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OR > OR Residency 2022 > Flashcards

OR Residency 2022 Flashcards

1
Q
A

Taper Needle

  • Spreads tissues as it goes between layers
  • Used for soft tissue, bowel, vascular, nerves, head and neck
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2
Q
A

Cutter Needles

  • Cuts tissue as it is passed through → may cause damage
  • Used for fascia, skin, tendons
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3
Q

Suture Types

A
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4
Q

Suture Sizes

A
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5
Q

Suture Size and Use

A
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6
Q

CT

A
  • Circle Taper
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7
Q

FS

A
  • For Skin
  • Fsx, FSlx → For skin extra large
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8
Q

PS

A
  • Plastic Skin
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9
Q

LR

A
  • Long Retention Suture
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10
Q

SH

A
  • Small half
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11
Q

CP

A
  • Circle Point
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12
Q
A
  • Keith (straight) needle
  • The straight-body needle is used to suture easily accessible tissue that can be manipulated directly by hand
  • Skin closure of abdominal wounds
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13
Q

Absorbable Sutures

A
  • Monocryl (Coral/Orange)
  • PDS II (Grey) lasts months
  • Fast Gut (Bright Yellow)
  • Plain Gut (Yellow)
  • Chromic Gut (Tan)
  • Vicryl/Dexon (Purple)
  • Maxon (Grey)
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14
Q

Non-Absorbable

A
  • Nylon (Green)
  • Prolene (Light Blue)
  • Gore-Tex (White)
  • Silk (Blue)
  • Cotton (Pink)
  • Stainless Steel → Used for Sternum
  • Ticron (Orange) → Mesh
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15
Q

Braided Sutures

A
  • Knots are more secure
  • Germs can reside inside of braids
  • Avoid vicryl (braided) if infection is present
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16
Q

Monofilament

A
  • has memory → Unravels (stretch to remove memory)
  • must tie multiple knots to hold
  • Better for infection
17
Q

Chromic Gut _____ ______ and is used in ________.

A
  • absorbs quick
  • head/neck
18
Q

Why might vicryl be appealing to gen surgery or ortho?

A
  • long healing time
19
Q

Why is prolene/silk appealing to vascular?

A
  • it keeps it’s integrity long term/over a life time
20
Q

Items to include with consent documentation

A
  • Name of healthcare facility
  • Specific name of the intervention to be performed
  • Indications for the proposed intervention
  • Name of the Health care professionals performing the intervention
  • Risks and benefits associated with the proposed intervention
  • Discussion of the risks and benefits with the patient or patient’s legal representative
  • Signature of the patient or the patient’s legal representative
  • Date and time the patient or the patient’s legal representative signed the informed consent document
  • Date, time, and the signature of the person who witnessed the patient or the patient’s legal representative signing the informed consent
21
Q

Am I responsible for obtaining the informed consent?

A
  • No. The surgeon, anesthesiologist, or other licensed practitioner obtains the informed consent.
22
Q

You may be asked to witness the patient or guardian’s signature on the informed consent …

A
  • This is only okay if you are not directly involved in the case.
23
Q

Complications of surgical bleeding

A
  • Obstruction of view of surgical field → longer operating times
  • Need for blood replacement therapy → Multiple organ failure, systemic inflammatory response syndrome, transfusion-related lung injury (TRALI), increased infection risk, increased mortality
  • Risk for hypothermia
  • Hemodilution and Acidosis
    • lactic acid forms with decreased O2 levels
    • large amounts of banked blood, acidosis can occur due to lactate production in the tissues, along with excessive IVF administration of chlorides
24
Q

Surgical hypothermia

A
  • Potential for coagulopathies
  • When core body temp nears 34°C (93.2°F), platelets begin to lose their ability aggregate; AKA hypothermic coagulopathy
  • Hypothermia alters the pharmacodynamics of anesthesia /meds, increased PACU stay, contributes to adverse myocardial outcomes.
25
Q

Methods for warming

A
  • Active
    • Forced air, conductive heating blankets
  • Passive insulation
    • Warm blankets
    • Ambient room temperature
    • Warmed IVF
26
Q

Thrombocytopenia may occur due to ____

A
  • Massive blood loss
  • After Heparin administration → HIT
27
Q

Hypovolemic shock

A
  • Decreased CO → affects gas exchange →compensation mechanisms can fail if bleed doesn’t stop → Patient death
28
Q

How to monitor I&O

A
  • Communicate amount of irrigation solution used → Subtract from suction canister
  • Place used sponges in location where the anesthesia professional can visualize them
  • Weigh sponges
29
Q

How to stop surgical bleeding

A
  • Hold pressure → with sponges
  • Electrosurgery
  • Energy generating devices
  • Suturing and ligaing
  • Turnoquets
  • Hemostatic agents and medications
  • Ligating clips
30
Q

Risks associated with energy generating devices

A
  • ignition source and the most frequent source of OR fires
31
Q

Medications for Hemostasis

A
  • Epinephrine → vasoconstriction
  • Vitamin K
  • Protamine
  • Vasopressors
32
Q

RN Circulator responsibilities rt RSI (Retained surgical items)

A
  • Ensure no open, countable items are in the room from a previous procedure
  • Verify that count boards and count sheets do not contain information from a previous procedure
  • Initiate the Count
  • View the surgical items being counted
  • Record in a visable location (count board) the counts of soft goods, sharps, misc. items, and items placed in the wound
  • Record instrument counts on preprinted count sheets
  • Report any discrepancy
  • Primary responsibility: Prevent RSI
33
Q

Scrub person responsibilities rt RSI (Retained surgical items)

A
  • Maintain organized sterile field and standardize instrument set ups
  • Perform counts in a manner that allows RN circulator to see the surgical items being counted
  • Know the location of soft goods, sharps, and instruments on the sterile field and in the wound
  • Know the character and the configuration of items used by the surgeon and first assistants
  • Speak up → for discrepancy
  • Inspect items for breakage or fragmentation before use and immediately after removal from the surgical site
  • Primary responsibiliy: accurately accounting for items used during surgical procedure
34
Q

Why are F/C always indicated for appendectomies?

A
  • To help monitor for bladder perforation
35
Q

Counts are performed when?

A
  • Before procedure
  • When adding new items
  • Before closure of a cavity within a cavity
  • When wound closure begins
  • Whenever RN/Scrub is permanently relieved
36
Q

How to document discrepancies

A
  • All actions taken to recover the missing item
  • Description and location of the item if known
  • Patient notification and consultation
  • Plan for FU care
37
Q

Document to prevent RSI

A
  • Who did the counts
  • Discrepancy? → What resolution?
  • Surgeon notification about the status of the count (if count is correct or if items are missing)
38
Q
A

OR (9 decks)

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