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Medicine year 3- MACS > lectures > Flashcards

lectures Flashcards

1
Q

Factors that affects surgical outcomes

A

Patient- age, sex, socioeconomic status, aerobic fitness, comorbidities
Surgical- emergency, minimally invasive, duration, blood loss, tumour (size), adhesions, surgical experience
Environment- cleanliness, temperature

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2
Q

How do you categorise surgical complications

A
  • Clavien Dindo classification
  • From 1 to 5
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3
Q

Causes of post op pyrexia

A
  • Cut: wound infection
  • Collection: pelvic or subphrenic abscess
  • Chest: infection or pulmonary embolism
  • Cannula: infection
  • Central venous catheter: infection
  • Catheter: urinary tract infection
  • Calves: DVT
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4
Q

X ray vs CT in bowel obstruction

A

CT abdomen
More accurate, useful for severity and risk of complications eg perforation/ischaemia.
15mSV radiation.

Abdominal x-ray
No obstruction on AXR does not exclude obstruction.
Unlikely to show cause.
0.7mSV radiation.

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5
Q

Large bowel obstruction

A

6cm upper limit normal
9cm upper limit normal (caecum)
Pouches – Haustra, Thicker than Small Bowel
Gas proximal to blockage
Collapse distal

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6
Q

Small bowel obstruction

A

3cm upper limit normal
More central
Valvulae conniventes- bands across the bowel

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7
Q

T wave inversion

A

Myocardial ischaemia

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8
Q

ECG signs of PE

A

S1Q3T3- right sided heart strain can cause a PE
PE- sinus tachycardia is the most common ECG finding

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9
Q

What report deals with the dying

A

Neuberger report

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10
Q

Key steps for caring for the dying

A
  • The possibility that a person may die within the coming days and hours is recognised and communicated clearly, decisions about care are made in accordance with the person’s needs and wishes.
  • Sensitive communication takes place between staff and the person who is dying and those important to them.
  • The dying person, and those identified as important to them, are involved in decisions about treatment and care.
  • The people important to the dying person are listened to and their needs are respected.
  • Care is tailored to the individual and delivered with compassion –
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11
Q

Warning score 0-4

A

Low risk
Ward based response

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12
Q

Red score in any parameter of NEWS

A

Low/medium
Urgent ward response

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13
Q

Eary warning score 5-6

A

Medium risk
Urgent response

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14
Q

Early warning score 7+ risk and response

A

High
Urgent/emergency response

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15
Q

GCS eyes

A

4 Spontaneous
3 To sound
2 To pressure
1 None

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16
Q

GCS verbal

A

5 Oriented
4 Confused
3 Words
2 Sounds
1 None

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17
Q

GCS motor

A

6 Obey commands
5 Localizes pain
4 Normal flexion
3 Abnormal flexion
2 Extension
1 None

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18
Q

Who are classified as vulnerable adults

A

Older people
People with learning disabilities
Mental health patients
People who are ill and need help functioning
Physically disabled people
Trauma
Those who have gone through domestic abuse/homelessness

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19
Q

Q sofa

A

RR >22
GCS <15
SBP <100mmHg

Identifies patients with an infection who may be at a greater risk of sepsis

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20
Q

Difference between aspetic and sterile

A

aseptic- contamination free, no harmful bacteria
sterile- entirely free of germs not even nice ones

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21
Q

Transition from theatre to recovery to wards

A

30 min obs post surgery
Can go to ward if BP stable, and resp rate is above 12
1:1 care post op

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22
Q

Main principles of wound management

A

Haemostasis
Cleaning the wound
Analgesia
Skin closure
Dressing
Follow up advice

23
Q

Wound management: how is haemostasis achieved

A

Pressure, elevation, tourniquet, suturing

24
Q

Wound analgesia

A

Lidocaine 3ml/kg

25
Q

How is skin closed on a wound

A

Steri strips, tissue adhesive, sutures, staples

26
Q

How do you dress a wound

A

First layer = Non adherent (wet)
Second layer = Absorbent material
Top layer = Soft gauze tape

27
Q

Steps of primary intention healing

A

1) Haemostasis: prevention of infection by scab formation
2) Inflammation: remove cell debris and pathogens
3) Proliferation: cytokines released by inflammatory cells drive proliferation of fibroblasts and granulation tissue
4) Remodelling: collagen fibres are deposited within the wound to provide strength in region

28
Q

Steps of secondary intention healing

A

1) Haemostasis: large fibrin mesh forms
2) Inflammation: more intense than in primary intention
3) Proliferation: granulation tissue forms at the bottom of the wound
4) Remodelling: inflammatory response resolves, wound contraction may occur

29
Q

How would you detect bleeding post op

A

Decreased Hb and increased platelets

30
Q

How can you detect paralytic ileus

A

Peristalsis ceases

31
Q

Types of infection after surgery

A

1-2 days post op: lung infection
3-5 days post op: UTI
4-6 days post op: PE/DVT
5-7 days post op: site infection ad abcess formation
7+ days post op: allergy

32
Q

Intra op enhanced recovery

A

Use of multimodal and opioid sparing analgesia
N and V prophylacis
Minimally invasive surgery
Goal directed fluid therapy

33
Q

Post op enhanced recovery

A

Adequate pain control
Early oral intake
MDT follow up

34
Q

Role of the outreach team

A

Post critical care follow up
High risk patient referrals from wards
Education and training
Critical care patient transfers
Management of trackys
Advanced life support
Cardiac arrest and emergency airway team

35
Q

Normal urine output

A

1ml/kg/hr

36
Q

Different levels of care

A

Level 0: normal ward care
Level 1 care: those at risk of deterioration or stepping down from a higher level. Can be ,managed on an acute ward with help from the critical care team
Level 2: HDU. support for a single failing organ system or post op
Level 3: ICU. Patients requiring respiratory support or support with 2+ failing organ system

37
Q

Level 1 pain ladder

A

Mild pain
Non opioid analgesics
NSAIDs
Aspirin
Paracetamol

38
Q

Level 2 pain ladder

A

Moderate pain
Weak opioids
Tramadol
Codeine
+/- non opioid analgesics

39
Q

Level 3 pain ladder

A

Severe pain
Strong opioids
Morphine
Buprenorphine
Fetanyl
Methadone
+/- Non opioids

40
Q

Clean surgery

A

An incision in which no inflammation is encountered in a surgical procedure, without a break in sterile technique, and during which the respiratory, alimentary and genitourinary tracts are not entered

41
Q

Clean contaminated surgery

A

An incision through which the respiratory, alimentary or genitourinary tract is entered under controlled conditions but with no contamination encountered.

42
Q

Contaminated surgery

A

An incision undertaken during an operation in which there is a major break in sterile technique or gross spillage from the gastrointestinal tract, or an incision in which acute, non-purulent inflammation is encountered.n

43
Q

Adrenaline side effects

A

Muscle necrosis
Necrotising fasciitis
Dizziness
HTN
Palpitations

44
Q

Amiodorone contraindications and side effects

A

Contraindications: Severe conduction disturbances, Bradycardia
Side effects: arrhythmias, corneal defects, thyroid disease, hepatotoxicity

45
Q

Adenosine contraindications and side effects

A

Contraindications: asthma, copd, AV block, severe hypotension
Side effects: bradycardia, AV block, paraesthesia, throat discomfort

46
Q

What percentage of O2 does a nasal canulase deliver

A

24-30%
max flow: 4L/min

47
Q

Oxygen percent for non re-breathe masks

A

70%

48
Q

Venturi mask

A

A face mask and reservoir bag device that delivers specific concentrations of oxygen by mixing oxygen with inhaled air. Regardless of resp rate and flow pattern.

49
Q

What are human factors

A

Interaction between the employee, their equiptment and the surrounding envioronment. Through understanding these processes, changes can be made to reduce human error.

50
Q

Examples of human factors

A

Learning styles
Behaviour and attitudes
Values
Leadership
Teamwork
Design of equipment and processes
Communication and organisation culture

51
Q

Delirium screening tools

A

4AT
CAM

52
Q

Dementia screening tool

A

MMSE

53
Q

Braden score

A

Pressure sores. Uses sensory perception, nutritional status, friction and shear, activity, moisture and mobility to find the risk of developing a pressure sore.

Medicine year 3- MACS (7 decks)

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