Operating Theatres Flashcards
Elements of Radiation Safety include
surgical masks, lead aprons, safety glasses
ORIF
Open Reduction Internal Fixation
Gowns have to be
2 piece, wear webbing belt as single gowns can weigh you down and cause pain in back
II stands for
Image intensifier
What are some questions that you need to know for prep for theatre?
1.What the operation achieves?
- Familiar with the radiographic requirements for the case?
- Are you familiar with the surgeon?
- Are you familiar with any special requirements?
You should develop dialogue
with the surgeon - communicate freely with him or her
What is exemplar dialogue in introducing yourself to the surgeon?
Hi, my name is Angela. I am one of the radiographers here. I haven’t worked with you before. I have done a few microscopic laparoscopy before, do you have any specific requirements? Sides?
Special requirements include
PACS (know which ones will be sent off), fluroscopy - dynamic/continuous or staggered; ambiguous language - have a process to get info - indication of the surgeon’s language - screen/go/mhm - recognise when they have stopped
Common questions for theatre
- “What side shall I come in from?”
- “What direction should the x-rays com from?”
- “Single shots, or fluoroscopy?”
- “What instruction to start screening?”
- “What instruction to stop screening?”
- “What instruction to capture an image?”
Doctor hierarchy (low to high)
Medical student, intern, resident, registrar, fellow, consultant/specialist
How would you position the C-arm machine
Start the case perpendicular to the ROI; use 2 loads of filtering - moving wheels/brakes; brake on and utilise handles
What are the common Field sizes
17cm field - no mag
14cm - mag 1
11cm - mag 2
A sterile field is
a designated area, created using aseptic drapes, that is maintained as free from microorganisms as possible to reduce the risk of infection during procedures like surgery or invasive procedures.
Orthopedics is
branch of med that deals with correction/prevention of deformities, disorders, injuries of skeleton and structures of muscles, ligaments, tendons
Gamma Nail
is a common operation - performed on the hip, on the trans cervical fracture of the femur
Where is the gamma nail secured in
Nail into the femoral shaft; pin secured superiorly from femoral neck into head & distally through a predrilled hole
Process of the gamma nail
- Prep, Drape, Incision over greater trochanter.
- Bore a hole into the greater trochanter.
- Place a guidewire past fracture site.
- Introduce the nail over the guidewire.
- Proximal locking into femoral neck.
- Distal locking through inferior nail.
Cannulated screws are used for
subcapital fractures where the femoral neck articualte with head
Femoral Nail
- Prep, Drape, Incision over greater trochanter.
- Bore a hole into the greater trochanter.
- Place a guidewire down to fracture site.
- Align fracture under x-ray guidance.
- Extend guidewire to distal femur.
- Ream out the medullary cavity (over the guidewire).
- Introduce the nail over the guidewire.
- Proximal locking into femoral neck.
- Distal locking superior to femoral epicondyles.
Humeral nail process
- Prep, Drape, Incision over greater tuberosity.
- Bore a hole into the greater tuberosity.
- Place a guidewire down to fracture site.
- Align fracture under x-ray guidance.
- Extend guidewire to distal humerus.
- Ream out the medullary cavity (over the guidewire).
- Introduce the nail over the guidewire.
- Proximal locking into humeral head / neck.
- Distal locking superior to humeral epicondyles.
Tibial nail
We need to bend the knee to have a 90 deg of flexion so we can get access of the tibial plateau
Radiographic considerations
- Be able to approach fracture site from 90 deg
- Femoral Nail: Approach as per a Gamma Nail.
- Humeral Nail: Ensure patient on edge of table.
Ext-fixes are
external fixateurs - used to keep fractures intact e.g. comminuted fractures/compressed fractures
Thickness of Wires in patient’s legs
varies on the regions of the body
K-wires and percutaneous fixation (through the skin)
least impactful; thin wire drilled and punctured into skin;
Closed Reductions include
realignment of fracture site
Arthrogram
an contrast enhanced image examination of joint space
In operating theatres, arthrograms are performed on child’s
hips - e.g. Clicky hip, other syndromes Cerebral palsy
Hip spicas and arthrograms should be
performed PA (red magnific); dose as low as possible; bilateral - place marker
