Memorise Flashcards
1
Q
Sentinel events
A
- Australian Commission on Safety an Quality in Health Care
- Sentinel event is a type of adverse patient safety event that is wholly preventable and results in serious harm to or death of a patient
- 10 Australian sentinel events
- Procedure on wrong side
- Procedure on wrong patient
- Wrong procedure performed
- Unintended retention of a foreign object after surgery
- Transfusion reaction from incompatible blood
- Suicide fo a patient in a psychiatric ward
- Medication error resulting in serious harm or death
- Physical or mechanism restraint causing serious harm or death
- Discharge or release of a child to an unauthorised person
- Incorrectly positioned pro or nasogastric tube causing serious harm or death
2
Q
Safe working hours
A
- RACS has a position statement on safe working hours
- Acknowledges that a standard 38 hour week is not realistic or ideal for surgical training
- Also acknowledges that at times surgical trainees work hours that would be considered unsafe
- Optimised between 50-60 Horus a week, maximum of 65, averaged over a 4 week period
- Rostered hours should include time for teaching, audits, required assessments
- Time made for recreational and study leave
3
Q
Complications of tourniquet use
A
- Nerve injury - most common complication
- Compartment syndrome
- Pressure sores
- Digital necrosis
- VTE
- Rhabdomyolysis
- Alcohol burn
- Post-tourniquet syndrome - swollen, stiff, pale, weak limb after 1-6 weeks
4
Q
Relative contraindications to tourniquet
A
- Severe infection
- Poor cardiac reserve
- PVD
- Concurrent DVT
5
Q
Recommendations fo surgeons with BBV
A
- Upon a diagnosis of a blood Bourne virus, must cease operating and first seek appropriate medical care
- Doctors have a responsibility to be aware of their BBV status
- To continue to perform operations
- HBV - must be under the care of an appropriate specialist, undergo viral load monitoring every 6 months and have. Viral load below 200
- HCV - must test HCV RNA negative if not treated, or have achieved a sustained virological response 12 weeks after treatment
- HIV - must be under the care of an appropriate specialist, undergo viral load monitoring every 3 months and must be either:
- On effective antiviral therapy and have a viral load below 200
- Meet the definition of an elite controller - which is outlined in the Australian National Guidelines for Healthcare workers living with blood borne viruses
6
Q
AHPRA mandatory reporting
A
- Impairment
- Intoxication while practicing
- Significant departure from accepted professional standards
- Sexual misconduct
7
Q
DCP mandatory reporting
A
- Must make a report to DCP if suspect on reasonable grounds that a child is or may be at risk of harm - is not required to prove
- Reasonable grounds include
- Observations of behaviour of child or their caregiver
- Child tells you
- Hearing from a third party who would be considered reliable
- Specifically in South Australia it is mandatory to report suspicions of:
- Physical abuse
- Sexual abuse
- Mental or emotional abuse
- Neglect
8
Q
AOA position on interaction with industry
A
- Must act in patient’s best interest when recommending or using medical treatments or devices
- Must not accept personal promotion or seek gifts
- Gifts, money or benefits that exceed $100 represent a declarable financial interest
- Reimbursement may occur for a genuine commercial relationship e.g. to learn a new surgical technique. Reimbursement must be limited to expenses that are strictly necessary and would withstand public scrutiny
9
Q
MOA of TXA, aspirin, clopidogrel, NOAC, warfarin
A
- TXA - Compound with anti-fibrinolytic properties through inhibition of plasminogen activation
- Aspirin - COX1 enzyme inhibitor, redues thromboxane and thus reduces platelet aggregation
- Clopidogrel - inhibits binding off ADP in platelets and thus reduces platelet aggregation
- NOACS - inhibit factors in the clotting cascade and ultimately reduces the conversion of prothrombin to thrombin
- Warfarin - vitamin K antagonist, requiring for the clotting cascade, ultimately reduces the conversion of prothrombin to thrombin
10
Q
Contraindications to TXA
A
- Allergy
- Active clotting e.g. concurrent VTE
- History of thrombosis
- Coronary stent past 12 months
- Uncontrolled seizure disorder
11
Q
Red flags of back pain
A
- Infection - fevers, IVDU, immunosuppression
- Fracture - trauma mechanism, midline tenderness
- Tumour - weight loss, fatigue, history of malignancy
- Neurological deficit - motor weakness, bladder or bowel changes
12
Q
How does diathermy work?
A
- Diathermy is a high frequency alternate polarity radio-wave electrical current, used to coagulate or cut during surgery
- Cutting - continuous waveform at low voltage
- Coagulate - pulsating waveform at high voltage
13
Q
Dangers of diathermy use
A
- Channeling effect - using monopolar on structure with narrow pedicure
- Ignition of flammable material e.g. chlorhex
- Return plate burns - even contact, off bony prominences or metal prosthesis
- Inadvertent activation burning skin
- Personal injury - diathermy tip can remain very warm after use
- Pacemakers - consult cardiology pre-op, have pacemaker checked. Use bipolar if possible, otherwise place plate so that correct directed away from pacemaker
14
Q
What do you know about the AOA training program
A
- Competency based program over a minimum of four years, including an introduction to orthopaedics, core orthopaedics, and transition to practice period.
- Training requirements
- In training assessment forms
- Feedback entries
- Electronic logbook
- Research requirement
- Bone school attendance
- Examination
- OPBS exam
- Fellowship exam
- Courses
- Bone camp
- ASSET
- CCRIPST
- TIPS
- EMST
- AOA workshops
15
Q
RACS surgical competence and performance guide
A
- 10 Topics
- Medical expertise
- Judgement and clinical decision making
- Technical expertise
- Professionalism
- Health advocacy
- Communication
- Collaboration and teamwork
- Leadership and management
- Scholarship and teaching
- Cultural competence and cultural safety
