S3: Surgical Instruments

Question 1

Answer 1

Rhyle tube:

1. Diagnostic
   Upper GI bleeding
   Aspiration of toxic substances
2. Nutrition for dysphagia or comatose
3. Lavage
4. Decompression - hematemesis

Question 2

Rhyle tube contraindications

Answer 2

1. Cribriform palate fractues
   2. Esophageal stricture and tear
2. Comatose - aspiration pneumonia
3. Severe sinusitis

Question 3

How to cofirm rhyle tube position in stomach

Answer 3

1. Introduce air - check for borborygmi over epigastrium
2. X rays
3. Ph testing
4. Putting end of tube in water - bubbles

Question 4

Sizes of urinary catheter

Answer 4

Male (16-18)

Female (12-14)

Question 5

Types of urinary catheters

Answer 5

1. Non-dwelling (1 opening)
2. Foleys catheter (3 opening)
3. Suprapubic catheters

Question 6

3 way catheter purposes

Answer 6

1. Inflate balloon
2. Irrigate fluid
3. Staright to urine bag

Question 7

Indications for catheterisation

Answer 7

1. BPH
2. Bladder washout
3. Cystourethrogram
4. Intravesical drug (mitomycin - bladder cancer)
5. Pre and post op
6. :hypovolemic shock

Question 8

Long term usage of catheter indication

Answer 8

1. Refractory obstruction
2. Neurologic bladder
3. Incontinence

Question 9

in-dwelling catheter indication

Answer 9

1. Continuous bladder drainage
2. Surgery
3. Comatose

Question 10

Contraindications of catheterisation

Answer 10

1. Urethra injury
2. Blood from meatus
3. Scrotal hematoma
4. Pelvic fracture
5. High riding prostate
6. Infection
7. Urethral stricture

Question 11

Complications of catheterisation

Answer 11

1. Balloon inflated in urethra
2. Ascending infection - stone formation
3. Strictures and perforation

Question 12

why prepuce should be replaced after catheterisation

Answer 12

Go avoid paraphimosis (retraction and constriction of foreskin behind glans penis

Question 13

Answer 13

Chest tube / tube thoracostomy / intercostal drainage with trocar

Question 14

Indications for chest tube

Answer 14

1. Drain of hemo, pneumo, pyothorax and pleural effusion
2. Drug in pleurodesis
3. Diagnostic (cs, afb, cytology)

Question 15

Contraindications for chest tube

Answer 15

1. Infection over insertion site

2. Coagulopathy

Question 16

Complications of chet tube

Answer 16

1. Damage to neurovascular bundle
2. Puncture - hemorrage
3. Infection (empyema, pyothorax)
4. Pneumothorax
5. Bronchopulmonary fistula
6. Subcutaneous emphysema
   7, rib fracture

Question 17

Position for chest tube insertion

Answer 17

Patient at 90

Question 18

How to avoid pneumothorax in chest tube insertion

Answer 18

1. Check chest X ray

2. Exhaling when removed

Question 19

Answer 19

Sengstaken - Blackmore / meinnesota tube

Question 20

Major components of minnesota tube

Answer 20

1. Gastric balloon
2. Esophageal balloon
3. Gastric and esophageal suction port

Question 21

Indications for minnesota tube

Answer 21

1. Esophageal and fundus varices
2. Liver cirrhosis
3. Coagulopathy

Question 22

Contraindicatios for minnesota tube

Answer 22

1. Comatose
2. Esophageal stricture
3. GE junction surgery

Question 23

Complications of minnesota tube

Answer 23

1. Pressure necrosis
2. Aspiration pneumonia
3. Asphyxia
4. Rupture

Question 24

Answer 24

Sengstaken blakemore tube

Question 25

How to avoid complications when using minnesota tube

Answer 25

1. Inflate cardiac balloon - esophageal
2. Checking pressure hourly
3. Not overinflating for >6 hr - normal is <10mmHg

Question 26

Answer 26

Central venous catheter

Question 27

Routes of access for CVC

Answer 27