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Medicine and Surgery Mushkies > Instruments Mushkies > Flashcards

Instruments Mushkies Flashcards

1
Q

5 types of vascular access?

A
  1. Peripheral venous cannula
  2. Triple lumen central venous catheter
  3. PICC line
  4. Hickman line
  5. Tessio catheter
  6. Port-a-cath
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2
Q

Peripheral venous cannula indication?

A

Peripheral administration of fluid and drugs

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3
Q

Types of peripheral venous catheters?

A

Colour, Gauge, Flow rate (ml/min)

  1. 24G = yellow = 15 ml/min
  2. 22G = blue = 30ml/min
  3. 20G = pink = 60ml/min
  4. 18G = green = 90ml/min
  5. 16G = grey = 230ml/min
  6. 14G = brown = 270ml/min
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4
Q

Poiseuille’s law?

A

Flow rate is proportional to r^4, and inversely proportional to length

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5
Q

Method of peripheral venous catheter insertion?

A

Inserted into a peripheral vein under ANTT

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6
Q

Complications of peripheral venous catheter insertion?

A
  1. Haematoma
  2. Malplacement
  3. Blockage
  4. Superficial thrombophlebitis
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7
Q

Triple lumen central venous catheter indication?

A
  1. CVP measurement = fluid balance
  2. Drugs requiring central administration = amiodarone, mannitol
  3. TPN
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8
Q

Method of central venous catheter insertion?

A
  1. Inserted using seldinger technique under US into internal jugular/subclavian/femoral veins
  2. Trendelenberg position, sterile, under LA, use US guidance, order CXR afterwards
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9
Q

Complications of central venous catheter insertion?

A
  1. Immediate = pneumothorax, arrhythmia, malposition into artery
  2. Early = haematoma, infection, catheter occlusion
  3. Late = thrombosis, sympathetic chain (Horners), phrenic nerve damage (hiccough, weak diaphragm)
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10
Q

4 procedures using Seldinger technique?

A
  1. Angiography
  2. Chest drain insertion
  3. PEG
    4 Triple lumen central venous catheter
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11
Q

PICC line?

A

Peripherally inserted central catheter

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12
Q

PICC line indication?

A

Long term central access

  1. Abx
  2. Chemo
  3. TPN
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13
Q

PICC line insertion method?

A
  1. Inserted into a peripheral vein e.g. cephalic
  2. Advanced until the tip sits in the SVC
  3. X-ray to confirm position
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14
Q

PICC line insertion complications?

A
  1. Early = arrhythmias, bleeding

2. Late = thrombosis, catheter occlusion, infection

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15
Q

Hickman line indications?

A

Long term central access

  1. Abx
  2. Chemo
  3. TPN
  4. Dialysis
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16
Q

Hickman line insertion method?

A

Tunnelled under skin to enter IJV and lay in SVC

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17
Q

Hickman line insertion complications?

A
  1. Early = arrhythmias, bleeding, pneumothorax

2. Late = thrombosis, catheter occlusion, infection

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18
Q

Tesio line indication?

A

Haemodialysis

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19
Q

Features and insertion method of Tesio catheter?

A
  1. Tunnelled subcutaneously, sterile insertion under X-ray guidance
  2. Cuffs promote tissue reaction –> better seal
  3. Arterial lead takes blood to machine
  4. Venous limb takes dialysed blood back to pt
  5. Arterial limb sits more proximally to prevent recirculation
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20
Q

Tesio line insertion complications?

A
  1. Early = pneumothorax, arrhythmia, bleeding

2. Late = thrombosis, catheter occlusion, infection

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21
Q

Port-a-cath indications?

A

Long therm chemotherapy or antibiotics

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22
Q

Port-a-cath insertio method and features?

A
  1. Centrally placed catheter
  2. Subcutaneous port made of self-sealing silicone rubber
  3. Accessed with 90 degrees Huber point needle
  4. Very low infection risk as skin breech is very small
  5. Inserted into IJV, tip sits in the SVC/RA
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23
Q

Blood culture bottle colours?

A
  1. Red = anaerobic culture medium

2. Blue = aerobic culture medium

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24
Q

Method of taking blood cultures?

A
  1. ANTT
  2. Replace needle with clean one
  3. Wipe top of bottles with alcohol
  4. Fill anaerobic bottle first
  5. Fill in pt details and send to path lab
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25
Q

Vacutainer colours?

A

PYR GBGB

  1. Purple
  2. Yellow
  3. Red
  4. Green
  5. Blue
  6. Grey
  7. Black
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26
Q

Purple vacutainer contains and use?

A
  1. Contains = EDTA, prevents clotting and keeps cells alive

2. Use = FBC, CD4, cross match

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27
Q

Yellow vacutainer contains and use?

A
  1. Contains = Activated gel, promotes clotting, gel facilitates easy separation of serum and red cells
  2. Use = U&E (serum chemistries), enzymes
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28
Q

Red vacutainer contains and use?

A
  1. Contains = Nothing, a ‘clotted sample’

2. Use = Immunology, Abs, Ig, protein electrophoresis

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29
Q

Green vacutainer contains and use?

A
  1. Contains = Li heparin, anticoagulant

2. Use = Plasma chemistries, enzymes

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30
Q

Blue vacutainer contains and use?

A
  1. Contains = Citrate, chelates Ca, prevents clotting

2. Use = coagulation

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31
Q

Grey vacutainer contains and use?

A
  1. Contains = fluoride (inhibits glycolysis), oxalate (anticoauglant)
  2. Use = Glucose
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32
Q

Black vacutainer contains and use?

A
  1. Contains = citrate, anticoagulant
  2. Use = ESR
  3. Special = need precise blood volume
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33
Q

Order of draw?

A
  1. Blood cultures
  2. Blue
  3. Yellow
  4. Green
  5. Purple
  6. Grey
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34
Q

ET tube indication?

A

To acquire a definitive airway in elective or emergency situations e.g. abdominal surgery or head injury

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35
Q

Features of an ET tube?

A
  1. Cuffed = adults, secured tube and prevents aspiration
  2. Uncuffed = children, avoid damaging the larynx
  3. Size = Female (7.5), Male (8.5)
  4. Double lumen = allow single lung ventilation, used in thoracic surgery
  5. Radio-opaque line = blue
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36
Q

ET tube insertion method?

A
  1. Pt is pre-oxygenated, sedated, and a muscle relaxant may be used
  2. Inserted into the trachea under direct vision using a laryngoscope
  3. Cricoid pressure may reduce risk of aspiration
  4. Bougi may be used for difficult airways = smaller, anterior curvature, can feel tracheal rings with tip
  5. Position confirmed and tube secured with tape
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37
Q

ET tube how to check position?

A
  1. Check for symmetrical chest movements
  2. Listen over epigastrium for gurgling
  3. Listen over each lung for air entry
  4. Use CO2 monitor
  5. CXR = just above carina
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38
Q

ET tube complications?

A
  1. Early

2. Late

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39
Q

Early ET tube complications?

A
  1. Oropharyngeal trauma
  2. Laryngeal trauma
  3. C-spine injury e.g. w/ AA instability
  4. Oesophageal intubation
  5. Bronchial intubation
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40
Q

Late ET tube complications?

A
  1. Sore throat
  2. Tracheal stenosis
  3. Difficult wean
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41
Q

Definitive airway defn?

A

Airway which is protected from aspiration

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42
Q

Types of definitive airway?

A
  1. Orotracheal or nasotracheal

2. Surgical = tracheostomy, cricothyroidotomy

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43
Q

Macintosh laryngoscope indication?

A

ET intubation

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44
Q

Macintosh laryngoscope features?

A
  1. Handle and light source

2. Removable blade, comes in different sizes, Macintosh (curved, preferred), and Miller (straight)

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45
Q

Macintosh laryngoscope method?

A
  1. Pt sedated and muscle relaxed
  2. Inserted with left hand, tongue displaced laterally
  3. Tip inserted into epiglotic vallecula
  4. Light source allows direct vision of vocal cords for intubation
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46
Q

Complications of macintosh laryngoscope?

A
  1. Oropharyngeal trauma
  2. Laryngeal trauma
  3. C-spine injury e.g. with atlanto-axial instability
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47
Q

Temporary tracheostomy tube indications?

A

Definitive surgical airway

  1. Acutely = maxillofacial injuries
  2. Electively = ITU pts with prolonged ventilation
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48
Q

Features of temporary tracheostomy tube?

A
  1. Obturator
  2. Cuff to prevent aspiration
  3. Flange to secure to pts neck
  4. Insufflation port
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49
Q

Temporary tracheostomy tube insertion method?

A
  1. Transverse incision 1cm above sternal notch
  2. Dissect throughout fascial planes and retract anterior jugular veins and strap muscles
  3. Divide thyroid isthmus
  4. Stoma fashioned between 2nd and 4th tracheal rings by removing anterior portion of tracheal ring
  5. Insert trachy with obturator
  6. Secure with tapes
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50
Q

Advantages of temporary trache tube over ET tube?

A
  1. Easier to wean pts
  2. No need for sedation
  3. Reduced discomfort
  4. Easier to maintain oral and bronchial hygeine
  5. Reduced risk of glottis trauma
  6. Less dead space so reduces work of breathing
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51
Q

Complications of temporary tracheostomy tube?

A
  1. Immediate
  2. Early
  3. Lat
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52
Q

Temporary trache tube immediate complications?

A
  1. Haemorrhage
  2. Pneumothorax
  3. Damage = oesophagus, RLN
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53
Q

Temporary trache tube early complications?

A
  1. Tracheal erosion
  2. Tube displacement
  3. Tube obstruction
  4. Surgical emphysema
  5. Aspiration pneumonia
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54
Q

Temporary trache tube late complications?

A
  1. Tracheomalacia
  2. TOF
  3. Tracheal stenosis
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55
Q

LMA indications?

A
  1. Non-definitive airway used in short day-case surgery where a pt doesnt require intubation
  2. May also be used in emergency if not able to insert ET tube
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56
Q

LMA features?

A

Inflatable cuff to create a seal over the larynx

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57
Q

LMA insertion method?

A
  1. Cuff deflated and lubricated with aquagel
  2. Inserted with open end pointing down towards the tongue
  3. Sits in orifice over larynx
  4. Cuff inflated and tube secured with tape
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58
Q

LMA complications?

A
  1. Dislodgement
  2. Leak
  3. Pressure necrosis in airway
  4. Aspiration = non-definitive airway
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59
Q

Oropharyngeal/Guedel airway indications?

A

Airway adjunct used in pts with impaired level of consciousness ut maintain patent airway, e.g. during extubation

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60
Q

Oropharyngeal airway insertion method?

A
  1. Sized from incisors to angle of mandible

2. Insert upside down and rotated once in the caivty

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61
Q

Oropharyngeal airway complications?

A
  1. Oropharyngeal trauma

2. Gagging –> vomiting

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62
Q

Nasopharyngeal airway indicaations?

A

Airway adjunct used in pts with impaired level of consciousness ut maintain a patent airway

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63
Q

Nasopharyngeal airway insertion method?

A
  1. Sized according to diameter of pts little finger
  2. Inserted into nasopharynx using a rotational action
  3. Safety pin and flared ends prevents the tube becoming irretrievable
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64
Q

Nasopharyngeal airway complications?

A
  1. Bleeding = trauma to nasal mucosa

2. Intracranial placement

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65
Q

Nasopharyngeal airway contrainidications?

A

Facial injury or evidence of basal skull fracture?

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66
Q

Evidence of basal skull fracture?

A
  1. Racoon eyes
  2. Battle’s sign = mastoid bruising
  3. Haemotympanum
  4. CSF rhinorrhoea or otorrhoea
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67
Q

Types of oxygenation?

A
  1. Nasal prongs
  2. Simple face mask
  3. Non-rebreathable Hudson mask
  4. Venturi mask
  5. CPAP
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68
Q

Nasal prongs fx?

A

1-4L/min = 24-40% O2

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69
Q

Simple face mask fx?

A

Variable O2 concentration depending on O2 flow rate

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70
Q

Non-rebreathing Hudson mask fx?

A
  1. Reservoir bag allows delivery of high concentrations of O2
  2. 60-90% at 10-15L
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71
Q

Venturi mask fx?

A
  1. Uses Bernoulli principle = increased speed of flow –> reduced pressure
  2. Provides precise O2 concentration at high flow rates
  3. Yellow = 5%
  4. White = 8%
  5. Blue = 24%
  6. Red = 40%
  7. Green = 60%
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72
Q

CPAP fx?

A
  1. Tight fitting mask connected to reservoir or high O2 flow, allowing FIO2 of around 1
  2. Positive pressure is applied continuously to the pts airway
  3. Usually has little effect on PaCO2
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73
Q

Advantages of CPAP?

A
  1. Recruitment of collapsed lung units
  2. Reduced shunt –> Increased PaO2
  3. Increased lung volume –> improved compliance –> reduced work of breathing
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74
Q

Types of ventilation?

A
  1. Non-invasive = CPAP or BiPAP

2. Invasive = ET or tracheostomy

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75
Q

Indications for ventilation?

A
  1. Resp failure refractive to less invasive Rx
  2. At risk airway
  3. Elective post-op ventilation
  4. Physiological control e.g. hyperventilation in raised ICP
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76
Q

Complications of ventilation?

A
  1. CVS compromise
  2. Pneumothorax
  3. Fluid retention
  4. VILI
  5. VAP
  6. Complications of artificial airway e.g. tracheal stenosis
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77
Q

VILI?

A

Ventilator induced Lung Injury

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78
Q

VAP?

A

Ventilated associated Pneumonia

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79
Q

Ryles tube indications?

A
  1. Draining the stomach
  2. Bowel obstruction
  3. Persistant vomiting e.g. pancreatitis
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80
Q

Features of Ryles Tube?

A
  1. Wide bore
  2. Stiff
  3. Radio-opaque line
  4. Metal tip
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81
Q

Ryles tube metal tip?

A
  1. Acts as lead point to facilitate advancement of NHT
  2. Weighs down NGT in the stomach
  3. Radio-opaque on XR, aiding visualisation
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82
Q

Ryles tube insertion method?

A
  1. Size tube by measuring from tip of pts nose to epigastrium, going around the ear
  2. Gain consent and explain the procedure
  3. Lubricate the tip with aquagel
  4. Insert the tube and ask pt to swallow with water when they feel it at the back of their throat
  5. Secure with tape when position confirmed
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83
Q

How to check location of ryles tube/feeding NG tube?

A
  1. Aspirate gastric contents and check pH (<4)
  2. Insufflate air and auscultate for bubbling (best to avoid in bowel obstruction)
  3. CXR = tip below diaphragm
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84
Q

Complications of ryles tube?

A
  1. Nasal trauma
  2. Blockage
  3. Malposition = airway, cranium
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85
Q

C/I of ryles tube or feeding NG tube?

A

Any suspicion of basal skull fracture

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86
Q

Feeding NG tube indications?

A

Provide enteral nutrition

  1. Catabolic = sepsis, burns, major surgery
  2. Coma/ITU
  3. Malnutrition
  4. Long term feeding
  5. Dysphagia = stricture, stroke
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87
Q

Features of feeding NG tube?

A
  1. Fine bore
  2. Soft silicone
  3. Radio-opaque guide wire ut stiffen tube and aid insertion
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88
Q

Feeding NG tube insertion method?

A
  1. Size tube by measuring from tip of pts nose to epigastrium, going around the ear
  2. Gain consent and explain the procedure
  3. Lubricate the tip with aquagel
  4. Insert the tube and ask pt to swallow with water when they feel it at the back of their throat
  5. Remove guidewire and secure with tape when position confirmed
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89
Q

Complications of NG tube

A
  1. NGT = nasal trauma, malposition, bloackage

2. Feeding = refeeding syndrome, e- imbalance, feed intolerance –> diarrhoea

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90
Q

Mx of refeeding syndrome?

A
  1. Identify at risk pts in advance
  2. Parenteral and oral phosphate supplementation
  3. Manage complications
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91
Q

Daily requirement fluid regimens?

A
  1. 3L dex-sal with 20mM K+ in each bag

2. 1L NS + 2L dex-sal with 20mM K+ in each bag

92
Q

Surgical drain indications?

A
  1. Prophylactic = prevent fluid accumulation

2. Therapeutic = drainage of established collections, drain a viscus e.g. bladder, collect blood for autotransfusion

93
Q

Types of surgical drains?

A
  1. Open or closed

2. Active or passive

94
Q

Open surgical drain?

A
  1. Fluid collects into dressing or stoma bag

2. E.g. corrugated rubber or plastic sheets

95
Q

Closed surgical drain?

A
  1. Tube attached to ao container

2. E.g. Chest drains, Robinson or Redivac

96
Q

Active drains?

A

Driven by suction e.g. Redivac drain

97
Q

Passive drains?

A

No suction, driven by pressure differential e.g. Robinson drain

98
Q

Removal of surgical drains?

A
  1. Remove once drainage stopped or <25ml/d
  2. Perioperative bleeding and haematoma 24-48hrs
  3. Intestinal anastomosis >5d
  4. T-tube = 6-10 days (T-tube cholangiogram first to ensure distal patency of CBD)
  5. Shortening = removal of drain by 2cm/d to allow tract to heal gradually
99
Q

Complications of surgical drain?

A
  1. Infection
  2. Damage may be caused by mechanical pressure or suction
  3. May limit pt mobility
100
Q

Robinson drain type and use?

A
  1. Type = Closed, passive

2. Use = abdominal surgery

101
Q

Redivac drain type and use?

A
  1. Type = Closed, active

2. Use = breast surgery (prevent seroma or haematoma), thyroid surgery (risk of haematoma)

102
Q

Bile bag type and use?

A
  1. Type = Closed, passive

2. Use = NGT, T-tube

103
Q

Pemrose drain type and use?

A
  1. Type = Open, passive

2. Use = abdominal surgery

104
Q

Tissue drain type and use?

A
  1. Type = Open, passive

2. Use = large cavities

105
Q

5 different drains?

A
  1. Robinson
  2. Redivac
  3. Bile bag
  4. Pemrose drain
  5. Tissue drain
106
Q

Suture types?

A
  1. Monofilament

2. Braided

107
Q

Monofilament suture advantages?

A

Less risk of infection, less friction in tissues

108
Q

Monofilament suture disadvantages?

A
  1. Harder to handle (stiff and has more memory)
  2. Knots may slip
  3. Less tensile strength
109
Q

Braided suture advantages?

A
  1. Easier to handle: less memory
  2. Knots may slip
  3. Greater tensile strength
110
Q

Braided suture disadvantage?

A

Increased risk of infection, increased friction on tissues

111
Q

Types of suture?

A
  1. Synthetic or Natural
  2. Absorbable or non-absorbable
  3. Monofilament or braided
112
Q

Natural suture types?

A
  1. Absorbable = catgut or chromic

2. Non-absorbable = silk (braided suture that may be used to secure drains)

113
Q

Synthetic suture types?

A
  1. Absorbable = monocryl, vicryl, PDS

2. Non-Absorbable = polypropylene, nylon, steel

114
Q

Suture removal time from face and neck?

115
Q

Suture removal time from scalp?

116
Q

Suture removal time from trunk?

117
Q

Suture removal time from arms?

118
Q

Suture removal time from legs?

A

10-14 days

119
Q

Types of needles?

A
  1. Straight = hand-held, for skin closure

2. Curved = require needle-driver

120
Q

Needle diameters?

A
  1. Fine = GI and vascular surgery
  2. Medium = general closure
  3. Heavy = hernia repair
121
Q

Blunt tip needle used for?

A

Abdominal wall closure

122
Q

J-shaped needle used for?

A

Abdominal wall closure

123
Q

Dever’s retractor indication?

A

Surgical retractor used in open abdominal surgery to retract viscera and increase the field of view

124
Q

Dever’s retractor method?

A
  1. Curved end inserted into abdomen and placed carefully to retract the viscera
  2. Can be bent to a suitable shape
125
Q

Dever’s retractor complications?

A

Damage to the skin and internal structures

126
Q

Self-retaining retractor indications?

A

Used to retract a surgical incision and retain the incision open, e.g. in hernia repair or appendicectomy

127
Q

Complications of self retraining retractors?

A

Compression of nerves of vessels

128
Q

Needle holders indication?

A

Forceps designed to hold the needle, allowing the surgeon to suture accurately

129
Q

Disposable proctoscope indication?

A
  1. Ix and Mx of pts with perianal pathology e.g. haemorrhoids, low rectal Ca
  2. Examination of the anal canal and lower rectum +/- biopsy
  3. Therapeutic = banding, sclerotherapy
130
Q

Features of disposable proctoscope?

A
  1. Obturator to aid insertion

2. Attachment for light source

131
Q

Complications of disposable proctoscope?

A

Haemorrhage and perforation

132
Q

Shouldered/Gabriel syringe indication?

A
  1. Injection of haemorrhoids with 5% phenol in almond oil (sclerosant)
  2. 2ml of phenol is injected above the dentate line: insensate
133
Q

Complications of shouldered/Gabriel syringe?

A
  1. Immediate = pain if injected below dentate line, Damage to nearby structures, Primary haemorrhage
  2. Late = Prostatitis, inmpotence
134
Q

Disposable rigid sigmoidoscope indications?

A
  1. Allows endoscopic examination of the rectum and recto-sigmoid junction with possible biopsy, and can be used in the outpatient or inpatient setting
  2. Investigation of: rectal bleeding, colonic neoplasia, IBD
135
Q

Features of disposable rigid sigmoidoscope?

A

Graduated plastic tube with an obturator to aid insertion

136
Q

Complications of disposable rigid sigmoidoscope?

A
  1. Perforation = mechanical (pushing against bowel wall), pneumatic (over-inflation)
  2. Bleeding
137
Q

Laparoscopic port indications?

A

Access the abdomen during laparoscopic surgery e.g. lap chole

138
Q

Features of laparoscopic port?

A
  1. Trocar +/- sharp blades
  2. CO2 insufflation port
  3. Instrument port with rubber flanges
139
Q

Where is the laparoscope usually inserted?

140
Q

Circular bowel stapler indications?

A
  1. Rectal anastomosis
  2. Gastrectomy
  3. Haemorrhoids
  4. Rectal prolapse
141
Q

Features of circular bowel stapler?

A
  1. Anvil sutured into proximal limb with purse string suture

2. Anvil fits into stapler and provides counterpoint for staple insertion

142
Q

Complications of circular bowel stapler?

A

Anastomotic leak

143
Q

How to check integrity of an anastomosis?

A
  1. Intra-operative = fell pelvic cavity with saline, insufflate rectum with air and look for bubbles in the saline
  2. Post-operative = water-soluble contrast enema
144
Q

Catheterisation indications?

A
  1. Diagnostic

2. Therapeutic

145
Q

Diagnostic catheter indications?

A
  1. Measure urine output
  2. Sterile urine sample
  3. Renal tract imaging
146
Q

Therapeutic catheter indications?

A
  1. Urinary retention
  2. Immobile pts
  3. Bladder irrigation
  4. Intermittent decompression of neuropathic bladder
147
Q

Foley catheter features?

A
  1. One port for drainage and one to fill the distal balloon with sterile water
  2. Distal balloon sits in the bladder and prevents displacement of the catheter
  3. Material = usually latex, silastic better for long-term placement (less blockage, less infection)
148
Q

French w/ regards to catheter meaning?

A

Circumference of the catheter in mm

  1. Male = 16-18F
  2. Female = 12-14F
149
Q

Complications of catheterisation?

A
  1. Early

2. Delayed

150
Q

Early complications of catheterisation?

A
  1. Creation of false tract
  2. Urethral rupture
  3. Paraphimosis
  4. Haematuria
151
Q

Late complications of catheterisation?

A
  1. Infection

2. Blockage

152
Q

C/I to catheterisation?

A

Urethral trauma

  1. Bloods at urethral meatus
  2. High riding prostate
  3. Scrotal haematoma
  4. Pelvic fracture
153
Q

Other types of catheter?

A
  1. Coude catheter = angled tip may help in big prostates

2. Condom catheter

154
Q

Mx of non-draining catheter?

A
  1. Blocked = flush with 20ml sterile NS or consider 3-way
  2. Bypassing catheter = consider a condom catheter
  3. Slipped into prostatic urethra = flushes but wont drain
  4. Catheter has perforated the lower tract on insertion and isnt in the bladder
  5. Renal/pre-renal AKI
155
Q

Catheter that flushes but wont drain?

A

Has slipped into the prostatic urethra

156
Q

TWOC?

A
  1. After 24-72 hours in acute urinary retention
  2. May be performed as urology outpatient if retention likely
  3. Tamsulosin reduces risk of retention after TWOC
157
Q

Indications for long term catheterisation?

A
  1. Chronic bladder outlet obstruction
  2. Neurogenic bladder with chronic retention
  3. Complications of incontinence = refractory skin breakdown, palliative care, pt preference
158
Q

Clean intermittent self-catheterisation?

A
  1. Alternative to indwelling catheter in chronic urinary retention
  2. Also useful in pts who fail to void after TURP
159
Q

Indications for Clean intermittent self-catheterisation?

A
  1. Chronic retention

2. Neuropathic bladder

160
Q

3 causes of a neuropathic bladder?

A
  1. MS
  2. DM neuropathy
  3. Spinal trauma
161
Q

3-way irrigation Foley catheter indication?

A
  1. Irrigate bladder in pts at risk of clot retention

2. E.g. after TURP or in pts with haematuria

162
Q

3-way irrigation Foley catheter features?

A

3 ports

  1. Balloon inflation
  2. Drainage (middle)
  3. Irrigation
163
Q

Suprapubic catheter indications?

A
  1. Urethral injuries

2. Urethral obstruction = BPH, Ca

164
Q

Suprapubic catheter insertion method?

A
  1. US guided insertion of catheter under LA

2. Trocar inserted into catheter and unit advanced through skin

165
Q

Complications of suprapubic catheter?

A
  1. Viscus perforation
  2. Haemorrhage
  3. Malignancy seeding
166
Q

Advantages of suprapubic catheter?

A
  1. Less UTIs
  2. Less stricture formation
  3. TWOC w/o catheter removal
  4. Increased pt comfort
  5. Maintain sexual function
167
Q

Disads of suprapubic catheter?

A
  1. More complex = need skills

2. Serious complications can occur

168
Q

C/I of suprapubic catheter?

A
  1. Known or suspected bladder carcinoma
  2. Undiagnosed haematuria
  3. Previous lower abdominal surgery = adhesion of small bowel to bowel wall
169
Q

Acute urinary retention clinical features?

A
  1. Suprapubic tenderness
  2. Palpable bladder = dull to percussion, cant get beneath
  3. Large prostate on PR = check anal tone and sacral sensation
  4. <1L drained on catheterisation
170
Q

Acute urinary retention Ix?

A
  1. Bedside = urine dip, MC&S
  2. Bloods = FBC, U&E, PSA (prior to PR)
  3. Imaging = US, Pelvic X ray
171
Q

Mx of acute urinary retention?

A
  1. Conservative = analgesia, privacy, walking, running water or hot bath
  2. Catheterise = use correct catheter (3-way if clots), STAT gent cover, hourly UO + replace, tamsulosin (reduces risk of recatheterisation after retention)
  3. TWOC after 24-72hrs
  4. TURP = failed TWOC, impaired renal function, elective
172
Q

JJ stent indications?

A
  1. Relieve ureteric obstruction = stones, tumours

2. May be inserted intra-op during renal transplant

173
Q

Method of JJ stent insertion?

A
  1. Retrograde = cytoscopic guidance

2. Anterograde = percutaneous

174
Q

Complications of JJ stent?

A
  1. Infection
  2. Blockage
  3. Displacement/migration
175
Q

Chest drain tube and trocar indications?

A
  1. Drainage of pleural cavities
  2. Pneumothorax = traumatic, ventilated, following needle decompression of tension, persistent after aspiration
  3. Pleural effusion = malignant, pus, blood, lymph
  4. Post-op = thoracotomy, post-oesophagectomy
176
Q

Method of chest drain insertion?

A
  1. Consent and explain procedure to pt
  2. Commonly insert smaller drains with seldinger technique
  3. Morphine analgesia
  4. Clean and drape area
  5. ID safety triangle
  6. Infiltrate 1% lignocaine to rib below and pleura of ICS
  7. Make small 1cm incision just above rib below, blunt dissect with Spencer-Wells down to pleura, sweep finger to clear adhesions and check location
  8. Attach drain to bottle and advance it into pleural cavity, directing it postero-inferiorly
  9. Close wound and ICD using modified mattress suture
  10. Get pt to cough and take deep breaths, check for swinging and bubbling
  11. CXR to check location
177
Q

Complications of chest drain?

A
  1. Early

2. Late

178
Q

Early complications of chest drain?

A
  1. Pain due to inadequate analgesia
  2. Haemorrhage due to NV bundle damage
  3. Organ perforation
  4. Incorrect location e.g. abdomen
179
Q

Late complications of chest drain?

A
  1. Failure = bronchopleural fistula
  2. Long thoracic nerve damage –> winging
  3. Wound infection
  4. Blockage
180
Q

Removal of chest drain?

A
  1. Remove when no longer swinging or bubbling and CXR confirms resolution of PTX
  2. Using 2 people, remove in forced expiration and use mattress suture to close wound
  3. CXR to check no new PTX
181
Q

Chest drain bottle indications?

A

As for chest drain tube

182
Q

Chest drain bottle method??

A
  1. Fill bottle to prime level with sterile level
  2. Connect drain to bottle
  3. Underwater seal allows one-way flow out of pleural cavity
  4. May add suction –> active drainage
183
Q

Chest drain bottle complications?

A
  1. Lifting bottle above the pt can –> retrograde flow into chest
  2. Complications of chest tube insertion
184
Q

Fracture plate indications?

A

Internal fixation of fractures

185
Q

Fracture plate method?

A
  1. Required open reduction
  2. Plate aligned with orientation of bone
  3. Screws used to fix plate to bone
186
Q

Fracture plate complications?

A

Relate to fracture, procedure, and the plate

1. Plate = infection, failure, malposition of the remodelled fracture

187
Q

Types of fixation?

A

PEC KDICF

  1. Plaster of Paris
  2. External fixation
  3. Continuous traction = collar and cuff
  4. K wires
  5. DHS
  6. IM nail
  7. Cannulated screw
  8. Fracture plate
188
Q

Hemi-arthroplasty prosthesis indications?

A

Intracapsular NOF: Garden 3/4

189
Q

Features of hemi-arthroplasty prosthesis?

A
  1. Fenestrated stem for osseous integration (non-cemented)
  2. Shouldered
  3. Large head
190
Q

Hemi-arthroplasty method?

A
  1. Placed in theatre under GA
  2. Posterior or anterolateral (most common) approaches
  3. Head of femur resected and femoral shaft reamed
  4. Stem is cemented (Thompson) or uncemented (Austin-Moore)
  5. Head relocated and joint function and stability assessed before closure
191
Q

Complications of hemi-arthroplasty prosthesis?

A

Complications involve the fracture, the procedure, and the prosthesis

  1. Early
  2. Late
192
Q

Early hemi-arthroplasty prosthesis complications?

A
  1. Cement reaction
  2. Deep infection
  3. Fracture
  4. Dislocation (3%) = squatting and adduction
193
Q

Late hemi-arthroplasty prosthesis complications?

A
  1. Loosening = septic or aseptic
  2. Failure = stem fracture
  3. Revision = most replacements last 10-15 years
194
Q

Total-arthroplasty prosthesis indications?

195
Q

Total arthroplasty features?

A
  1. Femoral component with small head
  2. Polyethylene acetabular component
  3. Most are cemented
196
Q

Total arthroplasty method?

A
  1. Placed in theatre under GA
  2. Posterior or anterolateral (commonest) approaches
  3. Head of femur resected
  4. Acetabulum and femoral shaft are reamed
  5. Stems and cups are trialled to find most suitable
  6. Head relocated and joint function and stability assessed before closure
197
Q

Complications of total arthroplasty?

A
  1. Immediate
  2. Early
  3. Late
198
Q

Immediate total arthroplasty complications?

A
  1. Nerve injury
  2. Fracture
  3. Cement reaction
199
Q

Early total arthroplasty complications?

A
  1. DVT = up to 50% w/o prophylaxis
  2. Deep infection (must remove metalwork before revision)
  3. Dislocation = 3%, squatting and adduction
200
Q

Late total arthroplasty complications?

A
  1. Loosening = septic or aseptic
  2. Failure = stem fracture, wear
  3. Revision = most replacements last 10-15 years
201
Q

IM nail indications?

A

Form of internal fixation used in the Mx of long bone fractures = femur, tibia, humerus

202
Q

IM nail features?

A
  1. Titanium or titanium alloy
  2. Screws insert proximally and distally provide rotational and longitudinal stability
  3. Curve fits contour of tibia
203
Q

Dynamisation defn?

A

Removal of one or more screws from IM nail in order to allow collapse –> increased loading of fracture site –> quicker union

204
Q

IM nail method?

A
  1. Inserted under GA
  2. Nail hammered into medulla of bone
  3. Screws lock nail in place
205
Q

Complications of IM prosthesis?

A
  1. Fracture during nail insertion
  2. Infection
  3. Embolus
  4. Delayed or non-union
206
Q

Fat embolism syndrome presentation?

A

SOB, petechial rash, confusion

  1. Typically b/w 24-72hrs between injury and onset
  2. Resp = dyspnoea +/- chest pain
  3. Petechial rash = upper anterior trunk, arms, neck
  4. CNS = headache, confusion, agitation
  5. Renal = oliguria, haematuria
207
Q

Fat embolism syndrome Ix?

A
  1. ABG = hypoxia, hypercapnia
  2. FBC = reduced plts and Hb
  3. CT chest
208
Q

Fat embolism syndrome Mx?

A
  1. Supportive = O2, volume resuscitation

2. Steroids

209
Q

Stiff neck collar indications?

A
  1. Stabilise the cervical spine in trauma pts

2. Used with 2 sandbags and tape

210
Q

Features of stiff neck collar?

A
  1. Comes flat packed and must be assembled

2. Hole at front allows access to trachea

211
Q

Stiff neck collar method?

A
  1. Sized by measuring the number of fingers from the clavicle to angle of the mandible
  2. “Key dimension” then compared to the sizing peg on the hard collar
212
Q

Complications of stiff neck collar?

A

Incorrect placement = neck not in neutral alignment, chin not flush with end of chin piece

213
Q

Mannitol indications?

A
  1. Osmotic diuretic
  2. Lower ICP
  3. Reduces intra-ocular pressure in hyphema
214
Q

Hyphema defn?

A

Pooling or collection of blood inside the anterior chamber of the eye

215
Q

Mannitol method of administration?

216
Q

Mannitol complications?

A
  1. May raise ICP in the long term

2. C/I in severe cardiac failure and pulmonary oedema

217
Q

Fogarty catheter indication?

A

Mx of acutely ischaemic limb secondary to embolus

218
Q

Fogarty embolectomy catheter method?

A
  1. Vascular access gained to femoral artery at groin
  2. Catheter passed distal to embolus
  3. Balloon is inflated and catheter withdrawn
219
Q

Swan-Ganz catheter indications?

A
  1. Flow directed pulmonary artery catheter
  2. Measures PCWP (indirect measure of LA filling pressure)
  3. Measures CO
  4. Used in cardiogenic or septic shock when accurate haemodynamic data is required
  5. Its use has not been shown to improve outcome
220
Q

Swan Ganz catheter method?

A
  1. Used in intensive care setting

2. Inserted into a central vein

221
Q

Tru-Cut biopsy needle indications?

A

Used to take histological specimens from lesions

  1. Part of triple assessment of breast lumps
  2. Liver
  3. Kidney
  4. Prostate = transrectally
222
Q

Tru-Cut biopsy needle method?

A
  1. Consent and explain method to pt
  2. Anaesthetise area with LA
  3. Needle advanced under US guidance
  4. Spring handle is pressed, advancing the specimen tray into the target lesion
  5. Further pressure fires the surrounding sheath, obtaining a biopsy
223
Q

Complications of Tru-Cut needle biopsy?

A
  1. Bleeding
  2. Pain
  3. Cancer seeding
224
Q

Renal biopsy indications?

A
  1. Unexplained AKI/CKD
  2. Acute nephritic syndrome
  3. Unexplained proteinuria/haematuria
  4. Systemic disease with renal involvement e.g. SLE
  5. Suspected transplant rejection
225
Q

Renal biopsy C/I?

A
  1. Abnormal clotting
  2. Single kidney (except Tx)
  3. Small kidneys from CKD (increased bleeding risk and too late)
  4. Renal neoplasms
226
Q

Renal biopsy procedure

A
  1. Stop aspirin (1wk) and warfarin (2d) in advance
  2. Check FBC, clotting and G&S
  3. US-guided Tru-Cut needle biopsy
227
Q

Renal biopsy complications?

A
  1. Macroscopic haematuria in 1%

2. Transfusion needed in 0.1%

Medicine and Surgery Mushkies (52 decks)

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