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Finals - PACES > Instruments > Flashcards

Instruments Flashcards

1
Q

Sutures

Indication, complications

A

Wound closure & approximation of tissue

Cause tissue foreign body reaction

Specific type chosen based on diameter, tissue strength, duration of closure

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2
Q

Absorbable suture types

Types, indication

A

Vicryl (polyfilament)
Monocryl, PDS (monofilament)

Also can have synthetic vs natural (catgut)

Used for: deep or rapid healing tissues e.g. bowel, biliary, urinary

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3
Q

Non-absorbable suture types

Types, indication

A

Monofilament - Nylon (Ethilon)
* Need 9 throws
* Percutaneous wound closure

Monofilament - Prolene
* Less likely to loosen
* Bowel, vascular anastomosis

Multifilament - Silk

Used for: permanent support & slower healing tissues, vascular anastomoses, tendon, fascia

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4
Q

Suture filament types

A

Monofilament = less trauma & tissue reaction, lower infection risk, prefrred for superficial wound closure

Braided (multifilament) = easier to handle, retain knots, increased infection risk (but can be coated in antibacterial substance to reduce)

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5
Q

How do absorbable sutures work?

A

Broken down by physiological processes of body e.g. enzymatic degradation, hydrolysis

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6
Q

Indications for ABG

A

New oxygen requirement

Identify acidosis / alkalosis
Identify resp failure
Identify any compensation
Identify poor perfusion (lactate)
Estimate of anaemia
Monitoring & Tx electrolyte disturbance - hyperK

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7
Q

Information given by VBG/ABG

A

pH
pO2, pCO2 - only useful in ABG
bicarbonate
Lactate
Hb (estimate)
Na+, K+
Glucose?

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8
Q

Order of blood bottle filling

A

Blue
Yellow
Purple
Pink
Grey

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9
Q

Blue blood bottle - components and indication

A

Buffered sodium citrate

Coagulation studies, INR, D-dimer

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10
Q

Yellow/gold blood bottle - components & indication

A

Silica particles and serum separating gel (SST)

U&E, LFTs
Immunology, microbiology, biochemistry, endocrinology, toxicology, oncology.

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11
Q

Purple blood bottle - component & indication

A

Contains EDTA

Haematology tests

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12
Q

Pink blood bottle - component and indication

A

EDTA

group and save, X match

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13
Q

Special requirement for pink blood bottle?

A

Patient information must be handwritten at bedside
(& should be double checked)

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14
Q

Grey blood bottle - components & indication

A

Sodium fluoride, Potassium o always

Glucose, lactate levels

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15
Q

Red blood bottle - components & indication

A

Silica particles

‘Sensitive tests’ - Toxicology, drug levels, Abs, hormones, bacterial and viral serology

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16
Q

Dark green blood bottle - components & indication

A

Sodium heparin

Ammonia, renin, aldosterone, insulin

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17
Q

Light green blood bottle - components & indication

A

Lithium heparin, plasma separator gel (PST)

Routine biochemistry

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18
Q

Rust top blood bottle - components & indication

A

Nothing?

Viral immunology

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19
Q

Blood culture bottle

Features, directions for use

A

Ideally >1 set taken from different sites at spaced intervals
Taken before giving Abx (unless delay)
Aseptic non touch technique
Taken before other blood samples
Minimise contamination of samples by air, commensals.

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20
Q

Blue vs purple blood culture bottle

A

Blue = Aerobic bacteria, fill first (if using vacutainer)

Purple = anaerobic

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21
Q

Indication for blood culture

A

Investigation of pyrexia
Suspected systemic sepsis

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22
Q

Indications for blood glucose monitoring kit?

A

Guide insulin dosing (T1 and some T2 DM)

Diabetic crises - DKA, HHS

Reduced GCS
Seizure

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23
Q

Indications for breast implant

A

Gender reassignment surgery
Reconstruction following mastectomy
Breast augmentation

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24
Q

Complications of breast implants

A

Rupture
Infection
Capsular contracture
Erosion through skin
Migration
Anaplastic large cell lymphoma - recent!

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25
Q

Indication for catgut suture

A

Stoma
Circumcision

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26
Q

How is catheter bag used

A

Attached to tubing that drains urine from bladder via urethra (urethral catheter) OR through small opening in abdomen (suprapubic catheter)

Collects urine

Urometer = bag + collection chamber, allows accurate recording of urine output

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27
Q

Central venous catheter

Indications

A

Central administration of medication (esp. irritants): vasopressors, inotropes, chemotherapy

Total parenteral nutrition

Access for extracorporeal circuit - renal replacement therapy

Monitoring - central venous pressure

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28
Q

Contraindications to central line insertion

A

Obstructed vein (clot)
Stenosis
Raised ICP
Severe coagulopathy
Resp failure with high FiO2
Contaminated, traumatised or burned site

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29
Q

Placement of central venous line?

A

Into SVC? via:
* Internal jugular vein
* Subclavian vein

Done under USS guidance

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30
Q

Complications of central line

A

Misplacement +/- Pneumothorax
Sepsis
Thrombosis

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31
Q

Surgical drains

Criteria for removal

A

Drainage stopped or < 25ml/day

If used for peri-operative bleeding: after 24-48 hrs

T- tube (CBD op): 6-10 days

Remove by 2cm/day to allow tract to heal

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32
Q

Uses of chest drain

A

Collect blood, fluid, pus from pleural space

  • Pneumothorax
  • pleural effusion
  • traumatic haemopneumothorax (wide bore)
  • empyema
  • post surgical
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33
Q

Types of chest drainage

A

Passive drainage - sterile water filled to “prime level” submerges drainage tube, creates underwater seal + 1-way valve, positive expiratory pressure and gravity drain pleural space (must be kept below patient)

OR attach suction to top of chest drain bottle to create active closed drainage system

Clamping + suction should only be performed under senior supervision

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34
Q

CSF Manometer - purpose?

A

Identify opening pressure during LP - gives a measure of intracranial pressure (in cm H2O)

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35
Q

Abnormal CSF manometer result?

A

Normal = 10-18cm H2O lying on side or 20-30 sat up

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36
Q

Devers rectractor - use

A

Open abdominal surgery

Retract tissues to allow surgeon to visualise and operate

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37
Q

Rigid sigmoidoscopy - use

A

Inspection of (anus), rectum and lower sigmoid

Allow biopsies to be taken of rectal mucosa e.g. UC

Decompress volvulus
Tx haemorrhoids

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38
Q

Rigid sigmoidoscope - how does it work?

A

Explain + consent pt
Attach light source and air pumping device
Patient in left lateral position
DRE performed then sigmoidoscope inserted with lubrication (pointing towards umbilicus)
Obturator removed + air insufflated to optimise view
Visual inspection for pathology

Max insertion 15-20cm

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39
Q

How does standard drainage bag work?

A

Closed passive drainage system - gravity reliant

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40
Q

Uses for standard drainage bag?

A

NG tube
Abdominal drain (post surgery or ascites)

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41
Q

Endotracheal tube - what is it

A

Definitive airway

Tube inserted into trachea via oropharynx under direct visualisation

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42
Q

How is ET tube inserted?

A

Via oropharynx
Using laryngoscope and Eschmann Tracheal tube introducer (bougie)
Balloon inflated with air through side port (blue) - maintains position, protects from aspiration
Secured with tape

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43
Q

Tracheostomy benefits

Vs ET tube intubation

A

Reduced dead space
Improved oral hygiene
Reduced sedation
Allows pt to speak (fenestrated inner cannula or speaking valve)

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44
Q

Indications for intubation

A

Decreased LOC & loss of airway reflexes (GCS < 8)
Failure to oxygenate (T1RF)
Failure to ventilate (T2RF)
Failure to maintain patent airway - angioedena, upper airway obstruction, facial/airway trauma

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45
Q

Complications of intubation

A

Early:
* Failure ‘can’t intubate, can’t ventilate’
* Trauma
* Bleeding
* Cuff perforation
* Endobronchial intubation

Late
* Tracheal necrosis
* Tracheal stenosis
* Trache-oseophageal fistula (prolonged ventilation)

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46
Q

Tracheostomy tube

A

Definitive airway

Inserted below glottis (1-2cm inferior to cricoid cartilage) - surgical or percutaneous access

Indications:
* weaning of mechanical ventilation
* severe maxillofacial trauma

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47
Q

How to check position of ET tube?

A

Symmetrical rising of chest
Breath sounds bilaterally
No gurgling over epigastrium (suggests oesophageal intubation)

Alternatives: CXR, CO2 monitor (best), aspirate

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48
Q

Oropharyngeal airway

Indications, Directions for use, Complications

A

1st line airway adjunct

Sized by measuring incisor -> angle of mandible

Insrted into mouth ‘upside down’ and rotated within oral cavity (EXCEPT CHILDREN)

Risks: vomiting, aspiration (if gag reflex present)

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49
Q

Complications of ET tube placement

A

Inappropriate placing
Injury to surrounding structures - larynx
Pneumothorax
Atelectasis
Infection

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50
Q

Indications for stool sample

A

Suspected pathogen in gut
Bristol stool chart 5, 6, 7

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51
Q

Tests that can be done on stool sample

A

MC&S - 4 days for result
Rotavirus, adenovirus, norovirus - same day
Glutamine dehydrogenase (for C diff) and C diff toxin if positive
C. Diff ribotyping - 2 weeks
Microscopy for ova, cysts, parasites - 4 days
H. Pylori antigen - 1 week

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52
Q

Indications for feeding NG tube

A

Unsafe swallow e.g. stroke
Inadequate oral intake - Anorexia nervosa

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53
Q

Fluid giving set - uses

A

Administration of IV fluids, IV medication including antibiotics, blood products

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54
Q

Forceps - difference & indications?

A

Toothed aka dissecting / Ramsay forceps = skin only

Non toothed - once inside peritoneal cavity

Held in pincer grip

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55
Q

Fracture plate - use

A

In conjunction with screws
To internally fix a fracture of bone

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56
Q

Colloid - example, indication

A

Gelofusin(e) = artificial e.g.
Blood, albumin = natural e.g.

Raise plasma oncotic pressure, expand intravascular compartment
Sepsis, hypovolaemic shock

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57
Q

Crystalloid - example

A

Hartman’s, Plasmalyte

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58
Q

Crystalloid solution - indication

A

Normal daily fluid requirement of patient
Supplement additional losses
Initial fluid resus in advanced trauma and life support guidelines

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59
Q

Hemiarthroplasty - indications

A

Intracapsular fracture of neck of femur

60
Q

Hickman line - what is it

A

Type of tunnelled central line

Has Dacron cuff = Abx infused cuff, stops infection tracking down line

Long term central venous catheter (months-yrs)

61
Q

Hickman line - how is it inserted

A

Often into subclavian via subcutaneous tunnel
Remnant of line is tunnelled subcutaneously to reduce infection risk

62
Q

Tesio line

Indications, features

A

2 x separate tunnelled catheters

Indication: haemodialysis (renal replacement therapy)

63
Q

Port-a-Cath

Indications, features

A

Lies under skin

Must only only Huber, non-coring needles (part instead fo cutting)

Indications: chemotherapy?

64
Q

VasCath

Indications, features

A

Similar to Tesio but 2 catheters are formed into 1

Indication: haemodialysis (renal replacement therapy)

65
Q

Hickman line - indications

A

Long term parenteral nutrition
Long term IV antibiotics, chemotherapy
Regular vascular access, blood sampling

?Renal replacement therapy

66
Q

Types of hip prosthesis

A

Hemiarthroplasty - single component

Total hip replacement - 2 components (femoral and acetabular)

67
Q

Total hip replacement - components

A

Femoral stem
Femoral head
Polyethylene liner
Acetabular shell

68
Q

Indications for total hip replacement

A

Elective: Severe osteoarthritis of hip

Emergency/acute: intracapsular NOF (hemi = comorbid, THR = healthier)

69
Q

Complication of total hip replacement

A

DVT
Infection
Dislocation
Osteolysis, metal sensitivity, nerve injury, chronic pain

70
Q

Histology pot - uses

A

Biopsy material, resected tumour etc.
Set in formalin for histological analysis

71
Q

Intramedullary femoral nail - uses

A

Internal fixation of femoral shaft fracture

72
Q

Intramedullary femoral nail - how is it used

A

Interlocking screws fix nail in place
Removed after 12-18 months

73
Q

Instillagel - what is it

A

Local anaesthetic and lubricant sterile gel

74
Q

Instillagel - indication

A

Insertion of male and female urinary catheter

75
Q

Cannula sizes

A

24G - yellow / 26G violet = paediatrics

22G - blue
20G - pink
Both standard on ward

16G - grey, fluid resus and trauma

76
Q

Laryngoscope - uses

A

Aid intubation
* Held in left hand
* Tip inserted into vallecula
* Light source turned on when fully extended

Also used to visualise larynx - diagnose vocal problems, strictures

77
Q

Laryngoscope - types

A

Curved blade - Mackintosh
Straight blade - Miller

78
Q

Complications of laryngoscope

A

Mild soft tissue injury
Laryngeal and pharyngeal scarring
Ulceration
Abscess formation

Esp. if by inexperienced user

79
Q

Laryngeal mask / iGel

what is it, indications

A

Supraglottic airway adjunct/device

Bridge to ET intubation (cardiac arrest)
Elective short surgery with low aspiration risk
Rescue airway in failed ET intubation

Does NOT protect against aspiration

80
Q

iGel - how does it work

A

Inserted via oropharynx (with number facing you when behind patient)
Cuff made from thermoplastic elastomer which shapes to patient perilaryngeal framework
Has separate lumen to allow passing of NG tube for gastric decompression
Can also be used as conduit to pass ET tube

81
Q

iGel - sizing?

A

Weight based
Size 2 and 3 most common

82
Q

Leg bags- what is it

A

Drainage / urine collection bag that is connected to urinary catheter and can be strapped to leg of patient

83
Q

Leg bag - indication

A

Mobile patient with short term or long term indwelling urinary catheter

84
Q

Mannitol - instructions for use

A

Use filter - crystals can form in ampoule

85
Q

Mannitol - indications

A

Lower a raised ICP (in context of trauma not malignancy)

Increase urine output in patient with obstructive jaundice - prevent hepato renal syndrome

86
Q

Diathermy - types

A

Monopolar - current flows between pen + dispersive electrode pad placed somewhere on patient

Bipolar - current flows between the two electrodes mounted on forceps, used where tissue can be grabbed from both sides

87
Q

Diathermy - uses

A

In open or laparoscopic surgery:

  • Coagulation - achieve haemostasis
  • Dissect tissues
88
Q

Self-inflatable bag-valve mask

Indications, flow rate

A

High levels of oxygen delivery (even at low-flow rate)

Cardiac arrest (prior to more definitive airway)

89
Q

Nasal cannulae

Indications, flow rate

A

1st line oxygen therapy (mild hypoxia)
* long term O2 therapy in COPD

Carries max 4-5L/min (usually 1-3)
Delivers 22-44% FiO2

90
Q

Venturi mask

Indications

A

Multiple valves of different colours allow controlled FiO2 delivery (FiO2 written on valve)

Risk of T2 respiratory failure + CO2 retention e.g. COPD

91
Q

Oxygen delivery ladder of escalation

A
  1. Nasal cannula
  2. Face mask (and venturi)
  3. Non re-breathe mask
  4. High flow nasa lcannula
  5. NIV - BiPAP, CPAP
  6. Mechnical ventilation
92
Q

Oxygen face mask

Indications, flow rate

A

O2 delivery in moderate hypoxia

Up to 10L/min
25-60% FiO2

When combined with bag + valve = non rebreathe mask
* 1st line acutely unwell pt
* up to 15L/min
* 80-85% FiO2

93
Q

Nasal cannulae - complications

A

Nasal sores, ulceration
Necrosis
Epistaxis

94
Q

Nasal speculum - uses

A

Open and expand nasal cavity
E.g. to visualise source of epistaxis

95
Q

Nasopharyngeal airway

Indications, sizing

A

Pts with decreased LOC but intact gag reflex

Diameter of tube sized against patients little finger (distal phalanx) OR by height (6 for female, 7 for male)

96
Q

Nasopharyngeal tube - how to insert

A

Inserted horizontally into nostril using rotational action

(Safety pin placed in end of tube to prevent inhalation)

97
Q

Nasopharyngeal tube - CONTRAINDICATIONS

A

Basal skull fracture
Facial trauma
Disruption of mid face, nasopharyngeal or roof of mouth
Transphenoidal or similar access surgery

Can result in cribiform insertion

Other complications: epistaxis, ulceration

98
Q

Nebuliser - components

A

Face mask
Medicine cup
Plastic tubing
Compressor

99
Q

Nebuliser - uses

A

Administration of bronchodilators for respiratory conditions e.g. salbutamol in asthma

100
Q

Needle holder - what is it/use

A

Specific type of hinged forcep
Designed to hold suture needles between teeth, used for passing needles through tissue when suturing

101
Q

General Presenting Structure

A

This is a ….[name]
It has/There are….[ description of features]
It is used for … [indications]
Common complications include ….

102
Q

Cannula

Indications, Directions for use

A

1st line for IV access for administering medication, fluids, blood products.
Can also be used to take blood (during insertion only
Aseptic non touch technique
Colour coded by gauge (diameter)

103
Q

Cannula sizing

A

Principle = use smallest size needed

  • Orange: 14G - trauma, rapid transfusion, surgery
  • Grey: 16G - trauma, rapid resus, rapid transfusion
  • Green 18G - trauma, rapid resus, rapid transfusion
  • Pink: 20G - most infusions, routine transfusion
  • Blue: 22G - most infusions, neonate/paeds, elderly
  • Yellow: 24G - as above + neonate blood transfusions
  • Purple: 26G - neonate/paeds
104
Q

Cannula - complications

A

Extravasation
Haematoma
Phlebitis
Thrombosis
Systemic infection

105
Q

Extension set/line

A

Single or multi lumen
Connects to cannula for administration of fluids, medications
Reduces risk of inadvertent cannula removal?

Directions for use: flushed & cleaned regularly, may need to be primed before initital connection to cannula?

106
Q

Central venous catheter

Directions for use

A

Inserted into (?SVC via) internal jugular, subclavian or femoral vein

Single or triple lumen

Short term use (days-weeks)

Seldinger technique

107
Q

Components of Seldinger (central line) kit

A

3-5 lumen cannula
Introducer needle
Guide wire
Dilator
Scalpel

108
Q

Types of central venous line/catheter

A

Central venous catheter

Peripherally inserted central catheter

Hickmann

Tesio

Vascath

Port-a-Cath

109
Q

Seldinger technique

Applications

A

central venous catheter
arterial access (angiography)
intra-abdominal/biliary/ureteric drainge
PEG insertion
Pacemaker lead/ICD insertion

110
Q

Seldinger technique

Process & applications

A
  1. Hollow needle inserted
  2. J-tip guidewire advanced
  3. (?Position confirmed using USS)
  4. Needle removed, leaving guidewire
  5. Sheath advanced over guidewire
  6. Sheath advanced to skin entry
  7. Guidewire & dilator removed leaving sheath/catheter
111
Q

Peripherally inserted central catheter (PICC)

Features, Directions for use

A

Inserted into basilic/cephalic veins, tip sits within Superior vena Cava (seen at cavo-atrial junction on CXR).

Medium term use (weeks - months)

112
Q

Indications for PICC

A

IV administration of medication, antibiotics, chemotherapy
Poor peripheral access

113
Q

Complications of central access

Central venosu catheter, Hickmna/Tesio, PICC

A

Immediate: haemorrhage, pneumothorax, arterial puncture, arrythmia, cardiac tamponade, air embolism.

Delayed: venous stasis, thrombosis, erosion of vessel, line fracture, catheter colonisation & line-related sepsis.

114
Q

Chest drain

Directions for use

A

Inserted into triangle of safety:
* anterior border of latissimus dorsi
* lateral border of pectoralis major
* line superior to the horizontal level of the nipple / 5th ICS
* apex below the axilla

Inserted just superior to rib to avoid neurovascular bundle

Position confirmed with CXR

115
Q

Complications of chest drain

A

Insertion related:
* Damage to nearby structures - intercostal artery, solid organ
* Subcutaneous emphysema
* Pneumothorax

Position related:
* Obstruction, kinking, dislodgement
* Re-expansion pulmonary oedema

Infection: wound, pneumonia, empyema

116
Q

Chest drain bottle movements

A

Swinging - movement of water column with respiratory cycle (up = inspiration, down = expiration)

Bubbling = air leaving pleural cavity, will stop when all air expelled

117
Q

Surgical drains

A

Tubes inserted into surgical field to allow decompression of fluid/air

Indications:
* Drainge of potential space post-op
* Removal of harmful fluid e.g. blood, pus, bile
* Detection of bleeding/leakage e.g. post-anastomosis

118
Q

Types of surgical drains

A

Open e.g. rubber, corrugates - connect to external environment, used in superficial wounds, increase risk of infection

Closed = connect via tubing to drain bottle

Active = maintained under negative presusure, improve wound closure

Passive = gravity, preffered in abdomen (less risk of visceral perforation)

119
Q

Complications of surgical drains

A

Ascending infection - more with open or passive system
Foreign body reaction - fibrosis, granuloma
Migration
Obstruction, kinking
Fistulation

120
Q

Nasogastric feeding tube

Features, Directions for use

A

Narrow bore (< 9 Fr)

Exaplain + consent pt
Lubricated and inserted via nostril whilst patient swallows
Inserted with guidewire
Position confirmed with pH of aspirate (< 4.5 but trust dependent) and/or CXR

121
Q

Indications for NG tube

A

Short/medium term feeding - max 4-6 weeks in pts with functional GI tract
Administration of drugs/contrast in unsafe swallow

122
Q

Ryles tube

A

Wide bore (16-18 Fr)
Thicker walls prevent tube collapse during aspiration
No guidewire

123
Q

Indications for Ryles tube

A

Gastric decompression
* bowel obstruction
* ileus
* post-surgery
* ?aspirating toxins

124
Q

CXR criteria for NG tube placement

A
  • Follows oeseophgagus/avoids contours of bronchi?
  • Bisects carina?
  • Cross diaphragm in midline?
  • Tip visible below let hemi diaphragm?
125
Q

Contrindications to NG tube

A

Basal skull fracture
Nasal injury
UGI stricture

126
Q

Complications of NG tube

A

Pulmonary
* Aspiration pneumonia - feeding through incorrectly sited tube
* Pneumothorax

GI
* Malposition in GI tract
* Obstruction, kinking, knotting
* Reflux oesophagitis, gastritis
* Visceral perforation - RARE

127
Q

Post-pyloric feeding

Directions for use, indications

A

Tube passed through pylorus and rests in jejunum
Endoscopic or fluoroscopic placement + confirmation

Indications:
* Gastroparesis - diabetes, critical illness
* Outlet obstruction - peptic ulcer disease, malignancy
* Recurrent aspiration
* Pancreatitis

128
Q

Urinary catheter

Directions for use, features

A

Aseptic non touch technqiue
Inserted via urethra into bladder
Balloon inflated with sterile water to secure
Drainage of urine

14-16 typical size
Latex (yellow) or silicone (transparent)
Silicone&raquo_space; if long term

Curved tip (Coude) also available, facilitates insertion past enlarged prostate

129
Q

Indications for urinary catheter

A

Urinary retention
Measurement of urine output (acute illness)
Abdominal/pelvic surgery

Neurogenic bladder - intermittent
Immobility
EOL care
Urinary incontinence
Sacral/perineal ulceration

130
Q

3-way urinary catheter

Directions for use, indications

A

Larger diameter (18 - 22)
3rd lumen allows bladder irrigation, prevents clot retention

Indications:
Visible haematuria + clots
Post bladder/prostate surgery

131
Q

Complications of urinary catheterisation

A

Immediate/early
* Urethral trauma
* Allergic reaction to material
* Balloon rupture
* Obstruction, bypass/leakage
* Bladder perforation - RARE

Delayed
* Bacteriuria/UTI
* Pyelonephritis
* Urethral stricture
* Bladder stones

132
Q

Proctoscope

Indications, directions for use

A

Inspect anus & lower rectum

Inserted as per rigid sigmoidoscope - L lateral position, DRE beforehand

  • biopsies?
  • polypectomy?
  • combined with sclerotherapy + banding (haemorrhoids Rx)
133
Q

Stoma bag

Features, indication, complication

A

Sticks to abdominal wall & collects flatus, faeces or urine.

May have filter to release wind + prevent inflation
May have deodorising component

Adhesive can cause irritation ‘stomal dermatitis’

134
Q

Scalpel

A

Formed of blade + handle

Handle = reusable or disposable

Blades = single use stainless steel, numbered by shape
* 10 blade = ‘traditional’, large cutting curve, skin incision
* 11 = pointed apex, puncturing movement
* 15 = smaller cutting surface, delicate

135
Q

Laparoscopic trocar

A

Create entry ports in laparoscopic procedures
Inserted via Veress needle, Hasson technique etc.
Once 1st port places + pneumoperitoneum established, further post inserted under direct vision

Risk = perforation/damage to viscera (1st port = highest risk as inserted ‘blind’)

136
Q

Pneumoperitoneum (in surgery)

A

Achieved with CO2

Inert, soluble in blood & tissues, rapidly cleared by expiration

137
Q

TED stocking

A

Graduated compression (maximum distally)

DVT prophylaxis, used in:
* patients undergoing surgery
* immobile pts
* can be combined with LMWH

138
Q

Contraindications to TEDs

A

Severe pepheral vascular disease
Severe skin breakdown - ulcers, infection

139
Q

Intermittent pneumatic compression

Features, indications

A

Inflatable sleeves, typically wrapped around calves
Inflated one side at a time

Reduce risk of venous stasis & VTE
* intra-operatively?
* post abdo-ortho surgery
* post-stroke

140
Q

Contraindications to Intermittent Pneumatic compression

A

Severe peripheral vascular disease or skin breakdown (ulcers, infection)

141
Q

Stiff Cervical Collar

A

Stabilising cervical spine in trauma patient

Forms part of triple immobilisation: collar, x2 sand bags, tape

Sized by measuring no. fingers from clavicle- angle of mandible (compare this with peasuring peg on collar)

142
Q

Trucut biopsy needle

A

Take specimens from lesions e.g. breast lump, liver for histological analysis

Can be performed under local anaesthetic

143
Q

Tesio line

A

2 x separate tunnelled catheters

Indication: haemodialysis (renal replacement therapy)

144
Q

Types of spinal needle

A

Traumatic
* ‘cutting’ needle
* Higher risk of post-LP headache

Atraumatic
* ‘pencil point’ needle
* allow blunt dissection of anatomy not cutting)

145
Q

Use of urine dip

A

Acute clinical or primary care setting

Identification of:
Micro-macroscopic haematuria
Proteinuria
Nitrites
Leucocytes
Glucose
Ketones
Bilirubin, urobilinogen

146
Q

Specimen swabs

Types, indication

A

Sterile swabs

MRSA screening - nasopharyngeal, rectal
Bluetop Transwab Amies - aerobes, anaerobes, fastidious organisms

147
Q

Epidural vs spinral anaesthesia

A

Epi:
* high volume
* slow onset (25-30m)
* no significant NM block (can move legs)
* continuous infusion
* Uses: C-section, labour

Spinal:
- low volume
- fast onset (< 5 mins)
- significant NM block
- single dose
- given only at L3/4
- Uses: knee replacement, abdo surg if resp disease?

Finals - PACES (9 decks)

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