Surgical Miscellaneous Flashcards
What are 3 indications that cellulitis is improving on examination?
Shrinks in size (use marker to track progression)
Blister formation
Wrinkling around area that is now healed
When asking about surgical history, what should you ask?
What the surgeries were and when they occurred
Open vs laparoscopic vs robotic
Complications, repeat admission
You are in a long case and youre suggesting surgical management of a disease. In preparation for any surgery, what will you do?
What if the patient was also a diabetic?
I will evaluate CV and Resp RFs primarily to ensure the patient is fit for surgery
CV: Exam, ECG, ECHO, and if needed, angiogram
Resp: Exam, PFT, CXR, ABG
I will ensure all imaging is available and sent appropriate requests
I will check patients medications and adjust them in line with hospital regulations e.g. anticoagulants, antiplateleys MAOI, etc…
I will request anaesthetic opinion and evaluation as needed
Diabetic: I will also ensure perioperative management of diabetes with regards to glycaemic control, preferably insulin
Perfect your 10 steps for the management of any acute abdomen
ABC. You must still state the basic steps you will do in each. Here is just the important points
1) Admit to hospital +/- Consider need for HDU/ICU
2) ABCDE: Send out FBC w/differentials, U&E, CRP, LFTs, and coag profile, ABG
3) NPO for all, NG tube if vomiting, Intubate if GCS 8 or under or if vomiting
4) O2 if in doubt until ABG becomes available (15L 100% O2 via non-rebreather mask)
5) 2x large bore cannulas, IV fluids at 100ml/hr until losses worked out via intake/output chart +/- urinary catheter (aim >0.5ml/kg/hr)
6) Type and save, group and hold, Group and cross match 4 units of blood (10 for AAA). If needed give in 1:1:1 aiming for Hb>8 and >10 in CVD
7) Analgesia (Paracetamol, NSAIDS, Morphine/oxynorm/oxycontin)
8) Antiemetics if needed (Ondansetron)
9) Antibiotics: Coamox/pip taz + Gent/Metronidazole (except in pancreatitis, wait for blood cultures to come back)
10) DVT prophylaxis (TEDs, Clexane, LMWH)
If >4 units used, activate Major Transfusion protocol
What is way to think of complications if stuck?
Anaesthesia -> Entry -> surrounding structures -> Procedure components and what can go wrong with each -> Post-op
What are the general complications of most surgeries?
Infectious: Wound site infection, sepsis, UTI (catheter use during surgery), Aspiration pneumonia
Bleeding: Post-op bleeding, haematoma
Thromboembolic: DVT, PE, stroke
Cardiovascular: MI, arrhythmia, A.fib, stroke
Anaesthetics: Atelectasis/barotrauma from intubation, GA intolerance, if spinal, LP (traumatic, incorrect)
Other: !!Complex regional pain syndrome!!, delayed wound healing, Adhesions!!
In a long case, you are asked to give your investigations of a certain disease. What is the full list of bedside investigations that you can pick out from?
Blood:
Glucometer
ABG/VBG
Urine:
Urine dipstick
Urinalysis M,C&S
Imaging:
Portable CXR
POCUS
Portable US (bladder)
Other:
Vital signs incl. pulse oximetry
ECG
DRE
Fundoscopy
Peak flow
A patient post-thyroidectomy is more likely to have hyper or hypocalcaemia?
What signs are shown?
How is it managed?
Hypo
Signs: Perioral paraesthesia, Trousseau signs, Chvostick sign
Tx: 10ml 10% IV Calcium Gluconate over 10 minutes
+ Vit. D supplements
What are the main indications for thyroid surgery
4 Cs
Cancer: Papillary, follicular, hurthle cell, medullary, anaplastic
Compression: Goitre or mass compressing trachea or SVC or other nearby structures
Carbimazole (just means medical tx has been exhausted)
Cosmetic
What cancers use neoadjuvant chemoradiotherapy?
Oesophageal Ca
Rectal Ca (specifically, not all colorectal)
Breast Ca
Ovarian Ca
Bladder (in some cases)
How would you describe the following terms for a patient?
Stoma:
PFA:
CT:
NG tube:
Stoma: Bag on tummy
PFA: X-ray of tummy
CT: Put in tunnel
NG tube: Drip for feeding
What Thy score is considered normal?
2
1 is equivalent to the hospital burning down (e.g. no sample, patient did not attend etc…)
A nurse undergoes primary immunisation against hepatitis B. What levels should be checked four months later to ensure an adequate response to immunisation?
Anti-HBs
What is the Seldinger technique?
Go through it
The seldinger technique is a minimally invasive technique for gaining access to vessels and hollow organs. It may or may not be guided by US or fluoroscopy
It involves
1) inserting a small gauge needle (with an attached syringe) into the vessel and confirming with an aspirate of blood
2) withdraw the syringe and advance the guide wire -confirm location of guide wire with free movement/US/Fluoroscopy
3) withdraw needle and advance dilator
4) withdraw dilator and advance catheter over guide wire
5) withdraw guide wire and aspirate + flush with !heparinised saline to ensure patency
In what situations is the seldinger technique used?
Any reason to obtain
Venous access (meds, fluids, food)
Arterial line (BP/serial BP, Repeat ABG)
Perm cath (haemodialysis)
Insertion of a drain or tube (chest drain, pleural effusion, biliary drainage
