Surgical complications/special prep Flashcards by K D

Nerve damage in posterior triangle lymph node biopsy

accessory nerve

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Nerve damage in Lloyd Davies stirrups

Common peroneal nerve

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Nerve damage in thyroidectomy

recurrent larryngeal nerve

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Nerve damage in anterior resection of rectum

hypogastric nerve autonomics

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Nerve damage in axillary clearance

Long thoracic nerve

Thoracodorsal nerve

Intercostobrachial nerve

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Nerve damage in inguinal herna surgery

Ilioinguinal nerve

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Nerve damage in varicose nerve surgery

Sural and saphenous nerves

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Nerve damage in posterior approach to hip

Sciatic nerve

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Nerve damage in carotid endartrectomy

Hypoglossal nerve

Greater auricular n

Superior laryngeal nerve

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Nerve damage in submandibular gland excision

Mandibular marginal nerve: facial asymmetry and dribbling

Lingual nerve

Hypoglossal nerve

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Surgical site infection prevention

No shaving, trimming with electrical clippers if necessary

Iodine incise drapes

Prophylactic abx

Clean skin with alcohol chlorhexidine intraoperatively

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When to give prophylactic abx for surgery

placement of prosthesis or valve
clean-contaminated surgery
contaminated surgery

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Prep for thyroid surgery

Vocal cord check

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Prep for parathyroid surgery

methylene blue dye to identify gland

Sestamibi scan

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Prep for thoracic duct surgery

cream

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Prep for phaeochromocytoma

Alpha and beta blockade

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Prep for carcinoid tumour surgery

cover with octreotide

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Reactionary haemorrhage timing

Within first 24hr post op (normally 6-8 hrs post op)

aka primary haemorrhoage

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Mx of reactionary haemorrhage

Needs immediate return to theatre

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Secondary haemorrhage timing

Between 5-10 days post op

Usually secondary to infection

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Secondary haemorrhage mx

Abx and admission

May need surgery

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Tourniquette absolute CI

PVD

previous vascular surgery

Fracture at the site

AV fistula

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Change in CVP, systemic vascular resisitance, BP and core temp after tourniquette application

Core temp, CVP, vascular resisitance and BP increase initially (then BP slowly decreases)

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VRI indications in peri-op diabetics

T1DM and insulin-dependent -> VRI

T2DM insulin-dependent -> VRI

T2DM NBM>12 hrs, missing more than 1 meal -> VRI

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Keloid scar RFs

Tension on the wound Dark skin Young

What are langer's lines

Naturally occuring lines in skin (creases) Surgical incisions along these lines reduce risk of keloid scars

Difference between clean contaminated wound and contaminated wound

Clean contaminated: viscus wall is breached, contents are contained and no spillage Contaminated: viscus wall breached and contents spilled

How much time between MI and major elective procedure

Allow 6 months

HRT peri-op management

Stop 4 weeks before elective surgery For emergency surgery, thromboprophylaxis required

BMI levels

25-30 overweight 30-40 obese \>40 morbidly obese

When does heparin need to be stopped prior to op

Heparin stopped 6-12 hrs before Can restart 4-6 hrs after

When does aspirin need to be stopped prior to op

7 days ( irreversible anti-platelet, platelet life up to 10 days)

Max tourniquet time

2 hrs

When to stop sliding scale post op

When person restarts eating and drinking

Diathermy current in coagulation

Interrupted Square shaped Low voltage

Diarthermy current in cutting mode

Continuous Sinus wave form

Diathermy frequency

400Hz to 10MHz

Risk of re-infarction peri-operatively in pt 3-6 months post MI

16%

Where to place diathermy pads

Close to op site Away from prosthetic implant On vascularised muscle eg thigh

Fluid of choice post obstruction metabolic alkalosis

Normal saline (chloride ions enhance excretion of bicarb)

Difference between sterilisation and disinfection

Disinfection: minimise the number of microorganisms Sterilisation: kill all microorganisms

How many hours does take to sterilise something in glutaraldehyde

up to 22hrs

Can you sterlise with 70% alcohol

No can only dis-infect

How long after gastrectomy could get osteomalacia

1-=20 yrs

Day 1 post op pyrexia cause

SIRS to trauma/pre-op infection

Day 2-3 post op pyrexia cause

atelactasis chest infection

Day 3-7 post op pyrexia cause

Infection Anastomatic leak

Day 7-10 post op pyrexia cause

VTE

ICU vs HDU admission criteria

ICU level 3 care: any patients with multi-organ failure or resp failure requiring advanced resp support HDU level 2 care: Single organ support

When to change a tracheostomy tube

at least 3 days post, to allow track forming

Massive haemorrhage definition

Loss of \>50% of in 3hr Loss of 100% in 24hr or \>150ml/min

Number 15 vs 10 blades

No 15- small curved cutting edge, for making short precise incisions, eg arteriotomy, dissecting abdo No 10, bigger for laparotomy No 20 even larger

Intra-operative heat loss

40% radiation (electromagentic waves) 30% convection (to air immediately surrounding body) 15 % evaporation (of water) 5 % conduction

Structures damaged in submandibular gland excision

Mandibular branch of facial Hypoglossal Lingual Facial artery Retromandibular vein

Sterlisation timing in autoclave

3mins at 134 15mins at 121

Confirmation of sterilisation test

Bowie-dick test St andrews diagonal cross in the centre of autoclave if not fully covered by the end needs redoing

How does the UV light sterlise equipment

Micro orgnaisms DNA absorbs it, Pyrimidine dimers form, altering the form of the DNA, interfering with normal base pairing

Sterilising endoscopic equipment

glutaraldehyde

Sterilising most reusable surgical equipment

Autoclaving

Diathermy modes voltage graph

Branchial cyst excision nerve damage

Mandibular of facial nerve Greater auricular Accessory nerve

Nerve damage in low anterior resection

nervi erigentes (pelvic splanchnic nerves that carry parasympathetic fibres)

Sx of damage to nervi erigentes

impotence

Difference between skin graft and flap

Flap comes with its own blood supply

Use of statins peri-operatively

In pts with peripheral vascular disease, taking statins prior to vascular disease has shown a 50% reduction in perioperative cardiac events

Control of bleeding from raw surfaces such as solid organs

Spray diathermy or argon plasma coaguation AND/OR Surgicell (topical haemostatic agent)

Fulguration diathermy

holding the probe away from the tissue Spray effect with local superficial destruction (low current and high voltage)

Dessication diathermy

Electrode in direct contact with the tissue (low current high voltage) Results in loss of cellular water but no protein damage Applying current over a large area

What device is used to remove parts of the brain

CUSA systems minimize thermal injury and current flow to the surrounding areas.