Surgical pathway Flashcards
What are some things to ask about when taking a surgery GI history ?
General: weight loss, pr bleeding, appetite, abdominal pain
Specific: jaundice, pale stools, dark urine, fever
What are some things to ask about when taking a surgery urology history ?
Infective: frequency, urgency, dysuria, nocturia
Obstructive: hesitancy, intermittency, poor flow, pis en deux
What are some things to ask about when taking a surgery vascular history ?
Non modifiable: age, gender, family history
Modifiable: diabetes, smoking, hypertension, dislipidaemia
What should you always ask if a patient has pain?
If they have ever had this pain before and if yes what was the diagnosis
What is the most important thing in a surgical drug history?
To establish whether they are on any anticoagulants
What acronym is used to take a history in trauma and what does it stand for?
AMPLE: Allergies Medication Past medical history Last meal Events
How is clinical examination done for surgery?
Inspection, palpation, percussion, auscultation
How is clinical examination done for surgery in trauma?
ABCDE Airway Breathing Circulation Disability Everything else
What surgical sieve can you use for differential diagnoses if you are unsure?
VITAMIN D Vascular Infective Traumatic Autoimmune Metabolic Iatrogenic Neoplastic Drugs
What acronym is used when presenting a condition?
'Dressed in a surgeon's gown physicians might make some progress' Definiton Incidence Age Sex Geography Pathology (micro or macro) Symptoms and signs Prognosis
What are some bedside investigations that can be done for surgery?
Vitals
Urine dipstick
Pregnancy test
What are some non invasive investigations that can be done for surgery?
Erect chest x ray
Ultrasound
CT
What are some invasive investigations that can be done for surgery?
Blood tests
Endoscopy
Diagnostic laparoscopy/ laparotomy
What acronym is used to present a chest radiograph?
ABCDE Adequacy Breathing Cardiac Diaphragm Everything else
How many ribs should be visible anteriorly on a chest radiograph?
6
How many ribs should be visible posteriorly on a chest radiograph?
10
On a chest radiograph, how large should the heart be?
1/3 of the diameter of the chest
How are the right and left hemiphrenic diaphragms different on chest radiographs?
The right sits higher than the left
What peri operative assessment do all surgical patients need?
Venous thromboembolism assessment which balances the patient’s likeliness of bleeding vs clotting
How is immediate peri operative management carried out in trauma?
Via ABC
First establish if they need to be given oxygen/ nebulisers
Gain IV access if needed, you can catheterise them, give fluids, do blood tests, insert NG tubes etc
What are the 3 methods of management for patient?
Conservative (watchful waiting)
Medical (eg abx)
Surgical
What are the main surgical consent forms and who are they used for?
Consent form 1= those over 16
Consent form 2= peads
Consent form 4= for interventions when doctors act based on patients best interest
What must the doctor discuss when gaining consent for surgery?
Make sure the patient is able to consent
Ensure they understand the procedure and why it needs to be done
Discuss alternate options for care
Make them aware of complications which they would reasonably want to know about
What info does the post operative note contain?
Oral intake
Anti coagulation
Drains
What does post operative pyrexia under 24 hours after the operation indicate?
A systemic response to trauma
Pre existing infection
What does post operative pyrexia 24-72 hrs after the operation indicate?
Pulmonary atelectasis
Chest infection
What does post operative pyrexia 3-10 days after the operation indicate?
UTI DVT PE Wound Collection Anastomotic leak
How is sepsis treated if suspected?
With sepsis 6= 3 in, 3 out
3 in= oxygen, IV fluids, IV abx
3 out= urine output (catheter), blood cultures, lactate
