Surgery Flashcards
What should be assessed when looking at a patients airway in the ABCDE approach?
Look: Signs of obvious airway obstruction e.g. vomit, Chest wall excursion, See-saw breathing
Feel: Breath
Listen: Stridor, Gurgling
What can be done to treat if a patient is having a problem with their airway?
Head tilt and chin lift
Jaw thrust
Adjuncts: Guedel airway, Nasopharyngeal airway, Laryngeal mask airway
Definitive airway
What is the definition of a definitive airway?
Requires a tube present in trachea with cuff inflated, tube connected to some form of oxygen enriched assisted ventilation and airway secured with tape
What are the different types of definitive airway?
Endotracheal (ET) tube Nasotracheal tube Surgical airway (tracheostomy or cricothyroidotomy)
What can you look for to assess a patient’s breathing?
Central/peripheral cyanosis Chest wall deformity Abnormal chest expansion: Asymmetry, Flail, See-saw breathing Tracheal tug Accessory muscle usage
What can you feel for to assess a patient’s breathing?
Asymmetric chest expansion
Deviated trachea
Displaced apex beat
Percussion
What can you listen for to assess a patient’s breathing?
Auscultation: Absent breath sounds, Crackles, Wheeze
What can you measure to assess a patient’s breathing?
Respiratory rate
O2 saturations
ABG
CXR
What can you measure to assess a patient’s circulation?
Heart rate Capillary refill Blood pressure Temperature Urine output: 0.5 ml/kg/hr
What are the different types of shock?
Hypovolaemic
Cardiogenic
Distributive: anaphylactic, septic, neurogenic
Obstructive
What are signs of hypovolaemic shock?
Tachycardia
Tachypnoea
Cool peripheries
Altered mental state
Why should you not use BP as a measure of hypovolaemic shock?
BP is a reasonably late change so look for urine output/HR changes first. Can have lost 2L blood before any change
What is the difference between neurogenic and spinal shock?
Neurogenic: lose sympathetic tone
Spinal: temporary spinal paralysis
What is the SIRS criteria?
2 or more of the following: HR: 90 or above RR: over 20 or PaCO2< 4.3kPa Temp: below 36 or above 38 WCC: <4x109 cells/L OR >12x109 cells/L OR >10% immature neutrophils
What is lactic acid and what is it an effective measure of?
Formed when glucose is broken down, then oxidised to pyruvate
Reduces NADH to NAD+, which enables respiration to continue
When cells are in a hypoxic state, they are forced to metabolise glucose anaerobically. Leads to a build up of lactic acid
Good indicator of tissue perfusion/hypoxia
What is the enhanced recovery after surgery strategy?
Combination of evidence-based peri-operative strategies which work synergistically to expedite recover after surgery
What are pre operative recommendations for enhanced recovery after surgery?
Pre op counselling and training
Curtailed fast: 6h solids, 2h clear liquids, pre op carb loading
Avoidance of mechanical bowel prep
DVT prophylaxis using LMWH
Single dose of prophylactic abx covering aerobic and anaerobic pathogens
What are peri-operative recommendations for enhanced recovery after surgery?
High (80%) oxygen concentration in peri operative period
Prevention of hypothermia
Goal directed intra operative fluid therapy
Preferable use of short and transverse incisions for open surgery
Avoidance of post op drains and NG tubes
Short duration of epidural analgesia and local blocks
What are post operative recommendations for enhanced recovery after surgery?
Avoidance of opiates, use of paracetamol and NDSAIDs
Early commencement of post op diet
Early and structured post op mobilisation
Administration of restricted amounts of IV fluid
Regular audit
What factors are on the surgical safety checklist when patient signs in?
Patient confirms identity, site, procedure, consent
Site marked
Anaesthesia safety check completed
Pulse oximeter on patient and functioning
Allergies?
Airway/aspiration risk?
Risk of over 500ml blood loss? (7ml/kg in child)
What factors are on the surgical safety checklist before any skin incision?
Confirm all team members have introduced themselves by name and role
Surgeon, anaesthetist and nurse verbally confirm patient, site and procedure
Anticipated critical surgical events: operative duration, expected blood loss
Anticipated critical anaesthetic events: patient specific concerns
Anticipated critical nursing events: sterility confirmed, equipment issues
Abx prophylaxis been given in last 60 mins?
Is essential imaging displayed?
What factors are on the surgical safety checklist when patient signs out?
Nurse verbally confirms: procedure, instrument needle and sponge counts are correct, how specimens are labelled, whether there are any equipment problems to be addressed
Surgeon, anaesthetist and nurse review key concerns for recovery and management of this patient
What details should be included on a surgical consent form?
Procedure, side, location (joint)
How should limb marking for surgery be carried out?
Clear arrow
Indelible ink
Not at site of incision