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General Surgery > Surgical Care > Flashcards

Surgical Care Flashcards

1
Q

What is a surgical site infection?

A

An infection that occurs in the incision created by an invasive surgical procedure

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2
Q

There are 4 main types of surgery depending on cleanliness. What are they?

A
  • Clean
  • Clean contaminated
  • Contaminated
  • Dirty
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3
Q

What is a clean surgery? Give some examples

A
  • incision in which no inflammation is encountered in a surgical procedure,
  • no break in sterile technique
  • respiratory, alimentary and genitourinary tracts are not entered.
  • Hernia repair
  • mastectomy
  • AAA
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4
Q

What is clean-contaminated surgery? List some examples

A
  • incision through which the respiratory, alimentary or genitourinary tract is entered
  • Cholecystectomy
  • Appendectomy
  • Bowel resection
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5
Q

What is a contaminated surgery? List some examples

A
  • incision undertaken during an operation in which there is a major break in sterile technique
  • gross spillage from the gastrointestinal tract
  • acute, non-purulent inflammation is encountered.
  • Open traumatic wounds that are more than 12–24 hours
  • Chole c bile spillage
  • Appendectomy of perforated appendix
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6
Q

What is a dirty surgery? List some examples

A
  • incision undertaken during an operation in which the viscera are perforated
  • acute inflammation with pus is encountered
  • Abscess drainage
  • Debridement of necrotising soft tissue
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7
Q

What are the RF (patient factors) for SSI?

A
  • extreme age
  • poor nutritional status
  • DM
  • RF
  • Immunosuppresed
  • Smoker
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8
Q

What are the RF (operation factors) for SSI?

A
  • Length of operation
  • preoperative shave
  • foreign material in surgical site
  • surgical drain insertion
  • poor wound closure
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9
Q

How many days post op does SSI typically appear?

A

5-7 days

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10
Q

What are the clinical features of SSI?

A
  • spreading erythema
  • localised pain
  • pus discharge
  • wound dehiscence
  • persistent pyrexia
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11
Q

What Ix would you perform for SSI

A

Bedside

  • wound swabs
  • blood test - inflammatory markers
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12
Q

How would you mx SSI?

A
  • Remove sutures or clips - allow drainage
  • Empirical abx
    *
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13
Q

There are 3 phases of preventing SSI. What would you do in the preoperative phase?

A
  • Prophylactic abx
  • Shower before surgery
  • Encourage weightloss and optimise nutrition
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14
Q

There are 3 phases of preventing SSI. What would you do in the intraoperative phase?

A
  • Apply povidone-iodine or chlorhexidine on skin at surgical site
  • change gloves or gown if contaminated
  • Use interactive dressing at end of operation
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15
Q

There are 3 phases of preventing SSI. What would you do in the postoperative phase?

A
  • Monitor wounds closely
  • Refer to tissue viability nurse for advice on wound dressing
  • Topical abx
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16
Q

What is Necrotising Fasciitis?

A
  • Infection of soft tissue and fascia
17
Q

What is the Px of NF?

A
  1. Infection starts at superficial fascia
  2. Organism release enzymes and proteins causing necrosis of fascial layer
  3. Infection spreads vertically up to skin and down to deeper tissue
  4. Thrombosis occludes arteries and veins
  5. Ischaemia > necrosis of soft tissue
18
Q

What organisms commonly cause NF?

A

Type 1 NF

  • Staph aureus
  • Haemophilus
  • E.Coli

Type 2 NF

  • Haemolytic group A Streptococci (GAS) - Strep pyogenes
  • MRSA

Type 3 NF

  • Clostridia Perfringens
19
Q

What are the RF of developing NF?

A
  • Immunocompromise
  • Obesity
  • Diabetes
  • Advance age
  • Drug abuse
  • Chronic illness
  • Aspirin
  • NSAIDs
20
Q

Where is the common area of developing NF?

A
  • Lower limb (most common)
  • Upper limb
  • perineum
  • buttocks
  • trunk
21
Q

What are the features of affected area?

A
  • Swelling
  • Purplish rash
  • Large dark marks with dark fluid
  • Blackened (necrosed) area
  • oedema
  • crepitus under skin - due to gas

*Sx occur after day 3-4

22
Q

What will pt c NF experience after day 4-5?

A
  • Severely pyretic
  • Low BP
  • Bacteremia
  • Loss of conscioussness
23
Q

What test can you perform to diagnose NF? Describe the test

A
  • Finger test
  1. 2cm vertical incision made on affected area
  2. Index finger is pushed into tissue
    • if the finger passes through subcutaneous tissue without resistance
24
Q

What Ix would you order for NF

A

Bedside

  • Bloods
    • Inflammatory markers
    • Urea
  • Blood culture
  • Deep tissue biopsy

Imaging

  • Xray, CT, MRI
25
Q

What is the Mx plan for NF?

A
  • High dose IV antibiotics
  • Iv fluids
  • O2
  • IV immunoglobulin
  • Surgical debridement
    *
26
Q

What are the Cx of NF?

A
  • Renal failure
  • Septicaemia
27
Q

What are the basic principles of wound management?

A
  • Haemostasis
  • Wound cleaning
  • Analgesia
  • Skin closure
  • Dressing
  • Follow up advice
28
Q

What are the examples to achieve Hemostasis in wound Mx?

A
  • pressure
  • elevation
  • torniquet
  • suturing
29
Q

What are the 5 aspects of wound cleaning?

A
  • Disinfect skin around wound
  • Decontaminate wound
  • Debride any devitalised tissue
  • Irrigate wound c saline
  • Abx
30
Q

What is the maximum level of lidocaine c and c/o adrenaline?

A
  • c adrenaline
    • 7mg/kg
  • c/o adrenaline
    • 3mg/kg
31
Q

What are the 4 main methods of achieving skin closure?

A
  • Skin adhesive strips (steri strips)
  • Tissue adhesive glue (Indermil)
  • Suture
  • Staples
32
Q

What are the 3 layers used in wound dressing?

A
  • First layer
    • Non adherent - saline soaked gauze
  • Second layer
    • absorbent material - attract wound exudate
  • Third layer
    • Soft gauze tape - secure dressing in place
33
Q

What advice would you give to pt for initial wound mx?

A
  • seek medical attention for signs of infection
  • take simple analgesia
  • keep wound dry as much as possible
  • suture or strips removed after 10-14 days

General Surgery (20 decks)

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