Procedures Flashcards
How to prioritise lists
Following adds priority:
- Clinical priority
- diabetes
- latex allergy
- paeds
Following should be last:
- Infection (MRSA or c dif)
Where are procedures under local anaesthetic prioritised
Varies
Either first or last to avoid the anaesthetist having to stick around
or
Middle to give anaesthetist a break
NCEPOD criteria
National clinical enquiry into patient outcome and death
1a. immediate
- life or limb threatening
- Ruptured AAA, spleen
1b. <6hrs
- life threatening but not immediate
- ischaemic bowel
- large bowel
- Urgent <24hrs
- appendicitis - Expedited <7d
- deterioration of elective condition
- acute cholecystectomy - Scheduled
Periop hyperglycaemia mx
- pt should be prioritised
- should not miss more than one meal
- sliding scale if insulin dependent or expected to miss more than one meal
- hourly BM monitoring 4-12
Difference between monopolar and bipolar
Monopolar: current passes between electrode and plate. Heat is transferred over a large surface area
Bipolar: current is transferred between two electrode tips
What complications are COPD patients at risk of post op
7 fold increase in complications such as:
- atelectasis
- pneumonia
- resp failure
What to use in pt with iodine allergy
chlorhexadine antiseptic
Colostomy preparations
- Stoma site marked
- within rectus abdominis below belt line
- avoid skin creases, previous scars
- stoma nurse review
When is vicryl absorbed
55-70 days
How long does its tensile strength last
2-3wks
How to protect tissue whilst tying at depth
- ensure lighting
- retraction of tissues out of the way
- controlled descend of the knot
FNA procedure
- needle on syringe
- clean skin
- stab and aspirate 2-4 times
- add a small sample in the green part of the needle on to slide
- add another slide at 90 angle and smear it across
- air dry one slide
- fixing agent on another
- place the rest in a pot
What is vicryl made off
polyglactin
How long before removing sutures from
- face
- scalp
- limb
- back
face: 3-5
scalp: 5-7
limb: 7-10
back: 10-14
Post op instructions for suturing wounds
- To seek medical advice if any temp, felt unwell, discharge, redness
- Give abx if dirty wound (if delayed presentation, multiple doses)
- Home on simple analgesia
Mech of action of xylocaine (lidocaine 1%)
Na channel depolarising blocker
What to give if allergic to xylocaine
bupivacaine
Removal of naevus step by step
- ensure 2mm margins either side
- draw lines either side and times it by 3
- V shaped excision either side
- close from the edges slowly towards the centre
Post op instructions for naevus skin removal
- post op analgesia
- RFs to seek medical advice
- Once the histology results available, MDT, followed by clinic appointment for discussion
What are langers lines
natural orientation of collagen fibres in dermis, generally parallel to muscle fibres underneath
Catheterisation
- WIPER: check allergies to latex
- Non-sterile gloves, clean the penis and foreskin
- sterile gloves
- drape
- slowly feed through
- inflate balloon
- pull
- document volume
- send sample for MC&S
How to insert a chest drain
- WIPER
position: supine, hand behind head exposing axilla - anaesthesia:
- local, first superficial, then deep - Incision:
parallel to superior aspect of the rib - procedure
insert haemostat and dissect the tissue, before entering the pleural cavity - insert the tube apically if pneumothorax, basally if haemothorax
- fogging of the drain indicates its in the right place
- suture in place
- attach to under water seal
- post procedure bubbling + CXR
Thoracotomy indications
- > 1.5 l on insertion or >200ml /hr for 2hrs
- persistant pneumothorax despite drainage
Rate of HIV/Hep B/Hep C transmission post needle stick
0.3% in HIV +
Hep B 30% (vaccine is 90-95% effective)
Hep C 1.8%
