Operative Surgery And Procedures Flashcards
Complications of thyroidectomy?
RLN injury- hoarse voice
SLN injury- loss of high pitch- monotonous voice
Early- thyroid storm, hypoparathyroidism, constricting haematoma, infection
Late- scarring, hypoT
Which side should insert a subclavian line into?
Right
Left has higher pleural dome and thoracic duct
Risks of surgical airway/ long term tracheostomy insertion?
Damage to thyroid IMA and ant jugular veins
Long term complications Fistulas Tracheomacia Stenosis Scarring
Blood supply of breasts?
Internal thoracic
Thoracodorsal
Lateral thoracic
Intercostals
What nerves may be damaged during a mastectomy?
Long thoracic nerve
Thoracodorsal nerve
Median/lateral pectoral nerve
Intercostobrachial nerve
Lymphatics of the breast
Node clearance levels
Axillary is 75% of lymphatic drainage
Parasternal/0post intercostal/supraclavicular/contral breast
Node clearance defined by pec major
Level 1 lateral
Level 2 behind
Level 3 medial
Signs of cardiac tamponade?
Becks triad
Muffled heart sounds
Raised jvp
Hypotension
Pulses paradoxus- decreased SV for every inspiration
Cyanosis
Decreased GCS
What is the process of laparotomy closure?
Jenkins rule
Mass closure. Peritoneum and rectus
Looped 1-0 PDS. On a blunt needle
Length of suture 4x wound
1cm bits 1 cm apart
Principles of bowel anastomoses?
Optimise patient No peritoneal contamination Tension free Serosa to serosa No mesentry twisting Well vascularised tissue
Indications for burr hole?
Clinically coning Rapidly decreasing GCS dilated pupils Extensor posturing Cushings reflex
On ct
Acute EDH/SDH with midline shift
Complications of craniotomy?
Immediate- bleeding/brain damage
Early- face bruising- sun gleal blood tracking
Infection
EDH- from bleeding bone edges
Late
Dysphagia- temporalis atrophy
Frontalis damage
Neuro impairement- deafness/blindness
Indications for ICP monitoring?
GCS < 8 and head injury
Extensor posturing
Hypoxia/hypovolaemia post head injury
Malfunctioning shunt
Procedure for ICP and complications
Kochers point. Right frontal mid pupillary line. 1 cm ant to coronary suture
ICH- 2%
Infection <1%
CSF leak
Failure of procedure
Layers when performing LP
Skin, fat, fascia Supraspinous lig Interspjnous lig Lig flavum Areolar tissue Dura mater Arachnoid mater
