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Surgery and other stuff > Reading material > Flashcards

Reading material Flashcards

1
Q

What is the order in which the blood tubes should be filled?

A
  1. Blood culture
  2. Tube withOUT additives (red tubes)
  3. Tubes WITH additives
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2
Q

What are red tubes used for?

A

Chemistries, amylase, Igs

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3
Q

What are blue tops used for?

A

PT
PTT
INR

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4
Q

What are green tops used for?

A

Ammonia

CPK isozymes

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5
Q

What are purple top tubes used for?

A

CBC

ABO types

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6
Q

What are gray top tubes used for?

A

Ethanol

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7
Q

What are pink top tubes used for?

A

Cross matching

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8
Q

Which colored tube does not have any additives?

A

Red

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9
Q

True or false: you should not draw blood on the side of the body that a mastectomy was performed

A

True

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10
Q

True or false: when drawing blood on the side of an arm with an IV in place, you should draw above the IV site

A

False– I don’t know why though

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11
Q

What should you never do after cleaning a venipuncture site?

A

touch it

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12
Q

True or false: you should gently invert or shake the tubes of blood in a blood draw

A

False– NEVER shake. But the inverting bit is a good idea

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13
Q

What are the landmarks that should be palpated before doing a cricoidotomy?

A

Thyroid and cricoid cartilage (between them in the cricothyroid ligament)

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14
Q

What direction should the needle face when performing a needle cricoidotomy? When should you stop advancing the needle?

A

45 degrees inferiorly

Stop when air is aspirated into the syringe

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15
Q

How long can adequate ventilation be achieved with a needle cricothyroidotomy?

A

30-45 minutes

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16
Q

What is the age cutoff (lower bound) for surgical cricothyroidotomy?

A

12 yo

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17
Q

Central line placement for the IJV is on what side of the body? Subclavian?

A 
IJV = right side
Subclavian = left side
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18
Q

What are the landmarks used for placing a central line into the subclavian? How should the hands be placed? How should the needle be inserted?

A

Thumb on the sternal notch
Index finger on the intersection between the clavicle and the first rib. Insert needle lateral to the thumb, and beneath the clavicle.

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19
Q

What are the landmarks used for central line placement in the IJV?

A

Between the two heads of the SCM

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20
Q

What way should the tip of the J wire be inserted in an IJV central line?

A

Toward the heart

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21
Q

What must be monitored with a IJV central line placement? Why?

A

EKG for arrhythmias

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22
Q

What is the minimal amount of blood that can be seen on a CXR for a hemothorax?

A

300-500 ml

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23
Q

What should you do if draining more than 1500 ml of blood from a chest tube?

A

Get to OR for thoracotomy to control bleeding

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24
Q

What are the ribs that are used for landmarks for a chest tube placement with a pneumothorax? Where?

A

3 4 or 5 intercostal space along the anterior axillary line

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25
Q

Which intercostal spaces are used for chest tube placement with a hemothorax?

A

3 4 or 5 along the posterior or midaxillary line

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26
Q

What is the position the pt should be placed in for a chest tube placement?

A

arm over head

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27
Q

What is the area relative to the rib where you should place the chest tube?

A

On top of the lower rib in the intercostal space to prevent hitting the intercostal arteries/nerves that lie below the ribs

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28
Q

What is the tool used to make the puncture for a chest tube?

A

Hemostat (after making an incision with a scalpel)

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29
Q

Which way should a chest tube be inserted toward for a hemothorax? Pneumothorax?

A 
Hemo = down
Pneumo = up
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30
Q

Widening of the mediastinum following a chest tube placement may indicate what?

A

Thoracic aorta dissection

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31
Q

What is tidaling with chest tube placement?

A

Movement of the ball in the pleurivac

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32
Q

True or false: except for checking for leaks, a chest tube should never be clamped off

A

True

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33
Q

What should be done with a pneumo and hemothorax concurrently?

A

Chtes tubes place anterior and posterolaterally

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34
Q

What indicated that a chest tube was successful?

A

No more tidaling

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35
Q

What is a laproscopic surgery?

A

Small tools + CO2 inflated peritoneum

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36
Q

What are the spaces that an LP should be performed at?

A

L4-L5

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37
Q

Which way should the needle be driven in a LP?

A

toward the naval

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38
Q

What is the only position in which you are able to get an opening pressure with a LP?

A

Lateral recumbent

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39
Q

Why should you never introduce negative pressure with a LP?

A

will cause hemorrhage

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40
Q

What are the first three tubes that are used in the collection of CSF (in order)?

A
  1. cell count and differential
  2. Gram stain cultures
  3. Glucose, protein,
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41
Q

What happens if you get a bloody tap?

A

May have hit the venous plexus, which will stop after you draw more

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42
Q

Name the mallampati score: clear visualization of the faucial pillar, soft palate, and uvula

A

I

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43
Q

Name the mallampati score: The uvula is masked by the tongue, but o/w clear visualization of the facial pillars and soft palate

A

II

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44
Q

Name the mallampati score: Only the soft palate is visualized

A

III

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45
Q

Name the mallampati score: Only the hard palate is visualized

A

IV

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46
Q

Why should you not rock the laryngoscope?

A

Will break teeth

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47
Q

Is it every okay to let go of the ET tube?

A

No

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48
Q

Each time the patient is moved with a ETT in, what is the chance that it will dislodge?

A

10-15%

49
Q

What is the Selleck manuver?

A

Applying pressure to the cricoid cartilage during an intubation

50
Q

Should you try to intubate through a glottis that is closed d/t a laryngeal spasm?

A

Never

51
Q

What are the four regions assessed during a FAST exam?

A
  1. Pericardial (Pericardial effusion)
  2. RUQ (spleen)
  3. LUQ (kidneys)
  4. Pelvic (pouch of douglas)
52
Q

Hyperechoic appears what color on the screen? Hypoechoic?

A 
Hyper = white
Hypo = black
53
Q

What does red flow indicate? Blue?

A 
Red = toward you
Blue = away from you
54
Q

What is the size of the urinary catheter that should be used for adults? What if they have gross hematuria?

A

16-18 french

22-24 for patients with gross hematuria

55
Q

What is the only absolute contraindication for urinary catheterization?

A

Trauma to the urethra (e.g. pelvic fracture)

56
Q

When are triple lumen catheters used?

A

For patients with clots or obstruction

57
Q

What way should the penis be held when doing a cath?

A

Perpendicular to the body

58
Q

What should you do prior to inflating the foley cath balloon?

A

Check for urine return

59
Q

Name two relative contraindications for urethral catheterization (3 are given)

A

Urethral stricture
Recent urethral/bladder surgery
Combative patient

60
Q

Name two contraindications to performing an LP.

A 
Cardiorespiratory compromise
Cerebral herniation
Focal neurological signs
Bleeding diathesis
Previous lumbar surgery
61
Q

What gauge needle is usually used for an LP?

A

20-22

62
Q

What should you do first if there is no flow from an LP?

A

Rotate the needle 90 degrees, since a nerve rootlet may be obstructing the flow

63
Q

What should you do if there is blood in an LP needle?

A

get a new needle and enter a new interspace, since you do not want it to clog

64
Q

Over what mmH2O is concerning in a spinal tap

A

20

65
Q

Why should you never aspirate a LP?

A

May cause a herniation

66
Q

What is the size of the triple lumen catheter that should be used for central lines? What about for fluid resuscitation?

A

7 french

11.5 if resuscitation

67
Q

What are the contraindications to tracheal intubation?

A 
Trauma
Burns
Tumor
Edema
Infection
68
Q

What does gauge measure? What does a high gauge needle mean?

A

Measures the diameter of a needle.

Larger gauge means smaller needle size

69
Q

What does bore size indicate?

A

size of the lumen (inside diameter)

70
Q

What are the three layers of a vessel, and what is the important part of each?

A

Outer layer = tunica adventitia (supporting vasculature)
Middle layer = tunica media (muscular layer)
Inner layer = tunica intima (elastic layer)

71
Q

How often should peripheral IV catheters be changed?

A

every 72 hours

72
Q

When is it appropriate to give D5W to a patient IV?

A

Never– will raise glucose levels too fast, and cause osmotic diuresis

73
Q

What type of fluids do you want to use when replacing volume: hypotonic, isotonic, or hypertonic

A

isotonic

74
Q

What are the electrolyte concentrations in NS? pH?

A

154 Na and Cl

pH is 4-5

75
Q

What are the electrolyte concentrations in LR? pH?

A

130 Na
110 Cl
4 K
100 H2O

7ish pH

76
Q

What are the electrolyte concentrations in D5W? D10W?

A 
D5 = 50 gm glucose
D10 = 100 gm glucose

both have 1000 ml of water

77
Q

What are the electrolyte concentrations in 3% NS?

A

513 Na

513 Cl

78
Q

What is the rule for choosing an IV rate per hour?

A

4 ml/kg for first 10 kg
2 ml/kg for next 10 kg
1 ml/kg for each kg thereafter

79
Q

What is the angle of the injection that should be done with SQ administration of a drug? IM?

A 
SQ = 45 degrees
IM = 90 degrees
80
Q

What are the sites of injection of IM meds?

A

Anterior/posterior forearms, tricep area, chest, or shoulder blade area

81
Q

What is the preferred site of injection for heparin?

A

Lower abdominal fat pad, beneath the umbilicus

82
Q

Under what age should the dorsogluteal muscle not be used?

A

3 years of age

83
Q

When injecting into the gluteal area, how do you ensure that you are in the correct area?

A

Place hand so that the 2nd finger is on the ASIS, and spread your fingers. Inject between the space formed by digits 2 and 3.

84
Q

What is meant by the “Z” track injection?

A

Pulling the skin back when injecting, thus creating a non-linear path for blood to flow out when the needle is removed and the skin released

85
Q

What are the indications for an NG tube? Contraindications?

A

Acute gastric dilatation/distention
Gastric outlet obstruction
Ileus

Contraindications:

  • recent esophageal surgery
  • absence of gag reflex
  • facial or nasal trauma
86
Q

True or false: esophageal varices are a contraindication to placing an NG tube

A

False

87
Q

What are the indications for a needle cricothyroidotomy?

A

Complete airway obstruction

Trauma to the face

88
Q

What are the two complications of a needle or surgical cricothyroidotomy?

A

Asphyxia

Aspiration

89
Q

What are the two contraindications to a surgical cricothyroidotomy?

A

Children under 12

There is a less radical means of establishing an airway

90
Q

What are the indications for a central line placement?

A

TPN

Long term infusion of drugs

91
Q

What are the contraindications for a central line placement?

A

Morbidly obese
Infection over insertion site
Pneumo/hemothorax on the ipsilateral side

92
Q

What are the two pre-procedure bits prior to doing a central line placement?

A

Consent and timeout

93
Q

What is the position the patient should be placed in for a central line placement?

A

Trendelenburg

94
Q

What gauge needle should be used when performing a subclavian or IJV central line placement?

A

18

95
Q

In what order should the scalpel, dilator, J wire, 18 gauge needle, and catheter be introduced in a central line placement?

A 
Needle/catheter
J wire
scalpel
dilator
Central catheter
96
Q

What should you do after placing a central line?

A

Check all ports for blood return

97
Q

What size tube should be used for pneumothorax in a child/adult? Hemo?

A

Pneumo: 22ish or 11ish
Hemo: 22 ish or 15ish

98
Q

True or false: when suturing, you should always select the smallest diameter suture that can adequately hold the tissue edges together.

A

true

99
Q

What size of suture should be used for regular skin closures?

A

3-0, 4-0, or 5-0

100
Q

What size of suture should be used for skin closure on the face?

A

5-0 or 6-0

101
Q

What size of suture should be used on abdominal fascia closure?

A

2 or 0

102
Q

What are the two types of points to a suture needle?

A

taper point

Cutting point

103
Q

What is a #10 blade used for? #11? #12? #15? #20?

A 
#10 - large incisions
#11 - stabs
#12 - ENT/GYN
#15 - small incision
#20 -Digit amputations
104
Q

What is the universal size for catheters?

A

16 french

105
Q

When do indwelling catheters need to be changed?

A

Every 72 hours

106
Q

What should you note in the medical record for a urine cath placement? (6)

A 
Indication
Size/type
Fluid injected
Urine output
Your name
Complications
107
Q

What drug needs to be in the syringe when doing an ABG?

A

heparin

108
Q

What are the pertinent findings in an ABG? (6)

A 
pH
PaCO2
PaO2
HCO3
O2
BE
109
Q

Are you oxygenating the patient, or ventilating them when performing a cricothyrotomy?

A

Oxygenating them

110
Q

In a needle cricothyroidotomy, what type of needle should be used?

A

12 or #14

111
Q

In a needle cricothyroidotomy, how many seconds do you oxygenate the patient by the tubing?

A

Occlude 1 second and release for 4

112
Q

How long can chest tubes stay in?

A

24-48 hours

113
Q

How can you check for air leaks in a chest tube?

A

Look at water seal chamber and if bubbles present = air leak

114
Q

When do you see tidaling with a chest tube placement?

A

When pleuravac is taken off suction; fluid in chamber should move with respiration and ventilation

115
Q

When should you obtain x-rays with a chest tube placement?

A

Beforehand, after insertion, serial during stay, and after pull out

116
Q

What is the purpose of undermining tissue?

A

Undermining = separation of superficial tissues (epidermis/dermis) from deeper tissues (SC tissue) in order to achieve better tissue approximation during suturing

117
Q

What is the most common cause of post-op fever? treatment?

A

Atelectasis

Spirometry

118
Q

What are the 5 W’s of post surgical infection?

A 
Wind (atelectasis)
Water (UTIs)
Walking (DVTs)
Wounds (duh)
Wonder drugs (rxn)
119
Q

What is the daily requirement for K?

A

40-100 mEq

Surgery and other stuff (25 decks)

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