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Principles of Surgery > Surgical Facilities and Basic Monitoring > Flashcards

Surgical Facilities and Basic Monitoring Flashcards

1
Q

What are the 3 general surgical areas in a hospital? Why are these areas kept separate?

A
  1. CLEAN AREA: clean traffic - already in caps and gowns; OR, scrub sink, sterile supply room
  2. MIXED AREA: mixture of both
  3. CONTAMINATED (dirty) ROOM: anesthesia, prep, lounges, offices

minimize infection

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2
Q

What are the hospital changing rooms used for?

A

used by personnel to change out of their street clothes and into their surgical scrubs
- cabinets for lockers for storage
- hamper for dirty scrubs

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3
Q

Where is the anesthesia and surgery prep area typically found in the hospital? Why?

A

adjacent to the surgical suite

don’t have to move the patient around too much and risk contamination

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4
Q

What equipment is commonly kept in the anesthesia and surgery prep area?

A
  • machines and monitoring equipment
  • drugs
  • catheter supplies
  • block supplies
  • laryngoscopes
  • ET tubes
  • clippers
  • crash cart
  • scrub materials
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5
Q

What is commonly kept in the supply rooms in hospitals?

A
  • anesthesia
  • sterile instruments
  • equipment
  • housekeeping supplies
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6
Q

What is nosocomial infection?

A

infections acquired during hospitalization

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7
Q

Where is the scrub sink area located? What common stock is kept there? What is the sink like?

A
  • near OR suite (not in it!)
  • antiseptic soap, reusable/disposable scrub brushes, booties, masks, scrub caps
  • stainless steel; knee vs. elbow vs. foot operated, motion sensor
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8
Q

Why do operating suites typically have one door?

A

minimize outside contamination - keep closed once the team is in!

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9
Q

What operating rooms typically have positive pressure air flow? Why?

A

one where high-risk surgeries are typically done

higher pressure in the room allows air to leave but keeps the same air from recirculating inside the room

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10
Q

What should be limited in the OR?

A
  • talking
  • moving
  • amount of horizontal surfaces
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11
Q

What is commonly found in the OR?

A
  • anesthesia machine
  • anesthesia crash cart
  • +/- sterile table
  • Mayo stand (where pack is opened)
  • operating table with heat source (+/- trough)
  • surgical lights (and emergency lights)
  • medical receptacle (sharps)
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12
Q

Where is the post-operative room located? What is found/done inside?

A

adjacent to the surgical area

individual kennels for small animals and recovery stalls for large animals
- careful monitoring
- warmer than OR
- emergency equipment

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13
Q

Where does the patient move to if they were critical before or became critical during their surgery?

A

ICU

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14
Q

What are the 3 possible positions used for surgery? What is a unique what that large animals can be operated on?

A
  1. dorsal recumbency (back on the table)
  2. sternal recumbency (belly on table)
  3. lateral recumbency (side on table)

standing

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15
Q

Why is the patient warmed during and after surgery? What are the 3 types of warming?

A

minimize heat loss during surgery

  1. PASSIVE WARMING: blanket/towel act as an insulator
  2. ACTIVE WARMING: heat source applied directly on the patient
  3. ACTIVE CORE WARMING: heat applied centrally, typically by heated fluids (more rapid)

(rewarm quickly, but carefully)

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16
Q

What are some effects of anesthesia suppressing many of the body’s normal automatic functions? How is this observed for safety?

A

affects heart rate, respiration, blood pressure, body temperature, etc.

monitoring equipment provides valuable information and can act as an extension of the anesthetist’s own senses

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17
Q

What are the main 5 vitals monitored during surgery? How is this done?

A
  1. TEMPERATURE: rectal thermometer vs. esophageal temperature probe
  2. HEART RATE/RHYTHM: ECG, stethoscope, esophageal tube
  3. RESPIRATORY RATE: capnography
  4. BLOOD PRESSURE: doppler vs. oscillometric monitoring device
  5. OXYGEN SATURATION: pulse oximeter
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18
Q

What are the main 4 functions of the anesthesia machine?

A
  1. deliver oxygen
  2. deliver anesthetic gas
  3. assist with ventilation
  4. removes exhaled carbon dioxide
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19
Q

What is the purpose of monitoring temperature? How long is it monitored after surgery?

A

prevent hyperthermia and hypothermia

monitored every 5-10 mins until the patient is sternal and a body temperature between 99F and 102F is reached

20
Q

What does an ECG do? How does it measure this?

A

continuously monitors the electrical activity of the heart, showing information on heart rate and rhythm

electrical signal is picked up by electrodes and is amplified and displayed on the screen

21
Q

Why is the monitoring of heart rhythm important along, not just the rate?

A

rate may be normal, but if there is arrhythmia, the patient can still be in danger

22
Q

What is an esophageal stethoscope?

A

thin, flexible tube attached to a regular stethoscope that allows for lung and heart auscultation of a draped/intubated patient when slid down the esophagus

23
Q

What are the 3 values used when measuring arterial blood pressure?

A
  1. systolic pressure - contracting of the heart
  2. diastolic pressure - relaxation of the heart
  3. mean arterial pressure (MAP)
24
Q

How can BP be directly measured? Indirectly?

A

DIRECT: arterial catheter

INDIRECT: doppler ultrasound, oscillometric

25
Q

What is the gold standard for blood pressure measurement? In what animals is this most easily done?

A

direct measurement using an arterial catheter connected to a monitor, which can give information on BP and HR and rhythm

large animals

26
Q

What are the 2 steps of measuring blood pressure using an ultrasonic doppler? How can this be detected by the doppler probe?

A
  1. occlude arterial blood flow by inflating a cuff
  2. deflate the cuff until the blood flow goes back to normal. just below systolic pressure

when the pressure in the cuff is just below systolic blood pressure, the blood flow can pass the cuff and is detected by the doppler probe, which uses ultrasonic waves to detect pulsatile blood flow or vessel wall motion and convert it into an audible signal = HR!

(only measures systolic pressure!)

27
Q

What 4 vitals can be measured from an oscillometric blood pressure monitoring device? Which is most accurate?

A
  1. systolic arterial pressure
  2. diastolic arterial pressure
  3. mean arterial pressure (MAP)**
  4. pulse rate
28
Q

How does the oscillometric blood pressure monitoring device compare to the ultrasonic doppler?

A

oscillometric device is most commonly used and more non-invasive
oscillometric device is less acurate than the ultrasonic doppler

29
Q

What are 5 common ways that respiration is confirmed?

A
  1. movement of thorax
  2. movement of the respiration bag
  3. auscultation (esophageal vs. stethoscope)
  4. condensation of ET tube
  5. monitors - capnograph
30
Q

How does the capnograph work? What 2 things is it able to diagnose?

A

measures the exhaled CO2 in the patients breath over time to measure respiratory rate

  1. respiratory airway obstruction
  2. leak in ET tube cuff
31
Q

What does the pulse oximeter do? Where is it commonly placed on the patient?

A

non-invasive method of measuring oxygen saturation of hemoglobin (SpO2) in arterial blood and providing a pulse rate

tongue, lip, ear, paws, toes, thin skin folds on extremities

32
Q

What is the pulse oximeter easily affected by?

A
  • movement
  • pigmentation of the patient
  • light
  • poor peripheral blood flow
  • drying of the tongue
33
Q

What is the main takeaway with monitoring equpiment?

A

never trust the vital sign monitor’s value alone - always double check values using traditional monitoring techniques

(monitor HR vs what you hear in the stethoscope)

34
Q

What is the point of fluid therapy? What rate is typically used? How is this different in healthy patients?

A

intraoperative fluid therapy helps restore and maintain tissue fluid, as well as electrolyte homeostasis and central euvolemia

10-15 mL/kg/hr of crystalloid fluids
lower rate of 5 mL/kg/hr can be used, especially in less invasive procedures

35
Q

What surgeries have the biggest fluid losses?

A

ones involving large abdominal and thoracic incisions —> high evaporative losses

36
Q

Where is skin preparation done? How is this done?

A

anesthesia/surgical prep area

  • surgery site is clipped with adequate margins while the animal is under
  • initial scrub
  • patient moved to OR
  • 3 additional scrubs
37
Q

What are the main 2 goals in skin preparation?

A
  1. reduce resident skin flora to prevent infection
  2. achieve residual antiseptic activity (NOT possible to completely sterilize the skin)
38
Q

What are the main 4 people making up a surgery team?

A
  1. surgeon
  2. assistant surgeon (if needed)
  3. anesthetist
  4. LVT
39
Q

What are some pre-operative, operative, and post-operative responsibilities of surgeons?

A
  • create a surgery plan
  • create a workflow
  • surgery
  • guide/direct team
  • communicate with techs and anesthesiologist about post-op care and treatment plans
  • prepare client discharge
40
Q

What are some pre-operative, operative, and post-operative responsibilities of assisting surgeons?

A
  • drape patient
  • retrieve/hold sterilized tool
  • help surgeon visualize surgery field
  • aid surgeon with surgery
  • create a post-op report
  • clean up
41
Q

What are some pre-operative, operative, and post-operative responsibilities of anesthesiologists?

A
  • calculate drugs
  • place catheters/intubate
  • give pre-surgical meds
  • monitor patient
  • chart
  • recover patient
  • post-op monitoring
42
Q

What are some pre-operative, operative, and post-operative responsibilities of LVTs?

A
  • prepare/sterilize drapes
  • prepare patient (clip hair, scrub)
  • open materials
  • chart
  • dispose sharps
  • clean instruments
  • laundry
  • recovery
43
Q

How should a surgeon prepare for surgery?

A

know the case - review pathophysiology and basics of procedure; review possible complications

ensure the patient is properly prepared

44
Q

What are 6 common surgical procedures done in general practice?

A
  1. ovariohysterectomy (Spay)
  2. neuter
  3. mass removal
  4. laceration repairs
  5. cystotomy
  6. gastrotomy
45
Q

What do the suffixes -tomy, -ectomy, -ostomy, -plasty, -pexy, -rrapthy, and -desis mean?

A

-tomy = surgeon cut something
-ectomy = surgeon cut something out
-ostomy = surgeon made an opening
-plasty = surgeon changed the shape of something
-pexy = surgeon moved the organ to the right place
-rraphy = surgeon sewed something up
-desis = surgeon made 2 things stick together

Principles of Surgery (16 decks)

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