Intro to Surgery (lec 2) Flashcards
Preop Nurse duties? (3)
Pt prep
Signatures of surg/anesthesia staff
Start IV w/ ordered meds
Anesthesiologist duties? (3)
Preop pt consult
Appropriate anesth type
Sleep, analgesia, airway, breathing, circulation
Circulating Nurse duties? (5)
Gets supplies, sterile equip Pt ID, positioning Sterility of suite OR manager Final counts
Scrub Nurse duties? (2)
(Sterile staff member)
Supply setup
Hands off sterile instruments/supplies
Surgeon duties?
Attending physician while pt in OR
First Assistant duties?
Knowledge requirements?
Assist surgeon
Anatomy/phys
Surgical procedures
Surgical handling of tissue/instruments
Retraction purposes?
1) provide counterforce
2) help w/ visualization
Laparoscopy is?
Inflation of peritoneum w/ CO2 gas,
Small incisions for instrument ports,
Camera guidance
Why CO2 gas for laparoscopy?
soluble in blood
Laparoscopy advantages? (5)
1) shorter hospitalization
2) less pain
3) less scarring
4) lower cost
5) lower risk of ileus (obstruction)
Laparoscopy Veress Needle used for?
CO2 insufflation (blown into gut) how?
Blind entrance
thru needle
Hasson technique for Laparoscopy?
Cut down/place trocar (tube) using direct visualization
Typical Laparoscopy procedures?
Cholecystectomy Appendectomy Inguinal hernia repair Ventral hernia repair Nissen fundoplication
Laparoscopy post-op shoulder pain caused by?
referred pain from CO2 stretch of diaphragm
Laparoscopic camera driving rules? (6)
1) Watch all trochars enter and exit
2) Watch all instruments enter/exit trochars
3) Ensure camera orientation
4) FRED (de-fog solution) lens
5) No contact w/ large bowel
6) Keep action centered
Laparotomy/Celiotomy is?
surgical incision into abdominal cavity
Exploratory Laparotomy performed when?
Acute, unexplained abd pain/pathology
Surgical Risk Assessment includes?
1) Prior hx (traditional risk factors)
2) Fxnl capacity
3) Procedural risk
4) ECG?? slide 28
Procedural Risk Mortality percentages:
High?
Intermediate?
Low?
High > 5%
Interm 1-5%
Low < 1%
Post Op considerations when managing meds?
Heightened SNS response ∆s metabolism, gut motility, absorption
With surgery, what type of meds should be continued? (4)
1) Meds w/ significant w/drawal sxs that do not affect anesthesia (esp alcohol)
2) CV meds
3) Statins
4) Meds that control glycemic levels
With surgery, what meds should be d/c’d?
Antiplatelets
7-10 days preop
SCIP is?
Surgical Care Improvement Project:
standards for abx use to ↓ surgical infections
SCIP rules for prophylactic use?
1) Prophy abx given w/i one hr PRE-incision
2) Prophy abx d/c’d w/i 24 hrs of surgery completion
Positioning Patient, purpose?
protect pt
Positioning Patient: Supine?
Use?
flat, face up
palms down
U for general surgery
Positioning Patient: Trendelenburg?
Use?
supine w/ head lowered below feet
↑ exposure to pelvic organs
placing central lines
Positioning Patient: Reverse Trendelenburg?
Use?
supine w/ head raised above feet
↑ exposure to abdominal viscera
Positioning Patient: Sitting?
Use?
Legs extended, hands in lap
craniotomies
cervical spine surgery
Positioning Patient: Lithotomy?
Use?
supine w/ knees raised in stirrups
Uro, gyn, rectal procedures
Positioning Patient: Prone?
Use?
face down w/ arms bent 90°, feet propped w/ knees bent
spinal surg
Positioning Patient: Lateral?
Use?
on side w/ hips/legs lowered ~ -30°
thoracotomies, nephrectomies, retroperitoneal procedures
-otomy is?
incision into
-ectomy is?
removal of
-ostomy is?
new opening
-plasty is?
repair
-plexy is?
fixation
-rrhaphy is?
suturing
Situational Awareness includes? (3)
1) perception of environment
2) comprehension of current situation
3) projection of future status
Degraded Situational Awareness caused by?
Precursors (lack of data/systems)
Humans (lack of judgement, training, skill or misinterpretation, distraction)
Intraoperative Improvement Initiative goal?
Effect outcomes
↓ morbidity/mortality
Intraoperative Improvement Initiative purposes? (3)
1) capture near misses
2) fix holes in system
3) ↓ chances of adverse events
Intraoperative Improvement Initiative categories of events? (9)
1) pt instability
2) physical injury to pt
3) communication failure
4) ∆ of plan
5) meds
6) blood products
7) equipment misuse or fail
8) access
9) everything else
Crew Resource Mgt/Mismgt due to? (5)
1) communication
2) personal readiness
3) supervision
4) organization culture/resources/process
5) safety vs cost
Structured Communication: Briefings purpose?
formulate and share op plan
U w/ checklist
Structured Communication: Sterile Cockpit is?
Reviewed when?
High risk period needing absolute team concentration
during debriefing
Structured Communication: Debriefings purpose?
(done immediately)
Eval performance of system/people/procedure etc
Identify areas for improvement
Sustain/grow improvements
Risks of surgery?
Wound/line infection UTI DVT/PE PNA GI ulcers Decubitus (bed sore) MI Arrhy Stroke Bleeding
VTE Prevention: low risk surg?
Mod - high risk surg?
mechanical prophy
anticoag prophy
