Moroccan Flashcards
knife handle
knife handles are used to hold various blades to create scalpel. Scalpels are used to make skin incisions or whenever a fine precision cut is necessary.
Towel Clamp
a ratcheted instrument with curved, sharp, tinelike jaws.
is used for holding towels in place when draping, when grasping tough tissue, and during reduction of small bone fractures.
Curved/ Straight forceps - clamp (Kelly)
a curved or straight clamp w/horizontal serrations that run the complete length of the jaws.
Blood Culture Bottles
blue for -aerobic
red for - anaerobic (put in here first)
Important to be sterile and use different needle than the one used to collect sample from the patient. There are filll lines on these bottles which indicate how much blood is needed
What are they all for / what do they ahve in them
Chest Drain Bottle/Bucket
Is a bucket which has measurement indicators on the side, a tube going into the bucket and all the way to the bottle (allows the formation for a water seal when sterile water is filled to the prime level - indicataed by a line on the bottle). This seal is important when draining a pneumothorax
Suction can be applied to encourage emptying and closure.
Bubbling - insinuates that air is still coming out
Swinging - reflects the rise and wall of the water chamber with respiration–> if this stops the tube could be blocked/ kinked. generaly reduces as the pneumothorax resolves
Uses - pneumothorax, haemothorax, pleural effusion, empyema, post-op
Mosquito forceps/clamp (Schmidt looks similar but is longer and is more curved - used for deeper wounds)
a curved or straight clamp w/fine tips and horizontal serrations that run the length of the jaws.
is used to occlude bleeders in small or superficial wounds before cauterization or ligation. Used often for delicate or small confined procedures. Some examples are plastics, pediatrics, thyroid, and hand procedures.
Allis / Babcock Intestinal Forceps
Interlocking fine teeth/ flat rounded edges- designed to minimise trauma to tissue as it is handled
Allis (the one with teeth) - is used for lifting, holding, and retracting slippery dense tissue that is being removed (vagina, tonsils bowel..)
Babcock - is used for grasping and encircling delicate structures (ureters, bowel etc..)
Foerster Sponge Forcep
can be curved or straight and has two round tips w/horizontal serrations.
is used to create a sponge stick, for grasping tissues such as the lungs, or for removing uterine contents.
Mayo NEedle holder
has a broader jaw that is rounded at the tip w/crisscross pattern on the inner jaw.
is used for holding heavy needles when suturing.
Debakey Tissue Forceps
an atraumatic tissue forceps w/an elongated, narrowed blunt tip. A set of parallel fine serrations runs the length of one jaw w/a center row of serrations on the oppostie side that interlocks to grip when closed
grasps numerous types of tissue; used in many types of surgery (particular vascular). Doesn’t damage tissue structures
Adson Toothed Tissue Forcep
aligns the edges of the wound during stapling of the skin; grasps superficial tissues so that Steri-Strips can be placed.
the fine tips have two small teeth on one side and one small tooth on the other side that fit together when closed. All of the Adson tissue forceps are the same size and shape. They are differentiated by the inner tips.
Straight Mayo Scissors
heavy scissors w/straight blades
are used to cut suture - use the tips of the scissors and rotate the scissors slightly to assess the length that is beign cut
Curved Mayo Scissors
heavy scissors w/curved blades and blunt or sharp tips.
dissect or undermine heavy fibrous tissues - only used to cut tissue!
Metzenbaum - the longer and thinner scissors shown. can be curved or straight
Used to cut more delicate tissue
i) Yankauer and ii) Poole (the fenestrated one) suction tips
These are tips attached to plastic tubes. Can be disposable or reusable (disposable more commonly used)
Yankauer - . Slightly bent at the end. disposable is the most widely used
Poole - allows for lots of suction to occur at once and can also be used to suction inside the femur.
Weitlaner (the one with three outward prongs) and gelpi (only one prong) tissue retractors
self-retaining finger-ringed instrument w/a ratchet/release device on the shanks, which holds them open in the wound
Weitlaner - 3 prongs
Gelpi - 1 prong
Hold wound edges open - Weitlaner can be sharp so be careful to avoid damage to tissue
Richard -eastman retractor - Looks like it has the platforms at each end
Richardson retractor - has a fancy handle
Army- navy retractor - has an oval hole in the middle and two platforms at each end
Deaver retractor - very curved looking end with a straight handle
Balfour with bladder blade and wingnut
Self-retaining retractor device with adjustable wing-nuts and an axis to adjust the size of field retracted. Shallow curved central point.
Use - Used in abdominal surgery near the bladder and allows shallow retraction so as not to interfere with the bladder.
What are the different types?
What do the numbers mean?
Which are A_______ and which are non- A______?
Abosrbable - Catgut, Monocryl and Vicryl
Non- Absorbable - Ethilon, Prolene, Silk
Numbers 11-0 –> 0 –> 7 - 11-0 finest you can get
7 - is the broadest you can get.
the broader ones are more braided whereas the finer ones have less filaments (11-0 = monofilament).
Monofilament (single strand) - is good for handling fine tissue, tie down easily and minimise scarring
Multifilament - has greater tensile strength, is stronger, have good tissue handling characteristics and are generally less absorbable/last longer.
Disposable rigid sigmoidoscope
A tube with a narrowed end that allows for the attachment of a light source and air insufflation
Must DRE first and the sigmoidoscope must be lubricated
Uses - Insepction of the rectum and distal sigmoid. Biopsies can be taken. Can facilitate the insertion of a decompression tube in voluvlus.
Non disposable rigid sigmoidoscope
Drainage bag
Can be connected to an NG tube/ or abdominal drains etc. Should be placed below wherever is being drained (drainage acts by gravity)
Cuffed ET Tube
Definitive airway. Should be sized appropriately for the patient and then the tube is passed under laryngoscopy guidance through the vocal cords.
Cuff should be inflated and then the position should be checked by looking for chest rise, foggy tube and also listening over the precordium for gurgling sound (insinuates that the tube is in the oesophagus)
indications:
GCS <8 in trauma
Long surgeries
ITU (short term)
Cardiac arrests
Feeding NG Tube
Fine bore tube made of sililastic (less prone to blockage). Passed through the nose (lubricated) and should be sited in Stomach, Duodenum, Jejenum.
Has a wire - this wire is kept in situ until x ray confirmation of correct position upon which it is removed.
Has 2 ports - one for food and one for medicine
uses - facilitates long term enteral feeding in –> unsafe swallow, upper GI surgery, malnutrition.
Fracture Plates
Metal device with holes for the attachment of intramedullary and extramedullary screws. Holes are distributed along this device to allow multiple points of fixation to control the bone.
hemiarthroplasty
Used in NOFs for patients >70
Has a ball (articulates with acetabulam) and stem (fitted into the femur).
Can be :
Cemented - Thompson
uncemented - Austin Moore ( is serrated and has holes in it allowing for bone to grow into the implant itself)
Cement can be impregnated with antibitics and the medulla of the femur should be ‘reemed’ or suctioned before placement.
Total hip replacement
Used in younger patients with NOF/ Osteoarthritis
Has an acetabular cap, ball and stem.
The stem is usually cemented
Total knee replacement (can be partial, total, or patellar replacements)
Constituents: Femoral implant, Tibial Implant, Plastic spacer (acts as the cartilage)
Implantsa are cemented into place
Patellar can be left as an attachment point for muscles if relatively undiseased
Ligaments:
ACL almost always removed
PCL usually removed
New ligament sparing appraoces are being innovated
approaches:
Traditional anterior approach - involves partial resection of quadriceps
Many other incisions including quadriecps sparing incision (Anteromedial)
Spinal Needle
Long Needle with a beveled end, graduations throughout, a depth stop and a removal stylet.
Used for taking CSF samples and for measuring CSF opening pressure
Send off for - Biochem (pH, LDH, Glucose, Protein), Cytology, Microbiology, Protein electrophoresis, Viral PCR
Opening pressure:
5- 20 cm H20
>20 = SAH, Meningitis
<5 = Dural leak
Nasal prongs
1-4 /l min
24-40 % O2
Simple face mask
4-6 LPM
40-60%
non - rebreather
60-90%
>10 LPM
The resevoir bag allows delivery of high concentration
Venturi Masks
DIfferent attachments with different concentrations of FiO2 delivered
Instructions on rate of oxygen to be delivered on each venturi attachment
verres needle
Spring loaded needle with an acess port at the end for the introduction of air into the peritoneum during surgery
PEG Tube
Gastrostomy is just beneath costal margin
Jejunostomy is just above a line through umbilucs
Both left sided
Indications for enteral feeding - Catbolosism (sepsis , burns), Coma, Malnutrition, Dysphagia (stroke, bulbar palsy, oesophageal strictures/srugery) 5
PICC Line (peripherally inserted central cathter
If it was shorter and triple lumened Hickmann Line
They’re both essentially tunneled lines for hte long term provision of drugs, and feed into a central vein
Indications: Prolonged obstruction or ileus (>7d), High output fistula, Short bowel syndrome, Severe Crohn’s, Severe malnutrition, Severe pancreatitis, Unable to swallow e.g. oesophageal Ca
Redivac
- example of a closed drainage system that is used to prevent haematoma formation
Wound drainage tube (Jackson pratt drainage device)
Closed system (with additional suction) post operatve drainage device to drain bodily fluids
Portacath - non visible type of central venous access.
Access port is subcutaneous and is accessed via non-coring huber needles.
Is tunnelled
Tube thoracostomy
central venous catheter
Goes into subclavian/ jugular vein and is used to give drugs centrally
Can have up to 5 ports allowing for multiple drugs to be given simultaneously
Kelly Proctoscope and Obturator
The obturator is removed once the proctoscope is in situ
Fibre optic proctoscoep
Simple Robinson Drain
Urometer
Designed for accurte urine output monitoring
Tracheostomy - definitive airway device
Cricothyrotomy kit
Swan Ganz Cathter
Inserted into the right pulmonary artery
Indirect measure of Left atrial pressure
