Surgical SAQ Flashcards
List 5 steps you would take if you thought you had inserted the verses into the bowel?
- turn off gas
- call for help
- inform anaesthetist
- leave veress needle in place
- prepare for palmers point entry or laparotomy
Explain Palmers point entry (steps)
palpate for splenomegaly
NGT by anaesthetist to deflate stomach
MCL - 2 finger breadths below the left costal edge
Tent skin up
Small skin incision
Veress entry - 90 degrees to skin
5mm port
List 4 auto-transfusion options (JW)
- donate blood pre operatively (to give during operation)
- cell saver
- ECMO
- cardiopulmonary bypass
List 5 steps you could take intraoperatively while performing a hysterectomy for a JW patient?
- double clamping and tying of knots
- TXA
- use of surgical/fibrillar
- consider minimal surgery - subtotal
- drain insertion
List 4 post op management steps you could use for a JW patient who has undergone hysterectomy
- Hydration
- VTE prophylaxis
- avoidance of hypotension
- EPO if blood loss more than expected
List 5 pre-operative steps you can make to minimise bleeding at hysterectomy
- Pre op bloods - coags, TFTs, iron, Hb
- optimise pre op anaemia
- stop anti-coagulants/anti-platelet therapy
- investigation/treatment of bleeding disorders
- optimise medical comorbidities
List 5 intra operative steps you can take to reduce heavy bleeding at a hysterectomy
- use of assistant and retractors
- double clamp and double tying of pedicles
- identify anatomy correctly
- haemostats to peritoneal edges that are bleeding
- haemostasis check with irrigation
- consideration of perclot/surgicel use
List the anatomical locations that a patient could be bleeding from at hysterectomy
- inferior epigastrics
- ovarian vessels (IP ligaments)
- uterine vessels
- omentum
- peritoneal edges
- vault
- round ligament
- ascending vaginal vessels
At hysteroscopy, the nurse tells you you have reached a 3L +ve balance of glycine. How should you manage this?
- drain uterine glycine
- FBC, U&E, creatinine, glucose, ammonia, plasma osmolality
- treat with hypertonic saline if Na less than 120
- aim for slow correction of hyponatremia
- frusemide if pulmonary oedema
- open disclosure
- documentation
How would you describe the Current of the cut mode on diathermy setting?
- continuous sinusoidal waveform
How would you describe the current on the coag setting of diathermy?
- intermittent (4-6% on, 94% off)
- higher peak voltage
what is the tissue effect fo the cut setting on diathermy?
vaporisation, non contact (spark)
desiccation on contact
what is the tissue effect of coag setting of diathermy?
fulguration spark
desiccation on contact
what does direct coupling refer to with regards electrosurgical injury
- current finds path of least resistance e.g. between retractor and electrode or clips and staples, leading to burns
What can increase the risk of electrosurgical injury?
- incorrect placement of electrode onto skin leading to burn injury
- ## metalware - e.g. burns at site of pacemaker
