Practice and Principles of Surgery Flashcards
What are elective operations?
the operation has been planned in advance and may or may not be medically required (i.e. surgical removal of wisdom teeth or breast enhancement)
What are emergency operations? examples?
Surgery is required medically and the operation has not been previously planned or when an elective procedure has to be expedited
ex. life or limb saving operations.
What does the choice of anesthesia (type of) depend on?
Procedure and patient dependant.
What 2 modalities can be used to perform surgery on the abdominal cavity?
- Open
- Laparoscopic.
What does open abdominal surgery involve?
- Use of a scalpel to make an incision/ wound to enter the abdominal cavity.
What does laparoscopic abdominal surgery involve? 2 advantages?
- Uses small incisions/pores to insert camera into the abdomen and visualize it.
- Advantages: less trauma to abdominal wall, shorter recovery time.
What does NCEPOD stand for?
National Confidential Enquire into Patient Outcome and Death
Why was NCEPOD developed and what does it do?
- Developed to reduce mortality in patients requiring emergency surgery.
- allows senior staff to expedite unwell patients regarding the urgency of surgery/ CLASSIFY PATIENTS IN EMERGENCY BASIS INTO WHO NEEDS TO GO TO THEATER MOST URGENTLY.
What are the four time frames for NCEPOD?
- Immediate
- Urgent
- Expedited
- Elective
What is classified as an IMMEDIATE NCEPOD surgery? How soon is it done?
- life saving.
- limb or organ saving.
- within minutes.
What is classified as an URGENT NCEPOD surgery? How soon is it done?
– Intervention for acute onset or clinical deterioration of potentially life-threatening conditions, for those conditions that may threaten the survival of limb or organ, for fixation of many fractures and for relief of pain or other distressing symptoms.
- within hours.
What is classified as an EXPEDITED NCEPOD surgery? How soon is it done?
Patient requiring early treatment where the condition is not an immediate threat to life, limb or organ survival.
normally within days.
What is classified as an ELECTIVE NCEPOD surgery? How soon is it done?
– Intervention planned or booked in advance of routine admission to hospital.
- timing to suit patient, hospital and staff.
What are physicians associates?
Have a science background/ allied healthcare professional background and have undergone a further degree - CAN DO THE SAME JOBS AS FOUNDATION DOCTORS BUT CANNOT PRESCRIBE DRUGS.
What are foundation doctors?
Doctors that have been qualified for 1-2 years and are in a post-graduate training scheme.
What are specialty trainees (StR)?
Doctors in specialty training to become a consultant.
What are specialty doctors?
Doctors who are experienced but have NOT undergone specialty training to consultant level.
What are consultants?
Doctors who have undergone the FULL specialty training - NHS SPECIALISTS.
What is handover?
Patients are discussed with other team members and handed to an oncoming team of doctors.
DONE AT EVERY WARD ROUND/ SHIFT CHANGE OVERS (BEGINNING AND ENDING OF SHIFT).
What are the 2 ward rounds done in surgery throughout the day called?
Thorough ward round.
Catchup ward round.
What is documented in the notes after a ward round?
Ward round date and time.
Whats is NEWS? What does it include?
National Early Warning System.
- Easy documentation of vital signs (pulse rate, respiratory rate, heart rate, oxygen saturation, blood pressure, neurological status and blood glucose levels).
What are the functions of NEWS (3)?
- Records patient vital signs.
- Allows identification of ill patients.
- Integrates escalation system based on the score.
What does a high NEWS score mean?
Higher score indicates a more urgent review my medical staff.
What is SBAR (give detail).
- Situation: Why are you calling? Highlight main concern/ urgency.
- Background: HPC or admission.
- Assessment: What clinical examination and relevant investigations have shown.
- Recommendation: State what you want to happen as a result of the phone call.
When is SBAR used?
- Acute care scenario.
- For admission or specialty referral.
What are 5 things to be included in a referral letter?
- Practice details.
- Patient details (name, address, phone number).
- Clinical history, medical history (including allergies), social history.
- Referrer FULL NAME + ROLE (ex. dentist?) + number.
- REFERRAL CATEGORY.
What patient details must be included in referral letter?
Name, address, CONTACT DETAILS (mobile number).
What are the 8 steps of the patient pathway?
Attend GMP or GDP
GMP/GDP referral to appropriate speciality
Attend for OPD (outpatient department) appointment ± additional investigations (X-rays, CT, MRI, bloods)
Elective surgery date proposed
Attend for surgery and consented
Undergo surgery
Discharge
OPD follow up review or review with GMP/GDP
what is pre-operative care?
Care given to patient before having the operation.
What is peri-operative care?
When patients are under anesthetic getting their operation.
What is post-operative care?
Recovery period.
What does a medical clerk in include? (4).
- Appropriate bloods.
- Blood gases.
- X rays.
- Scans (CT/ USS).
When is a medical clerk in performed?
All elective admissions.
(emergency situations may not be possible if life/ limb emergency).
When is patient clerking done?
May be done by anesthetists at OPD and reviewed at surgery ward or done in surgery ward.
If emergency, may only be able to get PMH, allergies etc (necessary info).
What does patient clerking include?
- HPC, PMH, PDH, FH + Physical examination (cardio, resp, neuro, gastro, confusion + ALLERGIES).
What is 2 types of medication that must be stopped before GA?
ACE inhibitors or other antihypertensives
Anticoagulants.
What is the aim of preoperative care?
Provide diagnostic and prognostic information whilst preventing morbidity or mortality.
What are 3 medical conditions important for GA?
- Family history of malignant hyperthermia.
- Sickle cell disease
- History of porhyria.
What can induce porphyria? What happens?
Anaesthetic agents and antibiotics.
Cause a neurovisceral crisis.
What are previous risk factors for DVT (8)?
Previous DVT, oral contraceptive pill, hormone replacement therapy, active malignancy, obesity, immobility, recent surgery, thrombophilia.
When is an ECG done in prep for surgery?
- known cardiovascular disease.
- patients over the age of 50 (sometimes 40).
When is a chest x-ray done in prep for surgery?
- known respiratory or cardiovascular disease.
- age over 65 years.
What must be prescribed to a patient fasting/ unable to take oral intake normally?
Maintenance/ fasting fluids.
What do maintenance fluids aim to cover?
- Normal intake
- Normal losses
- Insensible losses
What are normal fluid losses?
0.5ml/kg/hour.
What is the recommended maintenance fluid therapy?
0.18% Saline with 4% dextrose ± K+(20-40 mmol/l) based on 1ml/Kg/hour.
What ABCDE stand for?
Airway, breathing, circulation, disability, Everything else.
What must be done if an airway is blocked?
- Airway maneuvres: head tilt chin lift, jaw thrust.
- Airway adjuncts: gaudal airway, nasopharyngeal airway, intubation.
- OXYGEN.
What is checked at the B of ABCDE?
- RR: 12/20 breaths/min.
- SpO2: 96% and above.
- Chest expansion and sound.
- Adjuncts: chest x-ray, blood gas sample.
- OXYGEN.
What is checked at C of ABCDE?
- Heart rate: 60-100 bpm.
- Blood pressure: 120/70.
- CRP: within 2 seconds.
- heart sounds, ECG.
IV ACCESS, IV FLUIDS, TAKE BLOODS, URINE CATHETER.
What is checked at D of ABCDE?
- ACVPU scale.
- Check blood glucose (less than 4mmol = hypoglycemia).
What is checked at E of ABCDE?
Expose and everything else.
- take temperature.
When can someone consent a patient to treatment?
ONLY consent when you can perform the procedure yourself either independently or under direct supervision of a competent clinician.
What are anticoagulants replaced with when stopped for surgery?
Low molecular weight heparin.
