Instruments Station Flashcards
1
Q
How do absorbable sutures work
A
They are broken down by physiological processes (e.g. enzymatic degradation, hydrolysis)
2
Q
what are the two types of sutures you can have
A
Monofilament
Polyfilament / braided
3
Q
benefits of monofilament
A
less friction on tissue
less risk of infection/inflammation
4
Q
disadvantages of monofilament
A
more throws for stable knot
5
Q
ABSORBABLE sutures :name a monofilament type
A
Monocryl
6
Q
ABSORBABLE sutures :name a polyfilament type
A
Vicryl
7
Q
Non- absorbable: name mono and polyfilament
A
monofilament: prolene, nylon
polyfilament: silk
8
Q
what order must you fill blood bottles
A
Blue
Yellow
Purple
Pink
Grey
9
Q
what do you get in blue bottle
A
Coag, INR, D ddimer
10
Q
what do you get in yellow bottle
A
UE CRP LFT amulase
calcium phosphate maghnesium
TFT lipids trop
11
Q
what do you get in purple bottle
A
FBC, blood film
ESR
HbbA1c
12
Q
pink bbottle
A
GS
XM
13
Q
grey bottle
A
glucose
lactate
14
Q
what are the two smallest bore cannulas you can use
A
Blue (22GG)
Pink (20GG)
– colouir of babies
15
Q
what are two large cannulas you cn use
A
Green (18GG)
Grey (16GG)
16
Q
what is the biggest canula youu can use
A
Orange (14GG
17
Q
what order must you fill culture bottles
A
aerobic (blue) first if using a vaccutaner
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
19
Q
what are the two types of catheter
A
urethral or suprapubic (through small opening made in lower abdomen)
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
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
22
Q
example of conditions chest drain is used for
A
pneumothorax
pleural effusion
haemothorax
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
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
25
how would you use an acive drainaage system for chest drain
by attaching suction
26
when is a devers retractor used
in OPEN ABDOMINAL SURGERY - a hand held retractor that retracts viscera
27
what are breast implants made of
silicone
28
what different breast implants are available
in different shapes and sizes to suit different body habitus
may be rounded or anatomical (teardrop) shapes
29
complications of breast implants
- degradation / rupture
- infection
- erosioon through skin
- migration
- anaplastic large cell luypmpha
30
when is a disposable rigid sigmoidoscope used
to inspect the rectum and lower sigmoid colon
to take biopsies
to treat haemorrhoids
t decompressbvolvulus
31
what is the difference between a disposable and non rigid sigmoidoscope
disposable sigmoidoscope is plastic
non disposable is metal
32
what are CSF manometers used for
to identiify the opening pressure in the subarachnooid space
33
what unit do CSF manometers record in
cm H20
34
what are three way catheters used for
for washout and irrigation of the bladder
so indicated in:
- haematuria
- clot retention
common if post-operative e.g. post bladder / prostate surgery
35
explain how you would use a rigid sigmoidoscope
* 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
36
indications for proctoscope
- allows visualisation of rectum and anus
- so use for fresh PR bleed (haemorrhoids, tumour, polup
- polypectomy
- biopsy
- haemorrhoid treatment (injection / banding)
37
how are ABGs useful in pt management
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)
38
what are two key types of forceps
TOOTH vs NON TOOTH
39
when do you use tooth forceps
for SKIN (good grasp of tissue, but may cause damage on viscera)
40
when do you use non tooth forceps
for VISCERA
41
explain NG tube insertion
1. explain, consent etc
measure from tip of nose to halfway between xiphoid and umbilicus
2. lubricate tube, insert into nostril
3. get patient to swallow watr as you advance tube with chin to chhest (to minimise risk of inserting into bronchi)
4. check position by X raying for the wire/ aspirating for pH
once happy remove wire > attach feed in sterile manner
42
NGT contraindications
base of skull fractures
nasal ingury
UGI stricturw
43
what are the two types of NG tube and what are their indications
Wide bore: RYLE'S - for decomplression and aspiration
Narrow bore: feeding parenterally
44
x ray criteria for appropriate NG tube location
1. descendingsa midline
2. bisects carina
3. crosses diaphragm in midline
4. tip sits below diaphragm
45
what is a catgut suture
a natural monofilament absorbable suture
used for circumcision / formation of stomas
46
what is a self retaining retractor
used to hold wounds open e.g. during hernia repair, appendicectomy
47
what does a faaecal sample tell you
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
what are the different types of central venous lines
- central venous catheter (CVC)
- peripherally inserted central catheter (PICC)
- Hickmann line
- Tesio
- Vascath
- Portacath
49
where is the CVC inserted
in the superior vena cava
via subclavian or internal jugular
50
what are the two types of CVC
single lumen
triple lumen (to run multiple inifusions via same site)
51
what are iindicationos for CVC insertion
- measure CENTRAL VENOUS PRESSURE
- Drug insertion e.g. amiodarone, dopamine, chemo
52
where is a PICC LINE (peripherally inserted central catheter) inserted
via the antecubital fossa
53
where does tip of PICC line sit
in the superior vena cava
54
how do you recognise a PICC line from CVC
PICC line is really long!!
55
what is a Hickmann line
central line that is tunnelled (partially buried) to reduce infection risk)
56
what is a tesio line like
2 separate tunneled catheters
57
what is a vascath like
similar to tesio line
but two catheters are formed into one
58
complicatioons of CVS
Short term (at inserton):
- pneumothorax
- haemorrhage
Long term
- infection
- thrombosis
- venous irritation
59
broad indications of CVL
- long term IV therapy (chemo, haemodialisis, abx, coma)
- TPN
- emergency access needed (NOT Hickmann)
60
when do you need to use a face mask with nebuliser
when nebulised drugs are required e.g. COPD, asthma exacerbation
61
what is the Seldinger technique
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
when is seldinger technique used
- insert CVC incl tesio
- chest drain
- PEG tibe
- digital subtraction angiography
- insertion of pacemaker / ICD
63
indications do you use a laryngoscope
VISUALISE LARYNX FOR
- aid intubation
- diagnose vocal problems
- visualise strictures
64
what are the two typeps of blades of a laryngoscope
curved: Macintosh
straight: Miller
65
when are histology specimen pots usd
routinely used in surgery
for biopsy (tumour resections) > placed here and set in formalin
66
what is a total hip replacement made up of
- Femoral stem with femoral head
- acetabular cap (polyethylene) that is inserted into acetabululm
67
what are the 3 types of airway you many get
oropharyngeal
laryngeal mask airway (LMA)
Endotracheal
68
What is another name for oropharyngeal airway
Guedel
69
indications for guedel arway
as airway adjunct - maintains airway patency
70
what is a type of LMA
iGel
71
when are LMAs used
they are NOT definitive airways - so just a step prior to intubation
Used in:
- elective procedures
- cardiac arrests
- prehospital airway management
72
list two downsides to LMAs
do not elimiinnate aspiration riksk
inflation of the end device can cause pressure lesins / nerve palsies
73
benefits of iGel
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
what is the only definitive airway
ENDOTRACHEAL TUBE
75
explain how an endotracheal tube works
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
explain difference between old and new cannula types
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
indications of breast implants
breast augmentation
reconstruction post mastectomy
gender ressignment
78
two types of spinal needles
traumatic
atraumatic
79
explain traumatic needles
these are CUTTING needles
carry higher risk of post-LP haeaaches
needle of choice for epidural
80
explain atraumatic spinal needles
blunt-tipped
for blunt diissection of the anatomu
needle of choice for LP
81
what are the uses of synthetic absorbable suturs
bowel anastamosis
tying fof vessels
82
what is mannitol used for
to lower raised ICP
prevent hepatorenal syndrome in partients with obstructive jaundice
83
what are specimen swabs routinely used for
MRSA screenign
84
how is OPA e.g. guedel sized
HARD to HARD
from incisor to angle of mandible
85
how is OPA inserted
insert into mouth upside down then rotated within cavity
but inserted the correct way up in children
86
how is NPA sized
SOFT TO SOFT
earlobe to nose
diameter sized using patients little fingr
87
how iis NPA inserted
insert into nose using rotatonal action
88
what is the flow rate of a non rebreather mask
10 to 15 L
delivers <90% oxygen concentration
89
what venturi mask do you start in for COPD
BLUE (24%)
90
complications of endotracheal tube insertion
- inappropriate placing
- injury to larynx
- pneumothorax
- atelectasis
- infection
91
when do you see an endotracheal tube being used
- trauma cases
-surgery with GA
- patients with GCS <8
92
what are benefits of a trachi over intubation
patient can speak (using spaking valve)
easier to weane patients off
reduced discomfort
reduced risk of glottis trauma
93
complications of nasal cannulae
nasal sores
epistaxis
94
cx of tracheoostomy
immediate: haemorrhagae, local structure damage
Early: tracheal erosion, block/displacement, surgical emphysema, aspiration pneumonia
late: trachemoalacia, tracheo-oesopahegal fisrtuala, tracheal stenosis
95
where is a tracheostomy inserted
1 to 2 cm inferior to cricoid cartilage
at 3/4th tracheal ring
96
whow does GCS determine which airway adjunct to use
GCS8, intubate
GCS >8 = OPA, NPA
GCS<=8 = ET tube
97
how do you confirm appropriate endotracheal tube location
clincial: breath sounds bilaterally, moisture in the tube, direct visualisation of vocal cords, no gurgling over epigastrium
98
summarise incremental flow rates of oxygen for each equioment type
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
how do you differentiate a swan-ganz catheter from central venous line
SGC: lots of wires
it is used to measure pressures in the heart
common if pt is in ITU / cardiogenic shock
100
what is the sizing unit for catheters
French (Ch)
the higher the Ch, the wider diameter the catheter
101
what are common cateter sizes
14, 16, 18
102
when is a nasopharyngeal airway used
when
- cannot insert OPA (e.g. oral trauma, spasm of muscles of mastication)
- to facilitate bag mask valve ventilation (oxygenation has remained liow)
103
what is the function of a haemostat
haemostatic clamp
used in surgery to clamp small blood vessels for haemorrhage control
104
what is a shouldered sysringe used for
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
what is a trucut needle used for
to take histological specimens from lesions e.g. breast lump or liver
can be done under local anaesthetic s
106
indications for tracheostomy
- prolonged requirement for invasive ventilation (e.g. covid ITU)
- upper airway obstruction
- after laryngeal surgery
