Firms: General Flashcards

1
Q

What is important to ask about alongside past surgical hx?

A

Anaesthetic hx

?issues, ?well intra and post op, ?PONV

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2
Q

How do you prep someone for surgery as an F1?

A
  1. NBM + Fluids
  2. Drugs: Allergies, Bleeding Risk, VTE, Abx
  3. Airway Difficulty
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3
Q

The pre-op drug regime

A

To stop - OCP/HRT, hypoglycaemics, clopidogrel, warfarin

To alter - S/C insulin + long term steroids

To start - LMWH, TED stockings, abx

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4
Q

What is involved in the pre-op examination?

A

General - identify any underlying undx pathology

Airway - predict difficulty of intubation

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5
Q

What is included in the airway examination?

A

Any obv facial abnormalities e.g. retrognathia

Degree of mouth opening, dentition and loose teeth, Mallampati classification

Neck ROM and distance b/w thyroid cartilage and chin <6.5cm difficult intubation

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6
Q

Outline the ASA classification

A

I - normal healthy pt

II - mild systemic disease: current smoker, preg, BMI 30-40

III - severe systemic disease: BMI >40

IV - above + constant threat to life

V - moribund + won’t survive w/o op

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7
Q

What does the ASA grade correlate with?

A

Risk of post op comps and absolute mortality

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8
Q

What is the surg safety checklist before induction of anaesthesia? (3)

A

Pt confirmed identity, site, procedure + given consent

The site is marked, anaesth machine + meds checked, pt has pulse ox on

Any allergies recorded, risk of blood loss, assessed difficulty of airway

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9
Q

What is the surg safety checklist before skin incision? (5)

A

Staff introductions, confirm pt name site procedure, abx prophylaxis, anticipated critical events, essential imaging displayed

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10
Q

What are the causes of a post op fever?

A

The 5W’s: wind, water, wound, walking, wonder drugs ie pneumonia, UTI, infection at incision organ blood, PE/DVT, drugs/transfusion

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11
Q

RFs for PONV

A

Patient: female, younger, non-smoker, prev ep, motion sickness

Surgical: prolonged, abdo lap, intracranial, middle ear, squint, gynae, poor pain control after

Anaesthetic: prolonged, intraop bleed, inhalational agents, overuse of bag and mask ventilation, spinal, opioids

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12
Q

Alternative causes of PONV

A

Infection, GI (ileus or obstrc), metabolic (hyperCa, uraemia, DKA), meds, raised ICP, anxiety

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13
Q

Mx of PONV

A

Prophylactic - antiemetics, dex at induction, anaesthetic measures

Conservative - adequate fluids, adequate analgesia, ensure no obstrc

Pharmaceutical - multimodal therapy

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14
Q

Antiemetics if impaired gastric emptying

A

Metoclopramide or Domperidone

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15
Q

Antiemetic if suspected obstrc

A

Hyoscine

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16
Q

Antiemetic if metabolic

A

Metoclopramide

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17
Q

Antiemetics if opioid induced

A

Ondansetron or Cyclizine

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18
Q

CIs for NG Tube

A

Absolute - mid face trauma + recent nasal surgery

Relative - coag abnormalities, recent alkaline ingestion, oesophageal varices/strictures

19
Q

How do you measure the length of a NG tube?

A

Tip of nose, to earlobe, to bottom of xiphoid process

20
Q

NG Tube Insertion Tips

A

Agree signal to stop procedure

Inspect for deviated septum and visible polyps

Aim the tube horizontally along the nasal cavity floor

Advance with each swallow and ask pt to tuck chin

21
Q

What pH indicates gastric acid?

A

<5.5

22
Q

Which veins can you insert a central venous catheter? (3)

A

Internal jugular, subclavian, femoral

23
Q

Why might a pt need a CVC? (3)

A

Meds that require administration centrally: vasopressors, inotropes, TPN, chemo

Access to extracorporeal circuit for haemodialysis

To monitor central venous pressure

24
Q

What is a common indication for a PICC line?

A

Following an oesophagectomy or Whipple’s procedure for chemo

They’re sited by specialist nurses, checked in place by CXR, only the radiologist or ICU consultant can approve placing

25
Q

How long does central venous access give you?

A

CVC - days to wks

PICC - wks to mnths

Tunnelled - mnths to yrs

26
Q

What are the comps of central venous access?

A

Immediate: haemorrhage, pneumothorax, arterial puncture, arrhythmias, cardiac tamponade, air embolism

Delayed: venous stenosis, thrombosis, erosion of vessel, line fracture, catheter colonisation, line related sepsis

27
Q

What are the borders of the triangle of safety for chest drain insertion?

A

Lateral edges of pectoralis major and latissimus dorsi, apex of axilla, fifth intercostal space

28
Q

Absorbable Sutures

A

Vicryl, monocryl, PDS

29
Q

Non-Absorbable Sutures

A

Nylon, prolene, silk

30
Q

The different ways of giving oxygen therapy

A

Nasal Cannula - max 4L/min and can deliver 25-35% FiO2

Face Mask - max 10L/min and can deliver 25-60% FiO2

Non Rebreathe - max 15L/min and can deliver 80-85% FiO2

Level 2 Care - high flow nasal cannula and NIV

Level 3 Care - mechanical ventilation

31
Q

Which is the rough estimate b/w litres per minute and approximate FiO2?

A

It inc in increments of 4% for every LPM given:

1 - 24%
2 - 28%
3 - 32%
4 - 36%
5 - 40%
6 - 44%
7 - 48%
8 - 52%
9 - 56%
10 - 60%
32
Q

Definition of definitive airway

A

A tube in the trachea w a cuff e.g. ET tube or a tracheostomy

33
Q

What is the dual blood supply of the liver?

A

70% Portal Vein + 30% Hepatic Artery

34
Q

What joins to form the portal vein?

NB: the PV has NO valves

A

Splenic + Superior Mesenteric

35
Q

What’s the most common site of rupture in Boerhaave syndrome?

A

Lower 1/3 in the left posterolateral distal oesophagus

36
Q

What are the main causes of Boerhaave syndrome? (3)

A

Alcoholics, GORD, iatrogenic

37
Q

Mackler Triad

A

Vomiting, lower chest pain, surgical emphysema

38
Q

Hamman Sign

A

O/e mediastinal crunch synchronous w the heartbeat

39
Q

Ix for Boerhaaves

A

CXR - pneumomediastinum, pneumothorax, pleural effusion

Oesophagram - extraversion of contrast material

CT w Gastrografin - identify the site of perforation

40
Q

What common cancers met to bone?

A

Men - prostate - sclerotic bone mets

Women - breast - lytic bone mets

41
Q

Which hernia is most likely to strangulate?

A

Femoral > Inguinal

42
Q

How do you know the bag + valve mask is working? (3)

A

The chest is rising, the mask is misting, end tidal CO2

43
Q

Why is CO2 used during laparoscopy? (3)

A

Inert
Soluble
Inflammable

44
Q

How does gastric ca typically present?

A

Dyspepsia + Anaemia