LAB #1 Flashcards
How often does a butterfly needle need to be changed?
q24 hrs
How often does an over the needle IV catheter need to be changed?
q72 hrs
What does the IV needle/catheter gauge refer to?
Diameter of the cannula
What does the IV bore size refer to?
Diameter of the needle
What is the most common complication of an IV catheter?
Thrombophlebitis
Outline the contents of NS (0.9%).
Na+= 154 mEq Cl-= 154 mEq
pH= 4-5
Outline the contents of LR.
Na+= 130 mEq Cl-= 110 mEq K+= 4 mEq Lactate= 28 mEq Ca++= 3 mEq
pH= 6.57-7.0
What is the only IV solution to contain K+?
LR
Outline the contents of D5 1/2 NS.
Na+= 77 mEq Cl-= 77 mEq Glucose= 50 gm
pH=4
What is the daily K+ requirement?
40-100 mEq
How much K+ should you add to D5 1/2 NS for a maintenance infusion?
20 mEq/L
What is the normal UOP for an adult?
1/2 mL/kg/hr
Therefore, a 70kg adult should output ~35 mL per hour
What is the formula to calculate maintenance IV fluids?
- 100 mL/kg for the first 10kg
- 50 mL/kg for the 2nd 10kg
- 20mL/kg for the rest of the bodyweight
Thus, a 70kg adult would require 2,500 mL/24 hours
How much K+ should be added to the normal adult maintenance fluids?
- 2.5L per 24 hours
- 20 mEq/L
Therefore, 50 mEq of K+
What are the two types of NG tubes? Which is used for suction and which is not?
Levin and Salem
*Remember, Salem Sucks
What are two indications for a urine catheter?
1) Acute retention
2) Irrigation of blood clots
What are the contraindications for a urine catheter?
1) Acute prostatitis
2) Trauma
3) Severe urethral stricture
What size urinary catheter is used for adults?
16 French
Note that kids get 5-12 French
How far do you insert a urinary catheter in a male?
To the flanged area
How far you insert a urinary catheter in a female?
Till urine return +1-2 inches
When do you inflate the balloon when inserting a Foley catheter?
AFTER urine return
How often should urinary catheters be replaced?
q72 hrs
What size suture is commonly used for general skin closure?
3-0, 4-0, and 5-0
What size suture is commonly used for skin closure on the face?
5-0 or 6-0
What size suture is used to close the abdomen of fascia?
0 or #2
What are the commonly used absorbable sutures?
Monocryl
Vicryl
Vetacryl
What is the commonly used non-absorbable suture?
Prolene
This is a nylon monofilaments that goes by various names
What suturing technique can only be used to close clean surgical incisions?
Running subcuticular
What is the Metzenbaum never used for?
Cutting suture
What could you use a #20 blade for?
Digital amputation
What is the purpose of Poole Abdominal Suction?
Removing large amounts of fluid from the abdominal cavity
What is a Rake used for?
Retracting tissues in shallow incisions
What is a Goelet Retractor used for?
Skin and subQ retraction
What is a Parker Retractor used for?
Retracting tissue is shallow incisions
When would you use a Ribbon/Malleable Retractor?
Special circumstances that require a unique shape
What is a Deaver Retractor for?
Deep cavity tissue retraction
What is a Richardson Retractor for?
Retracting tissue during incision
What is a Gelpi Retractor for?
Retracting heavy tissue i.e. muscle
What is a Balfour Abdominal Retractor for?
Retracting wound edges and organs during abdominal procedures
What is Weitlaner Retractor for?
Retracting tissue in shallow areas
What is a Bookwalter Retractor for?
Retracting wound edges and internal organs in abdominal surgery
What is a Right Angle for?
Clamping hard to reach vessels
What is a Babcock for?
Grasping/holding tissue of the GI tract
What is Kocher for?
Grasping heavy tissue such as fascia or muscle
What are Sponge Forceps for?
Holding sponges securely
What are DeBakey Tissue Forceps for?
Grasping delicate tissue, organs, and vessels
What are Ferris Smith Tissue Forceps for?
Fascia closure
What Tissue Forceps With Teeth for?
Fascia closure
In what area are Russian Tissue Forceps most commonly used?
OB/GYN
What is the Kraske position?
This is the “bend over and take it” position
*Used for renal and rectal surgery
What is a clean wound?
Surgical wound with scrub and no break in technique or complications
1.5-5% infection risk
What is a clean/contaminated wound?
Clean wound WITH minor break in technique or entry into non-infected organ system
7% infection risk
What is a contaminated wound?
- Traumatic wound
- Entry into viscus or gross spillage of colon contents
- Major break in surgical technique
10-15% infection risk
What is a dirty/infected wound?
Severely contaminated would from trauma or pre-op infection
14-40% infection risk
What is healing by primary intention?
Suturing closed immediately
What is healing by secondary intention?
Leaving the wound open
What is healing by tertiary intention?
Leaving the wound open for a few days and then suturing closed
*Generally better result than secondary intention
When should sutures and staples generally be removed?
7-10 days post
How long does it take for a wound to epithelialize? What are the implications?
~48 hours
1) Dressing removed POD #2
2) Shower on POD #2
What are the two amide local anesthetics?
1) Bupivicaine (12-18 hours)
2) Lidocaine (60-90 min)
What are the two ester local anesthetics?
1) Chlorprocaine (60-90 min)
2) Procaine (60 min)
How many mg/mL of anesthetic are in a 0.5, 1.0, and 2.0% solution?
- 5= 5mg/mL
- 0= 10 mg/mL
- 0= 20 mg/mL
What is the purpose of adding epi to local anesthetics?
1) Increase duration of action
2) Decrease systemic toxicity
Where should epi NOT be used?
1) Nose
2) Fingers
3) Penis
4) Toes
*or any area with end-arteries or poor circulation
What immunization do you need to check on for an I and D?
Tetanus
How soon after the procedure should the patient come back to the office?
2-3 days for re-eval
Write the format for recording blood gases.
pH/PaCo2/PaO2/HCO3/O2 sat/BE
What is the order of blood tubes for a venous blood draw?
1) Blood cultures
2) Red–no additives
3) Blue
4) Green
5) Purple
6) Gray
7) Pink
What is the use of the red tube?
Chemistry and amylase
What is the use of the blue top?
PT, PTT, and INR
What is the use of the green top?
Ammonia, CPK isozymes
What is the use of the purple top?
CBC, ABO type
What is the use of the gray top?
Ethanol
What is the use of the pink top?
Cross-match
Write the template for a blood count, [PT, PTT, and INR] and BMP (with Ca++).
p. 192
Which type of cricothyroidotomy is contraindicated in a pediatric patient?
Surgical
What is the desired site for a subclavian central line?
LEFT
What is the desired site for an IJ central line?
RIGHT
What patients are likely to poorly tolerate the Trendelenburg position needed for central line?
1) CHF
2) Elevated ICP
What is the proper way to wash your hands for a central line?
1) Medical scrub
2) Dry hands
3) Surgical gel
S/p tube thoracotomy, what are the indications for thoracotomy?
1) Initial 1,500 mL
2) 2,000+ mL/hr
What is Tube 1 for in LP?
Cell count and diff.
What is Tube 2 for in LP?
Gram stain, bacterial, and viral cultures
What is Tube 3 for in LP?
Glucose, protein, protein electrophoresis
What is Tube 4 for in LP?
Optional/special tests
What should you NEVER do in LP?
Aspirate CSF
What are the four positions on the FAST exam?
1) Pericardial (Subxiphoid)
2) RUQ (Morrison’s pouch)
3) LUQ (Perisplenic)
4) Pelvic (Douglas/ Suprapubic)
What is the the mnemonic for writing admit orders?
ADC VAAN DIMLE
A= admit D= diagnosis C= condition
V= vitals A= allergy A= activity N= nursing
D= diet I= IV M= meds L= labs E= extra
How is Tylenol ordered for a fever?
325mg 1 tab PO q6 hr PRN for fever
How is oral Percocet ordered?
5/325 mg 1-2 tabs PO q 6 PRN for pain
How is morphine ordered?
2-5 mg IV q2 hr PRN pain
How is Dilaudid ordered?
0.5-2mg IV q1 hr PRN pain
How is Phenegran ordered?
12.5-25mg IV q6 PRN nausea
How is Zofran ordered?
4-8mg IV q6 PRN nausea
How is Benadryl ordered?
20-50mg IV or PO q6 PRN itching or insomnia
What are the 5W’s for a post-op fever?
1) Wind
2) Water
3) Walk
4) Wounds
5) Wonder drugs
