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Y6 Senior Surgery > Instruments Station > Flashcards

Instruments Station Flashcards

1
Q

How do absorbable sutures work

A

They are broken down by physiological processes (e.g. enzymatic degradation, hydrolysis)

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2
Q

what are the two types of sutures you can have

A

Monofilament

Polyfilament / braided

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3
Q

benefits of monofilament

A

less friction on tissue

less risk of infection/inflammation

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4
Q

disadvantages of monofilament

A

more throws for stable knot

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5
Q

ABSORBABLE sutures :name a monofilament type

A

Monocryl

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6
Q

ABSORBABLE sutures :name a polyfilament type

A

Vicryl

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7
Q

Non- absorbable: name mono and polyfilament

A

monofilament: prolene, nylon
polyfilament: silk

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8
Q

what order must you fill blood bottles

A 
Blue 
Yellow 
Purple 
Pink 
Grey
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9
Q

what do you get in blue bottle

A

Coag, INR, D ddimer

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10
Q

what do you get in yellow bottle

A

UE CRP LFT amulase
calcium phosphate maghnesium
TFT lipids trop

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11
Q

what do you get in purple bottle

A

FBC, blood film
ESR
HbbA1c

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12
Q

pink bbottle

A

GS

XM

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13
Q

grey bottle

A

glucose

lactate

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14
Q

what are the two smallest bore cannulas you can use

A

Blue (22GG)
Pink (20GG)
– colouir of babies

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15
Q

what are two large cannulas you cn use

A

Green (18GG)

Grey (16GG)

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16
Q

what is the biggest canula youu can use

A

Orange (14GG

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17
Q

what order must you fill culture bottles

A

aerobic (blue) first if using a vaccutaner

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18
Q

when do you use a blood glucose montioring kit

A

To test real time cap glucose levels

  • diabetic patients (CBG) to help guide insulin / record BG
  • diabbetic crisis

of in ALS, ATLS protocols

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19
Q

what are the two types of catheter

A

urethral or suprapubic (through small opening made in lower abdomen)

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20
Q

what are indications for inserting a central line

A

parenteral nutrition
emergency venous access
fluid resus
infusion of irritant drugs, vasopressors or inotropes
delivery of meds/fluids that may be harmful orally or peripherally

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21
Q

what can chest drain bottle be used for

A

to collect air or blood, pus, fluid from pleural space

collects fluid from the chest drain

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22
Q

example of conditions chest drain is used for

A

pneumothorax
pleural effusion
haemothorax

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23
Q

how is pssive drainage set up in a chest drain

A

1, fill up the chest drain bottle with sterile water up to the line (PRIME LEVEL)
2. Place tube end UNDER the sterile water
THIS CREATES A WATER SEAL

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24
Q

how does passive drainage of the pleural space occurs

A

the underwater seal in the chest drain bottle emplowys

  • positive expiratory pressure
  • gravity

to drain the pleural pspace

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25
Q

how would you use an acive drainaage system for chest drain

A

by attaching suction

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26
Q

when is a devers retractor used

A

in OPEN ABDOMINAL SURGERY - a hand held retractor that retracts viscera

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27
Q

what are breast implants made of

A

silicone

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28
Q

what different breast implants are available

A

in different shapes and sizes to suit different body habitus

may be rounded or anatomical (teardrop) shapes

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29
Q

complications of breast implants

A
  • degradation / rupture
  • infection
  • erosioon through skin
  • migration
  • anaplastic large cell luypmpha
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30
Q

when is a disposable rigid sigmoidoscope used

A

to inspect the rectum and lower sigmoid colon

to take biopsies
to treat haemorrhoids
t decompressbvolvulus

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31
Q

what is the difference between a disposable and non rigid sigmoidoscope

A

disposable sigmoidoscope is plastic

non disposable is metal

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32
Q

what are CSF manometers used for

A

to identiify the opening pressure in the subarachnooid space

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33
Q

what unit do CSF manometers record in

A

cm H20

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34
Q

what are three way catheters used for

A

for washout and irrigation of the bladder

so indicated in:

  • haematuria
  • clot retention

common if post-operative e.g. post bladder / prostate surgery

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35
Q

explain how you would use a rigid sigmoidoscope

A
  • bowel prep *
  1. introduce, explain, consent etc., position patient in left lateral
  2. attach light source and air pumping device
  3. perform DRE
  4. lubricate sigmoidoscope with gelly
  5. insert sigmoidoscope pointing towards umbilicus
  6. pump air into rectum to visualise rectal lumen
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36
Q

indications for proctoscope

A
  • allows visualisation of rectum and anus
  • so use for fresh PR bleed (haemorrhoids, tumour, polup
  • polypectomy
  • biopsy
  • haemorrhoid treatment (injection / banding)
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37
Q

how are ABGs useful in pt management

A

useful in acute environment
- PO2, CO2 - respiratory failure

VBG as well- give quick results for:

  • pH (acidosis, alkalosis)
  • lactate (poor perfusion, tissue ischaemia)
  • Hb (anaemai)
  • quick testing of electrolytes)
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38
Q

what are two key types of forceps

A

TOOTH vs NON TOOTH

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39
Q

when do you use tooth forceps

A

for SKIN (good grasp of tissue, but may cause damage on viscera)

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40
Q

when do you use non tooth forceps

A

for VISCERA

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41
Q

explain NG tube insertion

A
  1. explain, consent etc

measure from tip of nose to halfway between xiphoid and umbilicus

  1. lubricate tube, insert into nostril
  2. get patient to swallow watr as you advance tube with chin to chhest (to minimise risk of inserting into bronchi)
  3. check position by X raying for the wire/ aspirating for pH

once happy remove wire > attach feed in sterile manner

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42
Q

NGT contraindications

A

base of skull fractures
nasal ingury
UGI stricturw

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43
Q

what are the two types of NG tube and what are their indications

A

Wide bore: RYLE’S - for decomplression and aspiration

Narrow bore: feeding parenterally

44
Q

x ray criteria for appropriate NG tube location

A
  1. descendingsa midline
  2. bisects carina
  3. crosses diaphragm in midline
  4. tip sits below diaphragm
45
Q

what is a catgut suture

A

a natural monofilament absorbable suture

used for circumcision / formation of stomas

46
Q

what is a self retaining retractor

A

used to hold wounds open e.g. during hernia repair, appendicectomy

47
Q

what does a faaecal sample tell you

A

Identification of pathogens:

  • MCS (microscopy for ova)
  • C diff toxin
  • H pylori antigen
  • viral (adenovirus, rotavirus, norovirus)

Occult Blood (FIT test)

Inflamm (faecal calprotectin)

pancreatic damage (chronic pancreatitis - faecal elastase)

48
Q

what are the different types of central venous lines

A
  • central venous catheter (CVC)
  • peripherally inserted central catheter (PICC)
  • Hickmann line
  • Tesio
  • Vascath
  • Portacath
49
Q

where is the CVC inserted

A

in the superior vena cava

via subclavian or internal jugular

50
Q

what are the two types of CVC

A 
single lumen 
triple lumen (to run multiple inifusions via same site)
51
Q

what are iindicationos for CVC insertion

A
  • measure CENTRAL VENOUS PRESSURE

- Drug insertion e.g. amiodarone, dopamine, chemo

52
Q

where is a PICC LINE (peripherally inserted central catheter) inserted

A

via the antecubital fossa

53
Q

where does tip of PICC line sit

A

in the superior vena cava

54
Q

how do you recognise a PICC line from CVC

A

PICC line is really long!!

55
Q

what is a Hickmann line

A

central line that is tunnelled (partially buried) to reduce infection risk)

56
Q

what is a tesio line like

A

2 separate tunneled catheters

57
Q

what is a vascath like

A

similar to tesio line

but two catheters are formed into one

58
Q

complicatioons of CVS

A

Short term (at inserton):

  • pneumothorax
  • haemorrhage

Long term

  • infection
  • thrombosis
  • venous irritation
59
Q

broad indications of CVL

A
  • long term IV therapy (chemo, haemodialisis, abx, coma)
  • TPN
  • emergency access needed (NOT Hickmann)
60
Q

when do you need to use a face mask with nebuliser

A

when nebulised drugs are required e.g. COPD, asthma exacerbation

61
Q

what is the Seldinger technique

A

insert TROCAR hollow needle to puncture vessel
pass in a guide line through the TROCAR and advance into lumen
confirm position via US
hold guidewire in place while trocar is removed
pass cannula over guidewire into cavity
leave cannula in situ and remove guide wire

62
Q

when is seldinger technique used

A
  • insert CVC incl tesio
  • chest drain
  • PEG tibe
  • digital subtraction angiography
  • insertion of pacemaker / ICD
63
Q

indications do you use a laryngoscope

A

VISUALISE LARYNX FOR

  • aid intubation
  • diagnose vocal problems
  • visualise strictures
64
Q

what are the two typeps of blades of a laryngoscope

A

curved: Macintosh
straight: Miller

65
Q

when are histology specimen pots usd

A 
routinely used in surgery 
for biopsy (tumour resections) >  placed here and set in formalin
66
Q

what is a total hip replacement made up of

A
  • Femoral stem with femoral head

- acetabular cap (polyethylene) that is inserted into acetabululm

67
Q

what are the 3 types of airway you many get

A

oropharyngeal
laryngeal mask airway (LMA)
Endotracheal

68
Q

What is another name for oropharyngeal airway

A

Guedel

69
Q

indications for guedel arway

A

as airway adjunct - maintains airway patency

70
Q

what is a type of LMA

A

iGel

71
Q

when are LMAs used

A

they are NOT definitive airways - so just a step prior to intubation

Used in:

  • elective procedures
  • cardiac arrests
  • prehospital airway management
72
Q

list two downsides to LMAs

A

do not elimiinnate aspiration riksk

inflation of the end device can cause pressure lesins / nerve palsies

73
Q

benefits of iGel

A

they have a thhermoplastic elastomer that moulds to the perilaryngeal framework with patient temperature

seal off oropharyngeal opening from larynx, prevening aspiration

can be used as conduit for intubation

74
Q

what is the only definitive airway

A

ENDOTRACHEAL TUBE

75
Q

explain how an endotracheal tube works

A

the tube is inserted into the trachea

the end of the tube is inflated > this prevents it from dislodging and creates a safe airway

76
Q

explain difference between old and new cannula types

A

old cannulas - required pre-flushed octopus
new cannulas - have a premade dual lumen system, allow blood to be taken diectly on insertion, lumens need to be flushed with each use

77
Q

indications of breast implants

A

breast augmentation
reconstruction post mastectomy
gender ressignment

78
Q

two types of spinal needles

A

traumatic

atraumatic

79
Q

explain traumatic needles

A

these are CUTTING needles
carry higher risk of post-LP haeaaches
needle of choice for epidural

80
Q

explain atraumatic spinal needles

A

blunt-tipped
for blunt diissection of the anatomu
needle of choice for LP

81
Q

what are the uses of synthetic absorbable suturs

A

bowel anastamosis

tying fof vessels

82
Q

what is mannitol used for

A

to lower raised ICP

prevent hepatorenal syndrome in partients with obstructive jaundice

83
Q

what are specimen swabs routinely used for

A

MRSA screenign

84
Q

how is OPA e.g. guedel sized

A

HARD to HARD

from incisor to angle of mandible

85
Q

how is OPA inserted

A

insert into mouth upside down then rotated within cavity

but inserted the correct way up in children

86
Q

how is NPA sized

A

SOFT TO SOFT

earlobe to nose
diameter sized using patients little fingr

87
Q

how iis NPA inserted

A

insert into nose using rotatonal action

88
Q

what is the flow rate of a non rebreather mask

A

10 to 15 L

delivers <90% oxygen concentration

89
Q

what venturi mask do you start in for COPD

A

BLUE (24%)

90
Q

complications of endotracheal tube insertion

A
  • inappropriate placing
  • injury to larynx
  • pneumothorax
  • atelectasis
  • infection
91
Q

when do you see an endotracheal tube being used

A
  • trauma cases
  • surgery with GA
  • patients with GCS <8
92
Q

what are benefits of a trachi over intubation

A

patient can speak (using spaking valve)
easier to weane patients off
reduced discomfort
reduced risk of glottis trauma

93
Q

complications of nasal cannulae

A

nasal sores

epistaxis

94
Q

cx of tracheoostomy

A

immediate: haemorrhagae, local structure damage
Early: tracheal erosion, block/displacement, surgical emphysema, aspiration pneumonia
late: trachemoalacia, tracheo-oesopahegal fisrtuala, tracheal stenosis

95
Q

where is a tracheostomy inserted

A

1 to 2 cm inferior to cricoid cartilage

at 3/4th tracheal ring

96
Q

whow does GCS determine which airway adjunct to use

A

GCS8, intubate

GCS >8 = OPA, NPA
GCS<=8 = ET tube

97
Q

how do you confirm appropriate endotracheal tube location

A

clincial: breath sounds bilaterally, moisture in the tube, direct visualisation of vocal cords, no gurgling over epigastrium

98
Q

summarise incremental flow rates of oxygen for each equioment type

A

nasal cannula <5L
facemask 5-10 L
Non rebreather / Hudson 10-15
Venturi: specific percentage (can go from 2L to 15L, from 24% to60%)

99
Q

how do you differentiate a swan-ganz catheter from central venous line

A

SGC: lots of wires
it is used to measure pressures in the heart
common if pt is in ITU / cardiogenic shock

100
Q

what is the sizing unit for catheters

A

French (Ch)

the higher the Ch, the wider diameter the catheter

101
Q

what are common cateter sizes

A

14, 16, 18

102
Q

when is a nasopharyngeal airway used

A

when

  • cannot insert OPA (e.g. oral trauma, spasm of muscles of mastication)
  • to facilitate bag mask valve ventilation (oxygenation has remained liow)
103
Q

what is the function of a haemostat

A

haemostatic clamp

used in surgery to clamp small blood vessels for haemorrhage control

104
Q

what is a shouldered sysringe used for

A

to inject haemorrhoids with 5%phenol in almond oil

the injection is performed with a proctoscope above the dentate line (as it is insensitive)

105
Q

what is a trucut needle used for

A

to take histological specimens from lesions e.g. breast lump or liver

can be done under local anaesthetic s

106
Q

indications for tracheostomy

A
  • prolonged requirement for invasive ventilation (e.g. covid ITU)
  • upper airway obstruction
  • after laryngeal surgery

Y6 Senior Surgery (10 decks)

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