electrolyte imbalance
- villous atrophy of GIT
- hyperglycaemia
- vit and mineral deficiencies
69
Refeeding syndrome - pathophysiology?
what is the main problem and what features does it cause
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
Chemistry in refeeding syndrome
LOW PHOSPHATE
and low K and Mg
71
How to prevent a DVT
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
Indications for Hartmann's
Trauma, Burns
73
how much Na in 1L 0.9% saline?
154mM
74
Two types of open drains?
pemrose, tissue drain
75
Suture types- +ves and -ves
Monofilament vs braided
```
Monofilament:
+ less friction
+ less infection
- memory
- slippy
```
76
Egs of diff sutures
Monocryl (monofilament + absorbable)
Vicryl (braided + absorbable)
Proline (non-absorbable)
77
Suture used for bowel anastomosis?
| For arterial anastomosis?
Bowel anastomosis = vicryl
Arterial nastamosis = prolene
78
Name of retractor used for abdo surgery
Denver's retractor
- can be bent to a suitable shape
79
length of rigid sigmoidoscope vs proctoscope
Rigid sig = 25cm
80
length of rigid sigmoidoscope vs proctoscope
Rigid sig = 25cm
| Proctoscope = 13cm
81
Indications for a disposable proctoscope
Investigation of PR bleed (?haemorrhoids, lower rectal ca)
Therapeutic: sclerotherapy, banding
82
Method of proctoscopy? complications
Pt in L lateral position, knees bent
Perform DRE
Lubricate + attach light source
Insert
83
What is injected into haemorrhoids for sclerotherapy? how is it injected?
5% phenol in almond oil
Inject 2mL above the dentate line
84
Name of syringe used for haemorrhoid sclerotherapy
Shouldered/Gabriel syringe
85
Indications/uses for rigid sigmoidoscope
? rectal cancer ? diverticular disease ? IBD
can also take a biopsy!
86
Method for rigid sigmoidoscope
- L Lat position + DRE first
- Lubricate the scope and insert
- Remove obturator
- Use light source +
- INSUFFLATE w air
87
What gas is used to inflate the abdomen in laparoscopic surgery? why?
CO2 - cheap +inert
88
Intra-operatively, how is the integrity of an anastomosis checked?
# Fill pelvic cavity w saline
Insufflate rectum w air + look for bubbles
89
Indications for catheterisation
Diagnostic: measure urine output, sterile urine sample
Therapeutic: relieve retention, immobility, bladder irrigation,
90
Urinary catheter - contraindications
Urethral trauma!
- Urethral stricture
- blood @ urethral meatus
- Post-op urological pts
91
Causes and Mx of non-draining cathter
Blocked? - flush w 20mL saline or consider 3 way catheter
Renal or pre-renal failure???
92
What is TWOc
Trial without catheter after acute urinary retention
| May be performed as a urology outpatient if retention again is likely
93
Indications for long term cathterisation
Chronic obstruction (BPH)
Neurogenic bladder
Complications of incontinence --> pt preference, palliative care
94
Indications for intermittent self cathterisation
Neurogenic bladder: DM, MS
Chronic retention
- an alternative to long term catheterisation
95
Indication for 3 way foley cathter
Irrigate bladder in pts @ risk of clot retention
eg after TURP or in pts w haematuria
96
Suprapubic catheter- indications?
Urethral obstruction: BPH, rotate ca
| Urethral INJURY
97
Method of insertion of suprapubic catheter
US guided insertion under LA
98
Complications of suprapubic catheter
Haemorrhage
Malignancy SEEDING
Viscus perforation
99
Advantages and disadvantages of suprapubic cathter
+ves: Fewer infections, less stricture formation, more comfortable, maintains sexual function
-ves: more complex
serious complications: eg malignancy seeding
100
Contraindications for suprapubic catheter
Bladder carcinoma
Undiagnosed suprapubic
Previous lower abdo surgery
101
Mx of acute urinary retention
- 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
2 different methods of JJ stent insertion
Percutaneously
OR retrograde, via cystoscopic guidance
103
3 indications for chest drain
Pneumothorax
Pleural effusion
After thoracotomy or oesophagectomy
104
Safe triangle for chest drain
Lateral edge of pec major
Anterior edge of Lat dorsi
5th ICS
105
How is incision made for chest drain insertion
Infiltrate area with
1cm incision w scalpel
Blunt dissect with SPENCER WELLS FORCEPS
Clear adhesions w finger
106
Indications for fracture plate
Internal fixation of fractures
107
How is a fracture plate used? how is it secured?
Internal fixation of a fracture
| Plate is aligned to the bone + screws fix the plate to the bone!
108
Complications of using a fracture plate
Infection
Failure
Malposition of remodelled fracture
109
Name of a hemiarthropalsty prosthesis? Indications?
Feature?
Austin Moore
Intracapsular NOF #, Garden 3/4 where pt is immobile
Has fenestrated stem - promotes bone growth around it
110
Complications of hip replacement
Early: deep infection, dislocation, DVT
Late: loosening (septic or aseptic)
Failure --> stem #
Revision - most replacements last 10-15 years
111
Cemented vs uncemented
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
Indications for intramedullary nail
Internal fixation for long bone #s:
| tibia, femur, humerus
113
Principle behind a DYNAMIC hip screw
Allows collapse of the femoral head onto the neck --> increased loading of fracture site --> quicker union
114
How does fat embolism syndrome often arise?
| Key Fx?
Embolisation of bone marrow fat in circulation, often due to intramedullary nailing or THR/TKR
Key features:
Hypoxaemia
Petechial rash
CNS depression
Pulmonary oedema
