Instruments for PACES station Flashcards
What is this?
Absorbable sutures
Compare the 2 types of absorbable sutures
Monocryl – monofilament, increased throws for stable knot (9).
Vicryl – polyfilament is braided and so is less likely to loosen at the surgical knot, less throws (3) but has increased fraying issues and local tissue inflammation and is more susceptible to infection
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/absorbable-sutures/ + https://geekymedics.com/suture-material/
What is this?
Arterial blood gas syringe
What information do you get from an ABG?
- pH
- pO2 and pCO2 – for identification of respiratory failure (arterial)
- Bicarbonate
- Lactate
- Hb
- Na+/K+
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/arterial-blood-gas-syringe/
What does the purple blood bottle contain, and what is it used for?
EDTA
Haematology
(Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/blood-bottles/)
What is the pink blood bottle used for?
EDTA
Group and Save and cross match
(Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/blood-bottles/)
What does the blue bottle contain and what is it used for?
Buffered sodium citrate
Used for coagulation screening
(Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/blood-bottles/)
What does the gold blood bottle contain and what is it used for?
Silica particles and serum separating gel
Used for various including U&E and LFT
What does the grey blood bottle contain and what is it used for?
Sodium fluoride and potassium oxalate
Used for glucose and lactate
(Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/blood-bottles/)
What does the red blood bottle contain and what is it used for?
Silica particles
Sensitive tests eg toxicology
(Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/blood-bottles/)
What is the rust top blood bottle used for?
Viral immunology
What are these?
Blood culture bottles
Anaerobic = purple top
Aerobic = blue top (fill first)
What is this?
Blood glucose monitoring kit
Recall some examples of how blood glucose monitoring kits are used
- Diabetic patients use CBG measurements to guide insulin dosing
- Acutely, CBG measurements are needed to guide treatment in diabetic crises, such as DKA, non-ketotic hyperglycaemia, hypoglycaemia and reduced GCS
(Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/blood-glucose-monitoring-kit/)
What are these?
Breast implants
Recall some possible complications of breast implants
Rupture (tend to last 10-15 years, may rupture after this) Infection Capsular contracture Erosion Migration ALCL (anaplastic large cell lymphoma)
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/breast-implants/
What is this, and when might it be used?
Catgut suture
Rarely used nowadays but sometimes still used in formation of stomas and circumcision
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/catgut-suture/
What is this?
Catheter bag
What is this?
Seldinger central line insertion pack
Which veins might a central line be inserted into?
Subclavian
Internal jugular
What can central lines be used for?
- Delivery of medications/fluids that may be harmful orally or peripherally
- Blood tests and central venous pressures
(Examples: parenteral nutrition, emergency venous access, fluid resuscitation, infusion of irritant drugs, vasopressors, inotropes)
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/central-line-insertion-pack/
Recall some possible complications of central line insertion
Pneumothorax, sepsis, thrombosis and misplacement
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/central-line-insertion-pack/
What is this?
Chest drain bottle
What are the 2 types of chest drain bottle
The first type contains a small amount of water, which acts as a seal preventing air or fluid coming back up the tube into the chest.
Alternatively, an electronic chest drainage device may be used (a Thopaz machine), which can deliver suction (to help the lung re-expand) and allows the doctors to measure if there is any ongoing air leak between the lung and pleural cavity.
Source: NHS North Bristol Trust - https://www.nbt.nhs.uk/our-services/a-z-services/respiratory-medicine/respiratory-patient-information/chest-drain
Where does the chest drain act?
It drains air/blood/pus etc from the pleural space
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/chest-drain-bottle/
Instructions to pt about chest drain?
- Bottle must always be below level of waist
- May be asked to cough so HCP can check if it’s working
- You will have a waterproof dressing over the suture site
What is this?
CSF manometer
What is a CSF manometer used for?
Identification of opening pressures
Measurement is in cm H2O
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/csf-manometer/
What are the ranges of normal opening pressures on LP?
10-18 cm H2O if patient is lying on their side
20-30 cm H2O when sat up
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/csf-manometer/
What is this and what is it used for?
Devers retractor
Retraction in abdominal surgery
What is this?
Diathermy (monopolar)
What are the possible complications of diathermy?
- Risk of burning hands
- Risk of fire if alcohol wash used
What is this?
Disposable rigid sigmoidoscope
What is this?
Drainage bag that may be attached to NG tube/ abdo drain (passive)
What is this?
Endotracheal tube with tape and syringe
How is an endotracheal tube inserted?
Using a laryngoscope and bougie
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/endotracheal-tube/
How is positioning of an endotracheal tube checked?
Looking for symmetrical rising of the chest on ventilation, breath sounds bilaterally and no gurgling over the epigastrium indicating oesophageal intubation
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/endotracheal-tube/
What is this?
Epidural insertion pack (needle, catheter, catheter adaptor)
What is this?
Faeces sample pot
What is this?
Feeding NG tube
What is this?
5% dextrose solution
What is this?
Fluid giving set
What are these?
Forceps (toothed and non-toothed)
What is this?
Fracture plate
What is this?
Hemiarthroplasty
What is this?
Hickman line - long term central venous line
What is a Hickman line most often used for?
Longterm parenteral nutrition
What is this?
Total hip replacement
What is this?
Histology specimen pot
What is this?
IM femoral nail - used to internally fix femoral shaft fractures
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/im-femoral-nail/
What is this?
Instillagell - anaesthetic lubricant gel used for catheterisation
Recall the guage of blue, pink and grey IV cannulas
Blue = 22G Pink = 20G Grey = 16G
What is this?
Laparoscopic port
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/laparoscopic-port/
What is this?
Laryngeal mask
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/laryngeal-mask/
What are these?
Airway adjuncts (i Gels) = supraglottic
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/laryngeal-mask/
What are laryngeal airways used for?
Supraglottic airway used prior to intubation
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/laryngeal-mask/
What is the main difference in function between a laryngeal airway and an iGel?
Laryngeal airway has an inflatable cuff whereas iGels contain a thermoplastic elastomer (styrene) that moulds to the perilaryngeal framework with patient temperature
Medlearn says iGel prevents aspiration and LMAs don’t but I can’t find any other info to backt this up online
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/laryngeal-mask/
Recall 2 risks of laryngeal airways
Inflation can cause pressure lesions and nerve palsies
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/laryngeal-mask/
What is this and what is it used for?
Leg bag
For mobile patients with catheters
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/leg-bag/
Recall 2 uses for mannitol
- Lower raised ICP
- Drive the urine output in a patient with obstructive jaundice to prevent hepato renal syndrome.
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/mannitol/
How much oxygen can be delivered by nasal cannulae?
Usually used to carry 1-3L of oxygen per minute (can be upto 5L/min)
This delivers between 28-44% of oxygen
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/nasal-cannulae/
Recall 2 complications of nasal cannulae
Nasal sores
Epistaxis
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/nasal-cannulae/
What is this and what is it used for?
Nasal speculum - for examining inside nose
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/nasal-speculum/
What is this and what is it used for?
Nasopharyngeal airway
Used as an airway in people with decreased GCS/decreased gag reflex
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/nasopharyngeal-airway/
How should nasopharyngeal airway be sized?
Diameter should be sized against patient’s own diameter of little finger distal phalanx
Length should be determined by measuring from tip of nose to earlobe
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/nasopharyngeal-airway/
What is one important contraindication for nasopharyngeal airway?
Suspected basal skull fracture
How do you prevent inhalation of nasopharyngeal airway?
Put a safety pin at the end
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/nasopharyngeal-airway/
What is this?
Nebuliser mask and chamber
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/nebuliser-mask-chamber/
What are these?
Needle holders
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/needle-holders/
Neurology: What size tuning fork is used for vibration of joints vs Rinne’s and Weber’s?
Joints: 128 Hz
Rinne’s/Weber’s: 512 Hz
What are these?
Ethylon non-absorbable sutures
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/non-absorbable-sutures/
What are non-absorbable ethilon sutures usually used for and why?
Usually used for percutaneous sutures as more likely to loosen over time than prolene non-absorbable sutures
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/non-absorbable-sutures/
Recall 2 uses of prolene sutures
Vascular and bowel anastamosis
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/non-absorbable-sutures/
What is this?
Non rebreather mask
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/non-rebreather-mask/
What is the flow rate of a non-rebreather mask and what % oxygen can it deliver?
10-15L/min
Up to 90% oxygen
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/non-rebreather-mask/
What is this?
Oropharyngeal airway
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/oropharyngeal-airway/
How should oropharyngeal airways be sized?
Measure size from angle of mouth to angle of mandible
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/oropharyngeal-airway/
How should oropharyngeal airways be inserted?
Upside down then rotated (apart from in children, where it is inserted the right way up)
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/oropharyngeal-airway/
What is this?
PICC line
Inserted peripherally and advanced into a central vein
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/picc-line/
Recall 3 uses of PICC lines
(Peripherally inserted central catheter)
- Long-term vascular access for blood sampling
- Chemotherapy administration
- Infusion of hyperosmolar solutions such as those used for total parenteral nutrition
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/picc-line/
What is this?
Protoscope
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/proctoscope/
What is this?
Ryles NG tool
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/ryles-ng-tool/
What is a Ryles NG tool used for?
- Primarily used for drip and suck
- Can also be used to insert drugs or contrast into the GIT
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/ryles-ng-tool/
What is this?
Scalpel
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/scalpel/
What is this?
Seldinger chest drain insertion pack
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/seldinger-chest-drain-insertion-pack/
What is this and what is it used for?
Self-retaining retractor
Holds wounds open for surgery
Source: https://www.vetorthopaedics.com/product/travers-self-retaining-retractor/
What is this?
Self-inflatable bag valve mask
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/self-inflatable-bag-valve-mask/
How much oxygen can a bag valve mask deliver?
100% oxygen at 10L/min and above
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/self-inflatable-bag-valve-mask/
What is this?
Shouldered syringe
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/shouldered-syringe/
What is a shouldered syringe used for?
Injection of haemorrhoids with 5% phenol in almond oil
Injection aided by protoscope and done under dentate line
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/shouldered-syringe/
What is this?
Single lumen CVC
Source: https://www.exportersindia.com/product-detail/4-6mm-single-lumen-central-venous-catheter-3920463.htm
Recall 3 drugs/ drug classes that need to be inserted via a central line
Amiodarone, chemotherapy and dopamine
https://medlearn.imperial.ac.uk/clinical-skills/glossary/single-lumen-cvp/
What are these?
Specimen swabs
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/specimen-swabs/
What are these?
Spinal needles
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/spinal-needles/
What are these each used for?
Top one is traumatic needle for epidural
Bottom one is ‘pencil top’ needle - needle of choice for LP as much lower risk of post-LP headache
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/spinal-needles/
What is this and how is it used?
Stiff neck cervical collar
Used in conjunction with sand bags and tape to immobilise neck in trauma patients
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/stiff-neck-cervical-collar/
How are stiff neck cervical collars sized?
By measuring the number of fingers from the clavicle to the angle of the mandible, and this is then compared to the measuring peg on the stiff neck collar
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/stiff-neck-cervical-collar/
What is this? Recall 3 patients who might have this
Stoma bag - mainly used in patients who’ve had ileostomy, colostomy or ileal conduit
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/stoma-bags/
What is this?
Surgical chest drain
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/surgical-chest-drain/
What is this?
Swan-Ganz catheter
Source: https://www.edwards.com/gb/devices/Hemodynamic-Monitoring/swan-ganz-catheters
What can Swan Ganz catheters be used for?
Pressures in heart, PAWP and cardiac output
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/swan-ganz-catheter/
What is this?
Synthetic absorbable suture
Source: https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/calcium-stearate
What is this?
Tracheostomy
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/tracheostomy/
What is this?
Triple lumen CVC
Source: https://tragate.com/product/three-lumen-central-venous-catheter-triple-lumen-breathing-anesthesia-and-emergency-apparatus-139571
What is this and what is it used for?
Trucut needle - for taking biopsies for histological specimens
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/trucut-needle/
What are these?
Urinary catheters - centre is Foley (up to 28 days) and left is longterm catheter
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/urinary-catheter/
What is this and what is it used for?
Three way catheter
Used in haematuria for bladder washout and irrigation
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/urinary-catheter/
What is this and what is it used for?
Urometer drainage bag
Measures urine output
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/urometer-drainage-bag/
What is this?
Venturi mask and valves
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/venturi-mask/
Recall the flow rate and % oxygen for each venturi valve (blue, white, yellow, red + green)
–BLUE = 2-4L/min = 24% O2
(Blue rhymes with two, 2-4L –> 24%)
–WHITE = 4-6L/min = 28% O2 (White = 5 letters = 4-6L/min)
–YELLOW = 8-10L/min = 35% O2
(Yellow is a happy colour = on cloud 9 = 8-10L/min)
–RED = 10-12L/min = 40% O2 (Red = colour of raspberries = 11 letters = 10-12L/min)
–GREEN = 12-15L/min = 60% O2
(Green rhymes with fifteen)
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/venturi-mask/
In what clinical scenario are venturi masks most often used?
In COPD patients where it is important not to over-oxygenate the patient
Source: https://medlearn.imperial.ac.uk/clinical-skills/glossary/venturi-mask/
VAC drain?
