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Q4 EM Surg > Intro to Surgery (lec 2) > Flashcards

Intro to Surgery (lec 2) Flashcards

1
Q

Preop Nurse duties? (3)

A

Pt prep
Signatures of surg/anesthesia staff
Start IV w/ ordered meds

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2
Q

Anesthesiologist duties? (3)

A

Preop pt consult
Appropriate anesth type
Sleep, analgesia, airway, breathing, circulation

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3
Q

Circulating Nurse duties? (5)

A 
Gets supplies, sterile equip
Pt ID, positioning
Sterility of suite
OR manager
Final counts
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4
Q

Scrub Nurse duties? (2)

A

(Sterile staff member)
Supply setup
Hands off sterile instruments/supplies

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5
Q

Surgeon duties?

A

Attending physician while pt in OR

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6
Q

First Assistant duties?

Knowledge requirements?

A

Assist surgeon

Anatomy/phys
Surgical procedures
Surgical handling of tissue/instruments

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7
Q

Retraction purposes?

A

1) provide counterforce

2) help w/ visualization

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8
Q

Laparoscopy is?

A

Inflation of peritoneum w/ CO2 gas,
Small incisions for instrument ports,
Camera guidance

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9
Q

Why CO2 gas for laparoscopy?

A

soluble in blood

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10
Q

Laparoscopy advantages? (5)

A

1) shorter hospitalization
2) less pain
3) less scarring
4) lower cost
5) lower risk of ileus (obstruction)

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11
Q

Laparoscopy Veress Needle used for?

CO2 insufflation (blown into gut) how?

A

Blind entrance

thru needle

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12
Q

Hasson technique for Laparoscopy?

A

Cut down/place trocar (tube) using direct visualization

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13
Q

Typical Laparoscopy procedures?

A 
Cholecystectomy
Appendectomy
Inguinal hernia repair
Ventral hernia repair
Nissen fundoplication
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14
Q

Laparoscopy post-op shoulder pain caused by?

A

referred pain from CO2 stretch of diaphragm

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15
Q

Laparoscopic camera driving rules? (6)

A

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

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16
Q

Laparotomy/Celiotomy is?

A

surgical incision into abdominal cavity

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17
Q

Exploratory Laparotomy performed when?

A

Acute, unexplained abd pain/pathology

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18
Q

Surgical Risk Assessment includes?

A

1) Prior hx (traditional risk factors)
2) Fxnl capacity
3) Procedural risk
4) ECG?? slide 28

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19
Q

Procedural Risk Mortality percentages:

High?

Intermediate?

Low?

A

High > 5%

Interm 1-5%

Low < 1%

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20
Q

Post Op considerations when managing meds?

A

Heightened SNS response ∆s metabolism, gut motility, absorption

21
Q

With surgery, what type of meds should be continued? (4)

A

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

22
Q

With surgery, what meds should be d/c’d?

A

Antiplatelets

7-10 days preop

23
Q

SCIP is?

A

Surgical Care Improvement Project:

standards for abx use to ↓ surgical infections

24
Q

SCIP rules for prophylactic use?

A

1) Prophy abx given w/i one hr PRE-incision

2) Prophy abx d/c’d w/i 24 hrs of surgery completion

25
Q

Positioning Patient, purpose?

A

protect pt

26
Q

Positioning Patient: Supine?

Use?

A

flat, face up
palms down

U for general surgery

27
Q

Positioning Patient: Trendelenburg?

Use?

A

supine w/ head lowered below feet

↑ exposure to pelvic organs
placing central lines

28
Q

Positioning Patient: Reverse Trendelenburg?

Use?

A

supine w/ head raised above feet

↑ exposure to abdominal viscera

29
Q

Positioning Patient: Sitting?

Use?

A

Legs extended, hands in lap

craniotomies
cervical spine surgery

30
Q

Positioning Patient: Lithotomy?

Use?

A

supine w/ knees raised in stirrups

Uro, gyn, rectal procedures

31
Q

Positioning Patient: Prone?

Use?

A

face down w/ arms bent 90°, feet propped w/ knees bent

spinal surg

32
Q

Positioning Patient: Lateral?

Use?

A

on side w/ hips/legs lowered ~ -30°

thoracotomies, nephrectomies, retroperitoneal procedures

33
Q

-otomy is?

A

incision into

34
Q

-ectomy is?

A

removal of

35
Q

-ostomy is?

A

new opening

36
Q

-plasty is?

A

repair

37
Q

-plexy is?

A

fixation

38
Q

-rrhaphy is?

A

suturing

39
Q

Situational Awareness includes? (3)

A

1) perception of environment
2) comprehension of current situation
3) projection of future status

40
Q

Degraded Situational Awareness caused by?

A

Precursors (lack of data/systems)

Humans (lack of judgement, training, skill or misinterpretation, distraction)

41
Q

Intraoperative Improvement Initiative goal?

A

Effect outcomes

↓ morbidity/mortality

42
Q

Intraoperative Improvement Initiative purposes? (3)

A

1) capture near misses
2) fix holes in system
3) ↓ chances of adverse events

43
Q

Intraoperative Improvement Initiative categories of events? (9)

A

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

44
Q

Crew Resource Mgt/Mismgt due to? (5)

A

1) communication
2) personal readiness
3) supervision
4) organization culture/resources/process
5) safety vs cost

45
Q

Structured Communication: Briefings purpose?

A

formulate and share op plan

U w/ checklist

46
Q

Structured Communication: Sterile Cockpit is?

Reviewed when?

A

High risk period needing absolute team concentration

during debriefing

47
Q

Structured Communication: Debriefings purpose?

A

(done immediately)

Eval performance of system/people/procedure etc

Identify areas for improvement

Sustain/grow improvements

48
Q

Risks of surgery?

A 
Wound/line infection
UTI
DVT/PE
PNA
GI ulcers
Decubitus (bed sore)
MI
Arrhy
Stroke
Bleeding
49
Q

VTE Prevention: low risk surg?

Mod - high risk surg?

A

mechanical prophy

anticoag prophy

Q4 EM Surg (27 decks)

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