Oral topics Flashcards
List the periods of the history of surgery! What were the milestones!
3 periods
I. From the primeval times until the middle of the 19th century
*Only removal of injured parts was used
II. From the discovery of narcosis (16.10.1846) until the 1960s
* Included not only removal of the injured parts, but also their reconstruction
* The milestone was the initiation and application of the principles of
asepsis and antisepsis, discovery of blood groups and the development of intensive therapy
III. Lasted from the 1960s until today
* The development of instruments, natural science, researchers, as well as technical development
When was the “Ether Day”? Who did and what on this day?
On October 16. 1846 Dr. William T. G. Morton anesthetized a patient with ethyl ether for
the first time
When and by whom was the chlorinated lime hand-‐washing introduced? What were his
findings?
Ignaz Semmelweis 1847
Doctors went from autopsy to child-delivery, maternal mortality went from 30%→1%
Who created the “antiseptic theory”?
Joseph Lister
Who introduced the “antiseptic theory” in hungarian surgery?
Hümer Hütl
(note that Marius and Stine were wrong on this answer! Check the department book and you can find it. However, this question on the topic list has now changed to not include “in hungarian surgery,” so it’s not totally clear)
Name 4 surgical instruments which refer to doctors involved in the development of
surgery!
- Kocher clamp
- Lumnitzer clamp
- Hagar needle holder
- Péan clamp
What does the acronym “NOTES” mean?
NOTES
Natural Orifice Transluminal Endoscopic Surgery
What is the definition of surgical intervention?
A procedure performed on a living body usually with instruments for the repair of damage or the restoration of health and especially one that involves incision, excision, or suturing
What do the septic and aseptic operating theatres stand for?
In the septic operating room the infected parts of the body are operated (e.g. purulent wounds, gangrenes)
In the aseptic operating rooms the danger of bacterial infection does not usually exist (e.g. varicectomy)
(There is no need to build the aseptic operating room in a separate area; the two different types can even share a common corridor)
How shall the staff and the patient enter the operating room?
Before entering into the operating room you should change your clothes in the locker
room and wear the surgical cap and the face mask
Following this, you can enter into the surgical territory
The patients are brought into the operating room after passing through a separate locker
room
Describe the structure of the operating room!
The operating room is 50-70 m2 , and does usually not have any windows
It is lighted and its walls are covered with light-colored tiles up to the ceiling
There is artificial ventilation and air-conditioning
The operating complex must be architecturally separated from the wards and the intensive care unit, but should be in the vicinity of the ICU
The complex consists of:
- Locker rooms
- Scrub-‐up area
- Preparing rooms
- Operating theatres
The walls and floor of the operating room have no gaps, so they can be cleaned easily (antiseptic gap-‐free floors)
The doors are automatic, and the rooms are equipped with central and portable vacuum systems, as well as pipes for gases
Main layout:
Operating lamp, operating table, Sonnenburg’s table, supplementary instrument stand, kickbucket, suction apparatus, diathermy, microwave oven, portable X-ray, anesthesia machine, and other instruments required during anesthesia
The central supply of electricity is automatically connected to batteries
List 8 equipments /instruments within the operating room!
Operating lamp, operating table, Sonnenburg’s table, supplementary instrument stand,
kick bucket, suction apparatus, diathermy, microwave oven, portable X-ray, anesthesia
machine, and other instruments required during anesthesia
Explain the rules of behaviour in the operating room!
1) Only those people whose presence is absolutely necessary should stay in the OR
2) Activity causing superfluous air flow (talking, laughter, or walking around) should be avoided
3) Entry into the OR is allowed only in operating room outfit and shoes worn exclusively in the OR
a. This complete change to the clothes used in the OR should also apply for the patient placed in the holding area (i.e. locker room)
4) Leaving the OR in surgical outfit is forbidden
5) The doors of the OR must be closed
6) Movement into the OR out of the holding area (locker room) is allowed only in a cap and mask covering the hair, mouth, and nose
Describe the general rules of the aseptic operating room!
Only sterile instruments can be used to perform a sterile operation
Only Sterile personnel can handle sterile equipment
Instruments which are located below the waist arenot considered sterile
If a sterile instrument comes in contact with aninstrument of doubtful sterility, it will lose its sterility
The edges of boxes and pots can not be considered sterile
A surgical area can never be considered sterile
However, the applications of aseptic rules of operations are mandatory
Explain the definition of asepsis!
Includes all the procedures, activities and behaviors designed to keep away the microorganisms from the patient’s body and the surgical wound
In other words, the purpose of asepsis is to prevent contamination (maintain sterility)
In a wider sense, asepsis means such an ideal state when the instruments, the skin, and the surgical territory do not contain microorganisms (prevention)
Explain the definition of antisepsis!
Includes all those procedures and techniques designed to eliminate contamination (bacterial, viral, fungal) present on objects and skin by means of sterilization and disinfection
Because skin surfaces and so the operating field and the surgeon’s hands cannot be considered sterile, in these cases we do not talk about superficial sterilization
In a wider sense, antisepsis includes all those prophylactic procedures designed to ensure surgical asepsis (treatment)
How to prevent the evolution of postoperative wound infections before the surgery?
Careful scrub and preparation of the operative site (cleansing and removal of hair) is necessary
Wearing sterile clothes in the OR
Knowledge and control of risk factors (e.g. normalization of the serum glucose level in case of diabetes mellitus)
In septic and high-‐risk patients: perioperative antibiotic prophylaxis
How to prevent the evolution of postoperative wound infections during the surgery?
Appropriate surgical techniques must be applied
Change of gloves and rescrub if necessary
Optimize body temperature of the patient
Narcosis may worsen thermoregulation
Hypothermia and general anesthesiabothinduce vasodilation, and thus the core temperature will decrease
The oxygen tension must be maintained
How to prevent the evolution of postoperative wound infections after the surgery?
Wound infection generally evolves shortly (within 2 hours) after contamination
Hand washing is mandatory and the use of sterile gloves is compulsory while handling wound dressings and changing bandages during postoperative care
What is the definition of sterilization!
To sterilize means to kill all microorganisms and spores to create a germ-‐free environment
Methods:
o Autoclave (steam with high pressure)
o Gas sterilization with ethylene-‐dioxide
o Cold sterilization with sprecide chemicals
o Gamma and electron radiation
o Plasma sterilization (low temperature
hydrogenperoxidegasplasma - effect of free radicals)
What is the definition of disinfection!
The aim is to decrease the number of or inactivate live microbes
Methods:
o Low temperature steam
o Chemical disinfectants (phenol, chloride containing compounds, alcohols)
Surgical hand-scrubbing is considered a disinfectingprocedure.
Explain the steps of the two-‐phase surgical hand scrub!
1st Phase: Mechanical cleansing
o Wash the hands and forearms thoroughly with soap and warm water
o The first phase has no time limit, only until we are satisfied
o Make sure to wash off all the soap, the disinfectant used in phase two is not
supposed to foam, so if during phase 2 foam appears on your hands, you have not
washed properly in phase 1 and will lose points
o Use tissue paper to dry carefully
2nd phase: Disinfectant phase o Disinfectant hand scrub should be rubbed on your hands 5 x 1 min o The disinfectant area should extend to the elbow and get shorter and shorter for each scrub 1st time: Whole forearm 2nd time: 2/3 of the forearm 3rd time: 1/2 of the forearm 4th time: 1/3 of the forearm 5th time: only hands and wrists
What is the purpose of isolation? How do we do it?
After skin preparation the operating area must be isolated from the non-‐disinfected skin surfaces, and body areas by application of sterile linen textile or sterile water proof paper drapes
The main aim is to prevent contamination from the patients skin
It is generally done with the help of 4 pieces
The scrub nurse and the assistant use a special specially folded first, big sheet to isolate the patient’s legs
The second, horizontal sheet is used to isolate thehead, and is fixed to the guard
Placement of the two sided sheets then follows
The isolated area is always smaller than thescrubbed area
4 Backhaus towel clips will fix the isolating sheets
List the basic surgical instrument groups!
- Cutting and dissecting instruments
- Grasping, clamping and occluding instruments
- Hemostatic instruments
- Refracting and exposing instruments
- Wound-‐closing instruments and material
- Special instruments
