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Yr 6 PACES knowledge COPY RJ Challenger > Instruments and images > Flashcards

Instruments and images Flashcards

1
Q

Central venous catheter Indications

A
  • Central venous pressure measurement - Administration of drugs: amiodarone - TPN
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2
Q

How is a central venous catheter used

A

Inserted using the seldinger technique under US guidance Sterile procedure Under LA Order CXR afterwards Common sites: int jugular vein, subclavian vein

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3
Q

Central venous catheter: complications

A

Immediate: pneumothorax, arrhythmia, malposition Early: infection, haematoma, occlusion Late: thrombosis, Phrenic nerve damage, sympathetic chain damage (corners)

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4
Q

Indication for central venous catheter vs PICC line vs Hickman line

A

CVC = short term use Hickman + PICC line = long term central access

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5
Q

Hickman line:

A

Tunneled under skin to enter IJV, and tip lies in the SVC

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6
Q

Tesio catheter: indication and features

A

Indication = haemodialysis Features = tunnelled subcutaneously Cuffs promote a tissue reaction –> creates a better seal Red limb: takes blood TO the machine Blue limb: takes dialysed blood BACK to patient

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7
Q

Tesio catheter: method

A

Sterile insertion under X-ray guidance

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8
Q

Tesio catheter: complications

A

Early: Pneumothorax Arrhythmia Bleeding Late: Infection Catheter occlusion Thrombosis

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9
Q

Blood bottles: Purple Yellow Grey - use? what does it contain?

A

Purple - contains EDTA to prevent clotting. use = FBC, X-match Yellow - contains activated gel. SERUM chemistry Grey - contains fluoride to inhibit glycolysis. Use = glucose

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10
Q

Endotracheal tube: indications

A

Definitive airway - long surgery: eg abdominal surgery - head injury –> reduced GCS

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11
Q

Endotracheal tube: features

A

Cuffed = prevents aspiration Long enough to sit below the vocal cords = definitive Blue line = radio-opaque

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12
Q

Endotracheal tube: method

A
  • Anaesthetist - Pt sedated and muscle relaxant may be used - Laryngoscope aids direct vision - Tube is secured using tape Check position: symmetrical chest movements + auscultate for BS, CXR
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13
Q

ET tube: complications

A

Early: misplacement into oesophagus/bronchus TRAUMA - oropharyngeal/laryngeal Late: sore throat, tracheal stenosis

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14
Q

Guedel airway: indications

A

Non-definitive airway Used in its with lowered GCS to maintain a patient airway .e.g. during extubation

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15
Q

Guedell airway: method

A

Measure size: incisors –> angle of mandible Insert upside down, rotate once inside oral cavity

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16
Q

Guedell airway: complications

A
  • Oropharyngeal trauma - Gagging –> vomiting –> aspiration
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17
Q

Ryles tube: indications

A

Draining the stomach, and NOT for feeding Drip + suck in obstruction

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18
Q

Ryles tube: features

A

Wider + stiffer than a feeding NGT Radio-opaque line –> to visualise on CXR

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19
Q

Ryles tube: insertion method

A

Sizing: tip of patient’s nose, down to epigastrium, going around the ear Lubricate the tip w gel Insert tube + ask pt to swallow sips of water when they feel is at back of throat Secure with tape Checking location: - Aspirate gastric contents + check pH<4 - CXR

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20
Q

Ryles tube: complciations

A

Nasal trauma Malposition Blockage

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21
Q

Feeding NG tube: indications?

A

Provides enteral nutrition: Reduced GCS/ITU Malnutrition Catabolic state: sepsis, burns, major surgery Dysphagia: stricture, stroke

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22
Q

Feeding NG tube: features and insertion?

A

Soft silicone + guide wire to aid insertion Sizing: tip of nose to epigastrium, going round the ear Lubricate tip w gel Insert via nostril + ask pt to sip water when they feel it at back of throat. Remove guide wire + secure with dressing Check location: CXR + aspiration of gastric contents <4

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23
Q

Foley urinary catheter: indications

A
  • Urinary retention - BPH, neuropathic bladder - Monitor urine output in acutely unwell pt - Immobile
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24
Q

Foley catheter: features

A

2 ports: one for drainage of bladder, one for inflating balloon which keeps catheter in place Usually latex

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25
Q

Foley catheter: method

A

Obtain consent from patient ANTT - Clean the perineal area - Instillagel in the urethra + wait 2 mins - Insert catheter - Ensure urine is draining before inflating the balloon - Replace foreskin to prevent paraphimosis

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26
Q

Foley catheter: complications

A

Early: Paraphimosis Haematuria Urethral trauma Late: Infection Blockage

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27
Q

Initial Mx of hip fracture

A

ABC: resus Analgesia Assess neurovascular status of limb IMAGING - orthogonal views Prep for theatre: Anaesthetist - inform + book for theatre Bloods - FBC, clotting, G+S, Xmatch, U+E CXR DVT prophylaxis ECG

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28
Q

Risk factors for hip fracture

A

AGE + osteoporosis!! Steroids Early menopause EtOH + smoking Low BMI Hyperthyroidism Renal/liver failure Low calcium + Vit D intake/absorption Pre-existing bone disease (myeloma, RA)

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29
Q

Garden classification

A

For intracapsular NOF# 1. incomplete, undisplaced 2, complete, undisplaced 3. complete, partially displaced 4. complete, completely displaced

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30
Q

Surgical management of NOF#

A

Extra capsular = DHS or intramedullary Intracapsular: 1,2: DHS 3,4: THR (if fit), hemiarthroplasty if elderly

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31
Q

Stages of fracture healing

A

Reactive phase (- 48 hrs) - bleeding into fracture site + inflammation Reparative phase (2 days - 2 weeks) - Callus formation Remodelling phase (—–7 years) - Lamellar bone remodels to cope with mechanical forces applied to it “form follows function”

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32
Q

How to describe a fracture

A

Pt details Pattern: transverse/oblique/comminuted/spiral Anatomical location: shaft/epiphysis/metaphysis Intraarticular? Deformity: translation/angulation Soft tissues: open/closed?

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33
Q

Suture types

A

Absorbable vs non-absorbable Monofilament vs braided Natural vs synthetic

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34
Q

+ves and -ves of monofilament vs braided

A

Monofilament: + Less friction - Has more memory - More slip - Less tensile strength Braided: + Stronger + Easier to handle - less slip and less memory - increased risk of infection

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35
Q

2 Egs of absorbable sutures?

A

Monocryl = monofilament Vicryl = braided

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36
Q

Eg of non-absorbable suture? what is its construction and what is it used for

A

Prolene monofilament, used for vessel anastomosis _ skin wounds

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37
Q

causes of long QT interval

A

Heart: post MI, post cardiac arrest Clin chem: low Ca, K, Mg Congenital Drugs: amiodarone, citalopram

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38
Q

blood culture bottles: which colours for which bacteria?

A

Red: anaerobic Blue: aerobic take BLUE (aerobic) FIRST

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39
Q

Blood culture bottles: method

A

Take blood using ANTT. REPLACE NEEDLE w a clean one. Wipe top of bottles with EtOH Fill AEROBIC (blue) bottle first Fill in pt details + send to path lab

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40
Q

Indications for blood culture

A

pyrexia, suspected sepsis

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41
Q

Peripheral venous cannula - indications? method? complications?

A

Indication; admin of drugs, fluid, taking blood during insertion Method: into peripheral vein w ANTT Complications: - Malplacement - puncturing an artery, Extravasation - Haematoma - Blockage

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42
Q

PICC line - where is it inserted?

A

usually brachial vein

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43
Q

Port a Cath - indications? features?

A

Indications: long term chemo or Abx Centrally placed catheter Subcutaneous port made of rubber Accessed at 90 degrees w Huber point needle V low infection risk as breech is v small

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44
Q

When should blood cultures be taken compared to other blood tests

A

blood cultures FIRST

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45
Q

Laryngoscope: features?

A

Light source + handle Blade is detachable and comes in diff sizes, and straight vs curved

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46
Q

Complications of a laryngoscope

A

Oropharyngeal trauma Laryngeal trauma C-spine injury

47
Q

Tracheostomy - indications? features?

A

Indications: - Definitive surgical airway - Emergency, in upper airway obstruction - Laryngeal surgery - Maxfax injuries Features: 1. Obturator - used to insert that trache, then removed 2. Cuff - to prevent aspiration 3. Flange - to secure to patient’s neck

48
Q

Advantages of tracheostomy tube over ET tube

A
  • no sedation - easier to maintain oral hygiene - less discomfort - less dead space –> reduced work of breathing
49
Q

Complications of tracheostomy

A

Immediate: Haemorrhage, damage to oesophagus/rec laryngeal nerve, pneumothorax Early: Obstruction Displacement Surgical emphysema Late Tracheal stenosis Tracheomalacia TOF

50
Q

LMA - indications

A
  1. Emergency, where ET tube cannot be placed 2. Non-definitive airway for short day case surgery
51
Q

LMA - features

A

Inflatable cuff to seal over the larynx

52
Q

LMA - method

A
  • Cuff is deflated + lubricated - Open end inserted pointing down towards tongue - Sits over the larynx - Cuff is inflated + tube secured w tape - Position confirmed by equal chest expansion + breath sounds
53
Q

LMA -complications

A

Aspiration - non definitive airway Dislodgement

54
Q

Guedell airway - indications

A

Emergency setting where ET tube cannot be inserted Maintaining airway in pt w low GCS!!

55
Q

Guedell - method

A

Initially inserted w open end pointing to roof of mouth, then twisted 180 Measurement - angle of mandible to incisors

56
Q

Guedell - complications

A
  • Oropharyngeal trauma - Gagging –> vomiting - Aspiration
57
Q

Nasopharyngeal airway - indications

A

Maintaining an airway in low GCS

58
Q

NP airway - method

A

diameter = little finger length = tragus of ear –> nostril Inserted into the nose w a ROTATIONAL action Safety pin at end prevents tube loss lol

59
Q

NP airway - complications

A

Trauma to nasal mucosa –> epistaxis Intracranial placement (via cribriform plate in basal skull #)

60
Q

NP airway - contraindications

A

Evidence of basal skull # - Racoon eyes - mastoid bruising - haemotympanum - CSF rhinorrhoea/otorrhoea

61
Q

Max rate of O2 delivery through nasal prongs

A

4L

62
Q

Non-rebreather mask: features

A

Enhances oxygen delivery, as long as pt can breathe unassisted Reservoir bag = 1.5L One way valve, prevents reinhalation of expired air

63
Q

Indications for ventilation

A

-Respiratory failure that is not improving with less invasive airway management

64
Q

Complications of ventilation

A
  • Pneumothorax - Fluid retention - pneumonia - tracheal stenosis
65
Q

Indications for parenteral nutrition

A
  • Unable to swallow (oesophageal ca) - Prolonged obstruction/ileus - Severe malnutrition - severe Crohns
66
Q

Delivery of parenteral nutrition

A

Must be delivered CENTRALLY as high osmolality –> toxic to vessels Short term - CVC Long term - PICC or Hickman

67
Q

Monitoring in parenteral nutrition

A

Fluid balance + electrolytes inc Zn, Mg FBC, glucose, U+Es, LFTs

68
Q

Complications of parenteral nutrition

A

Line related: infection, thrombosis, pneumothorax, arrhythmia Feed related: - electrolyte imbalance - villous atrophy of GIT - hyperglycaemia - vit and mineral deficiencies

69
Q

Refeeding syndrome - pathophysiology? what is the main problem and what features does it cause

A

Starvation –> low insulin, low protein + fat metabolism and low intracellular phosphate Refeeding –> high insulin, rapid uptake of phosphate into cells Main problem = hypophosphatemia –> rhabdo, seizures, arrhythmia, shock

70
Q

Chemistry in refeeding syndrome

A

LOW PHOSPHATE and low K and Mg

71
Q

How to prevent a DVT

A

Pre-op: Stop OCP 4 weeks before VTE risk assessment Hydration Intra-op: Short length Minimal access Intermittent pneumatic compression boots Post-op: Analgesia –> mobilisation Hydration LMWH

72
Q

Indications for Hartmann’s

A

Trauma, Burns

73
Q

how much Na in 1L 0.9% saline?

A

154mM

74
Q

Two types of open drains?

A

pemrose, tissue drain

75
Q

Suture types- +ves and -ves

A

Monofilament vs braided Monofilament: + less friction + less infection - memory - slippy

76
Q

Egs of diff sutures

A

Monocryl (monofilament + absorbable) Vicryl (braided + absorbable) Proline (non-absorbable)

77
Q

Suture used for bowel anastomosis? For arterial anastomosis?

A

Bowel anastomosis = vicryl Arterial nastamosis = prolene

78
Q

Name of retractor used for abdo surgery

A

Denver’s retractor - can be bent to a suitable shape

79
Q

length of rigid sigmoidoscope vs proctoscope

A

Rigid sig = 25cm

80
Q

length of rigid sigmoidoscope vs proctoscope

A

Rigid sig = 25cm Proctoscope = 13cm

81
Q

Indications for a disposable proctoscope

A

Investigation of PR bleed (?haemorrhoids, lower rectal ca) Therapeutic: sclerotherapy, banding

82
Q

Method of proctoscopy? complications

A

Pt in L lateral position, knees bent Perform DRE Lubricate + attach light source Insert

83
Q

What is injected into haemorrhoids for sclerotherapy? how is it injected?

A

5% phenol in almond oil Inject 2mL above the dentate line

84
Q

Name of syringe used for haemorrhoid sclerotherapy

A

Shouldered/Gabriel syringe

85
Q

Indications/uses for rigid sigmoidoscope

A

? rectal cancer ? diverticular disease ? IBD can also take a biopsy!

86
Q

Method for rigid sigmoidoscope

A
  • L Lat position + DRE first - Lubricate the scope and insert - Remove obturator - Use light source + - INSUFFLATE w air
87
Q

What gas is used to inflate the abdomen in laparoscopic surgery? why?

A

CO2 - cheap +inert

88
Q

Intra-operatively, how is the integrity of an anastomosis checked?

A

Fill pelvic cavity w saline Insufflate rectum w air + look for bubbles

89
Q

Indications for catheterisation

A

Diagnostic: measure urine output, sterile urine sample Therapeutic: relieve retention, immobility, bladder irrigation,

90
Q

Urinary catheter - contraindications

A

Urethral trauma! - Urethral stricture - blood @ urethral meatus - Post-op urological pts

91
Q

Causes and Mx of non-draining cathter

A

Blocked? - flush w 20mL saline or consider 3 way catheter Renal or pre-renal failure???

92
Q

What is TWOc

A

Trial without catheter after acute urinary retention May be performed as a urology outpatient if retention again is likely

93
Q

Indications for long term cathterisation

A

Chronic obstruction (BPH) Neurogenic bladder Complications of incontinence –> pt preference, palliative care

94
Q

Indications for intermittent self cathterisation

A

Neurogenic bladder: DM, MS Chronic retention - an alternative to long term catheterisation

95
Q

Indication for 3 way foley cathter

A

Irrigate bladder in pts @ risk of clot retention eg after TURP or in pts w haematuria

96
Q

Suprapubic catheter- indications?

A

Urethral obstruction: BPH, rotate ca Urethral INJURY

97
Q

Method of insertion of suprapubic catheter

A

US guided insertion under LA

98
Q

Complications of suprapubic catheter

A

Haemorrhage Malignancy SEEDING Viscus perforation

99
Q

Advantages and disadvantages of suprapubic cathter

A

+ves: Fewer infections, less stricture formation, more comfortable, maintains sexual function -ves: more complex serious complications: eg malignancy seeding

100
Q

Contraindications for suprapubic catheter

A

Bladder carcinoma Undiagnosed suprapubic Previous lower abdo surgery

101
Q

Mx of acute urinary retention

A
  • Catheterise (3 way if clots) - Analgesia - hourly UO + replace - STAT GENTAMICIN COVER - (tamsulosin - reduces risk of recathetrisation after retention) - TOWC after 24-72 hours
102
Q

2 different methods of JJ stent insertion

A

Percutaneously OR retrograde, via cystoscopic guidance

103
Q

3 indications for chest drain

A

Pneumothorax Pleural effusion After thoracotomy or oesophagectomy

104
Q

Safe triangle for chest drain

A

Lateral edge of pec major Anterior edge of Lat dorsi 5th ICS

105
Q

How is incision made for chest drain insertion

A

Infiltrate area with 1cm incision w scalpel Blunt dissect with SPENCER WELLS FORCEPS Clear adhesions w finger

106
Q

Indications for fracture plate

A

Internal fixation of fractures

107
Q

How is a fracture plate used? how is it secured?

A

Internal fixation of a fracture Plate is aligned to the bone + screws fix the plate to the bone!

108
Q

Complications of using a fracture plate

A

Infection Failure Malposition of remodelled fracture

109
Q

Name of a hemiarthropalsty prosthesis? Indications? Feature?

A

Austin Moore Intracapsular NOF #, Garden 3/4 where pt is immobile Has fenestrated stem - promotes bone growth around it

110
Q

Complications of hip replacement

A

Early: deep infection, dislocation, DVT Late: loosening (septic or aseptic) Failure –> stem # Revision - most replacements last 10-15 years

111
Q

Cemented vs uncemented

A

Cement = acts as glue to attach the prosthesis to the existing bone Uncemented = promotes the new bone to grow around it. but longer recovery period

112
Q

Indications for intramedullary nail

A

Internal fixation for long bone #s: tibia, femur, humerus

113
Q

Principle behind a DYNAMIC hip screw

A

Allows collapse of the femoral head onto the neck –> increased loading of fracture site –> quicker union

114
Q

How does fat embolism syndrome often arise? Key Fx?

A

Embolisation of bone marrow fat in circulation, often due to intramedullary nailing or THR/TKR Key features: Hypoxaemia Petechial rash CNS depression Pulmonary oedema

Yr 6 PACES knowledge COPY RJ Challenger (16 decks)

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