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YR6 Images + Instruments > Instruments for PACES station > Flashcards

Instruments for PACES station Flashcards

1
Q

What is this?

A

Absorbable sutures

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2
Q

What are absorbable sutures broken down by?

A

Physiological processes: enzymatic degradation + hydrolysis
Clinical status e.g. sepsis can affect rate of absorption

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3
Q

Compare the 2 types of absorbable sutures

A

Monocryl: monofilament, increased throws for stable knot (5-7).

Vicryl: polyfilament is braided; so is less likely to loosen at the surgical knot, less throws (3)

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4
Q

What does the tensile strength of sutures depend on?

A

Diameter of thread
The more 0’s the finer the thread

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5
Q

What are the disadvantages of vicryl sutures?

A

Increased fraying issues
Additional trauma + local tissue inflammation: Generate high friction + drag
Increased infection risk (gaps between strands + capillarity)

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6
Q

What is this?

A

Arterial blood gas syringe

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7
Q

What information do you get from an ABG?

A

pH
pO2 + pCO2: for identification of resp failure (arterial)
Bicarbonate
Lactate
Hb
Na+/K+

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8
Q

What does the purple blood bottle contain, and what is it used for?

A

EDTA
Haematology

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9
Q

What does the pink blood bottle contain and what is it used for?

A

EDTA
Group + Save and cross match

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10
Q

What does the blue bottle contain and what is it used for?

A

Buffered sodium citrate
Used for coagulation screening

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11
Q

What does the yellow/ gold blood bottle contain and what is it used for?

A

Silica particles + serum separating gel
Used for tests that require separated serum for analysis inc. immunology, microbiology, biochemistry, endocrinology, toxicology, oncology, U+E’s + LFT

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12
Q

What does the grey blood bottle contain and what is it used for?

A

Sodium fluoride + potassium oxalate

Used for glucose + lactate

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13
Q

What does the red blood bottle contain and what is it used for?

A

Silica particles
Sensitive tests eg toxicology, drug levels, antibodies, hormones, bacterial + viral serology

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14
Q

What does the dark green blood bottle contain and what is it used for?

A

Sodium heparin
Used for ammonia, renin, aldosterone + insulin tests

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15
Q

What does the light green blood bottle contain and what is it used for?

A

Lithium heparin + plasma separator gel
Used for routine biochemistry

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16
Q

What is the rust top blood bottle used for?

A

Viral immunology

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17
Q

What are these?

A

Blood culture bottles
Aerobic = Blue top (fill first)
Anaerobic = Purple top

Blue = Before

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18
Q

What is this? What is it used for?

A

Blood glucose monitoring kit
Test real-time capillary blood glucose

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19
Q

Give 2 examples of how blood glucose monitoring kits are used

A

Patients use to guide insulin dosing

Acutely to guide Tx in diabetic crises, such as DKA, non-ketotic hyperglycaemia, hypoglycaemia + reduced GCS

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20
Q

What are these? What are they made from? How long do they last?

A

Breast implants
Round or anatomical shaped
Made from silicone
Last ~10-15y

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21
Q

Recall 6 possible complications of breast implants

A

Rupture (last 10-15y, may rupture after this)
Infection
Capsular contracture
Erosion
Migration
ALCL (anaplastic large cell lymphoma)

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22
Q

What is this, and when might it be used?

A

Catgut suture
Natural absorbable suture
Rarely used nowadays but sometimes still used in formation of stomas + circumcision

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23
Q

What is this?

A

Catheter bag
Urethral or Suprapubic

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24
Q

What is this? List the contents

A

Seldinger central line insertion pack:
3-5 lumen cannula
Guide wire
Dilator
Scalpel
Introducer needle

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25
Q

Which veins might a central line be inserted into?

A

Subclavian
Internal jugular

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26
Q

What can central lines be used for?

A
  1. Delivery of medications/ fluids that may be harmful orally or peripherally
  2. Blood tests + central venous pressures
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27
Q

Give 4 indications for a central line

A

Parenteral nutrition
Emergency venous access
Fluid resuscitation
Infusion of irritant drugs, vasopressors, inotropes

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28
Q

Recall 4 possible complications of central line insertion

A

Pneumothorax
Sepsis
Thrombosis
Misplacement

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29
Q

What is this?

A

Chest drain bottle

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30
Q

Give 6 indications for a chest drain

A

Pleural effusion
Pneumothorax
Haemothorax
Empyema
Talc pleurodesis
Post-thoracic cavity procedures e.g. cardiac surgery

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31
Q

What are the 2 types of chest drain bottle?

A

Passive drainage system: employs a positive expiratory pressure and gravity to drain the pleural space, helps recreate a -ve pressure in the pleural space (Contains a small amount of water)

Active closed drainage system: delivers suction (to help the lung re-expand), allows to measure if there is any ongoing air leak between the lung + pleural cavity.

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32
Q

Where does the chest drain act?

A

It drains air/ blood/ pus etc from the pleural space

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33
Q

What can be seen once a chest drain has been inserted?

A

Bubbling as air leaves pleural space

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34
Q

Instructions to pt about chest drain?

A
  • Bottle must always be below level of waist
  • May be asked to cough so HCP can check if it’s working
  • You will have a waterproof dressing over the suture site
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35
Q

What is this?

A

CSF manometer

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36
Q

What is a CSF manometer used for?

A

Identification of opening pressures- represent intracranial pressure in LP

Measurement is in cm H2O

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37
Q

What are the ranges of normal opening pressures on LP?

A

10-18cm H2O lying on their side

20-30cm H2O when sat up

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38
Q

What is this and what is it used for?

A

Devers retractor

Retraction in abdominal surgery

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39
Q

What is this? What is it used for?

A

Diathermy (monopolar)
Coagulation + dissection of tissue

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40
Q

What are the possible complications of diathermy?

A
  • Risk of burning hands
  • Risk of fire if alcohol wash used
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41
Q

What is this? What is it used for?

A

Disposable rigid sigmoidoscope
Inspection of rectum + lower sigmoid colon
Can take biopsies of rectal mucosa

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42
Q

Describe use of disposable rigid sigmoidoscope

A

Light source + air pumping device attached
Patient in left lateral position
Lubricate scope
Insert pointing towards umbilicus
Air pumped into rectum to allow visualisation of lumen

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43
Q

What is this?

A

Drainage bag that may be attached to NG tube/ abdo drain
(closed passive drainage system, relies on gravity)

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44
Q

What is this? When is it used?

A

Endotracheal tube with tape and syringe
= definitive airway
used in trauma cases, surgery with GA + patients with GCS <8

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45
Q

How is an endotracheal tube inserted?

A

Using a laryngoscope + Eschmann Tracheal Tube Introducer (ETTI aka bougie)
Balloon at end inflated with air through blue side port to maintain position + protect from aspiration
Tape secures the airway
Connected to O2 + ensures adequate gaseous exchange

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46
Q

How is positioning of an endotracheal tube checked?

A

Looking for symmetrical rising of the chest on ventilation, breath sounds bilaterally + no gurgling over the epigastrium indicating oesophageal intubation

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47
Q

List 5 complications of endotracheal tube usage

A

Inappropriate placing (oesophageal)
Injury to larynx
Pneumothorax
Atelectasis
Infection

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48
Q

What is this?

A

Epidural insertion pack (needle, catheter, catheter adaptor)

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49
Q

What type of needle is used for epidurals?

A

Touhy needle with clear depth marking for accurate insertion depth reading

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50
Q

What is the epidural catheter specially designed for?

A

Short + long term anaesthesia + pain relief
Adaptor for safe + secure attachment to catheter for convenience of procedure

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51
Q

What is this?

A

Faeces sample pot

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52
Q

What tests can be used on a stool sample? How long does it take for results to come back?

A

MCS: up to 4d
Rotavirus/ Adenovirus/ Norovirus: same day
Glutamine Dehydrogenase (GDH): C.diff
C.DIff Toxin test: only performed if GDH +ve
C.Difficile ribotyping: up to 2w
Microscopy for Ova, Cysts + parasites: 4d
Helicobacter antigen testing: up to 1w

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53
Q

What is this? What is it used for?

A

Feeding NG tube (clinifeed tube)
Long term enteral nutrition

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54
Q

How is a feeding NG tube specially designed?

A

Thin bore + soft: more comfortable
Silastic: blocks less often

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55
Q

How is an NG tube inserted? How is correct positioning checked?

A

Lubricate tube
Wire inside aids introduction
Advance tube as patient swallows
Position checked with XR for wire
Wire removed if in correct position + feed attached

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56
Q

What is this?

A

5% dextrose solution

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57
Q

What does 1L of 5% detrose contain?

A

50g dextrose in 1L water
Sugar in the fluid is metabolised to CO2 + water, you are essentially giving them water

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58
Q

What is this?

A

Fluid giving set

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59
Q

What are these?

A

Toothed Forceps (bottom)
Non-toothed Forceps (top)

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60
Q

What are dissecting forceps often known as? What are they used for?

A

Ramsay Forceps
Used for grasping tissue
General rules:
* tooth only used for skin
* in peritoneal cavity, only non-tooth used

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61
Q

What is this?

A

Fracture plate
Used in conjunction with screws to interally fix a bone fracture

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62
Q

What is this? What is it an example of? When are these useful?

A

Gelofusin (artificial colloid)
Colloids raise plasma oncotic pressure + expand intravascular compartment
Natural: blood + albumin
Useful in shock due to sepsis/ hypovolaemia

63
Q

What is this? What is it an example of? When is this used?

A

Hartmann/ Plasmalyte Solution (crystalloid solution)

Similar composition to extracellular fluid, contains sodium, chloride, bicarbonate + lactate

Provide normal daily fluid requirements/ supplement loses

Given initially in trauma

64
Q

What is this?

A

Hemiarthroplasty
(hip prosthesis)

65
Q

What is a hemiarthroplasty used for?

A

Cases of intracapsular fractures of the NOF (avascular necrosis of femoral head is a common complication)

66
Q

What is this? How is it inserted?

A

Hickman line: long term central venous line
Inserted in similar way to central line (usually subclavian)
Remnant of line tunnelled subcutaneously; decreases risk of line infection

67
Q

What is a Hickman line most often used for?

A

Long term parenteral nutrition/ IV abx therapy/ chemotherapy

68
Q

What is this? What does this consist of?

A

Total hip replacement
2 distinct parts:
1. Femoral stem with femoral head
2. Polyethylene acetabular cap that is inserted into the acetabulum

69
Q

Give an indication for a total hip joint replacement.
List 3 complications of THR

A

Severe osteoarthritis
DVT
Infection
Dislocation

70
Q

What is this?

A

Histology specimen pot

71
Q

What is placed in histology specimen pots? Why are these significant?

A

Biopsies
Resected tumours
Ensuring correct labelling forms part of WHO “sign out” checklist

72
Q

What is this? What is it used for?

A

IM femoral nail
Used to internally fix femoral shaft fractures

73
Q

How do IM femoral nails stay in place? For how long?

A

Interlocking screws fix nail
Removed after 12-18 months

74
Q

What is this? What is it used for?

A

Instillagell: sterile gel containing LA + lubricant gel
Used for catheterisation

75
Q

Recall the guage of blue, pink and grey IV cannulas

A

Blue = 22G (wards)
Pink = 20G (wards)
Grey = 16G (fluid resus + trauma)

76
Q

How do you interpret cannula size?

A

The smaller the gauge size, the larger the diameter
Determined by how many cannulae fit into a tube with inner diameter 1 inch

77
Q

Describe the cannula you need to use to give fluid quickly

A

Short + large bore

78
Q

What is this? What is it used for?

A

Laparoscopic port
Used to insert a telescope + instruments into the patient

79
Q

What is this? What is it used for? What are the different types?

A

Laryngoscope
Used to aid intubation, visualisation of larynx + aid dx of vocal problems + strictures
Different blades: curved (Macintosh- seen here) + straight (Miller)

80
Q

Give 4 complications of laryngoscope use

A

Mild soft tissue injury
Laryngeal + pharyngeal scarring
Ulceration
Abscess formation

81
Q

What is this?

A

Laryngeal mask airway (LMA)

82
Q

What are these?

A

Airway adjuncts (i Gels) = supraglottic

83
Q

What are laryngeal airway masks and iGels used for?

A

Supraglottic airway devices used as a step prior to intubation
Good for elective procedures, cardiac arrests + pre-hospital airway Mx

84
Q

Name a benefit of using laryngeal airway masks and iGels

A

Reduced trauma to oropharynx (seen with intubation)
Therefore reduce length of hospital stay in elective patients

85
Q

What is the main difference in function between a laryngeal airway and an iGel?

A

LMA has an inflatable cuff whereas iGels contain a thermoplastic elastomer (styrene) that moulds to the perilaryngeal framework with patient temperature

iGel seals off oropharyngeal opening from the larynx helping protect against aspiration.
LMA does not protect against aspiration

86
Q

Name 2 benefits of the designs of iGels

A

Gastric channel: allows passing of NG tube for gastric emptying
Can be used as a conduit for intubation

87
Q

Recall 2 risks of laryngeal airways

A

Inflation can cause pressure lesions + nerve palsies

88
Q

What is this and what is it used for?

A

Leg bag
For mobile patients with catheters

89
Q

What is mannitol? Recall 2 uses for mannitol

A

Osmotic diuretic
1. Lower raised ICP
2. Drive the urine output in a patient with obstructive jaundice to prevent hepato renal syndrome.

90
Q

How much oxygen can be delivered by nasal cannulae? What do nasal cannulae differ from?

A

Usually used to carry 1-3L of oxygen per minute (can be upto 5L/min)
This delivers between 28-44% of oxygen

Differ from high flow therapy (NIV)

91
Q

Recall 2 complications of nasal cannulae. What are patients advised to avoid these?

A

Nasal sores
Epistaxis
Use water-based creams to moisturise

92
Q

What is this and what is it used for?

A

Nasal speculum: open + expand nasal cavity for examining inside nose

Thudichum Nasal Speculum

93
Q

What is this and what is it used for?

A

Nasopharyngeal airway
Used as an airway in people with decreased GCS/ decreased gag reflex

94
Q

How should nasopharyngeal airway be sized and inserted?

A

Diameter should be sized against patient’s own diameter of little finger distal phalanx
Length should be determined by measuring from tip of nose to earlobe
Insert into nose with rotational action

95
Q

What is one important contraindication for nasopharyngeal airway?

A

Suspected basal skull fracture

96
Q

How do you prevent inhalation of nasopharyngeal airway?

A

Put a safety pin at the end

97
Q

What is this? What is it used for?

A

Nebuliser mask and chamber
Used to administer all commonly prescribed bronchodilators for respiratory conditions
Aerosol drug effectiveness depends on quality of delivery to the

98
Q

What are these?

A

Needle holders

99
Q

What is this? Describe the function of each piece

A

128 Hz tuning fork: Vibration for joints
512 Hz tuning fork: Weber’s + Rinne’s
Neurotips for blunt/ sharp sensation
Orange stick: Babinski reflex
Tendon hammer: reflexes

Others may include: Snellen chart, opthalmoscope + tongue depressor

100
Q

Neurology: What size tuning fork is used for vibration of joints vs Rinne’s and Weber’s?

A

Joints: 128 Hz
Rinne’s/ Weber’s: 512 Hz

101
Q

What are these? Name another example

A

Ethilon (nylon) non-absorbable sutures: monofilament
Require 9 throws to maintain strong knot

Prolene

102
Q

What are non-absorbable ethilon sutures usually used for and why?

A

Percutaneous wound closure as more likely to loosen over time than prolene non-absorbable sutures

103
Q

Recall 2 uses of prolene sutures

A

Vascular anastamosis
Bowel anastamosis

104
Q

What is this? What is it used for an when?

A

Non rebreather mask (NRB)
Used in delivery of O2 therapy
It requires patient can breathe unassisted

105
Q

What is the flow rate of a non-rebreather mask and what % oxygen can it deliver?

A

10-15 L/min
Up to 90% oxygen

106
Q

What do non-rebreather masks attach to?

A

External oxygen tank
Bulk oxygen supply system

107
Q

What type of solution is normal saline?

A

Crystalloid

108
Q

What is this? When is it used?

A

Oropharyngeal airway
Used to provide an airway for a patient where there is impaired consciousness

109
Q

How should oropharyngeal airways be sized?

A

Measure size from angle of mouth to angle of mandible

110
Q

How should oropharyngeal airways be inserted?

A

Upside down then rotated (apart from in children, where it is inserted the right way up)

111
Q

What is this?

A

Peripheral IV Central Catheter (PICC) line

Inserted peripherally + advanced into a central vein

112
Q

Recall 3 uses of PICC lines

A
  1. Long-term vascular access for blood sampling
  2. Chemotherapy administration
  3. Infusion of hyperosmolar solutions e.g. those used for total parenteral nutrition
113
Q

What is this? What is it used for?

A

Proctoscope
Used to visualise anal canal + lower rectum
Used when injecting or banding haemorrhoids

114
Q

What is this?

A

Ryles NG tool

115
Q

What is a Ryles NG tool used for?

A
  • Primarily used for drip + suck
  • Can also be used to insert drugs or contrast into the GIT
116
Q

How is position of Ryles NG tube checked?

A

Aspirate gastric contents; check for acidity on dipstick

XR

117
Q

What is this? What are the 2 types?

A

Scalpel
Disposable
Non-disposable (blade changed)

118
Q

What is this?

A

Seldinger chest drain insertion pack

119
Q

List 4 indications for use of seldinger chest drain insertion

A

PTX: in ventilated patient. tension PTX after needle relief, persistent PTX or large spontaneous PTX

Symptomatic malignant pleural effusions

Empyema

Traumatic haemothorax

120
Q

What is this and what is it used for?

A

Self-retaining retractor

Holds wounds open for surgery

121
Q

What is this? What is it useful for?

A

Self-inflatable bag valve mask
Useful for delivering high levels of O2 even at low flow rates

122
Q

How much oxygen can a bag valve mask deliver?

A

100% oxygen at >10L/min

123
Q

What is this?

A

Shouldered syringe

124
Q

What is a shouldered syringe used for?

A

Injection of haemorrhoids with 5% phenol in almond oil

Injection aided by protoscope
Performed above dentate line as it is insensitive

125
Q

What is this? What is it made of and used for?

A

Silastic Urinary Catheter
Made of silicone
More appropriate than latex for long term catheterisation

126
Q

What is this?

A

Single lumen central venous catheter
Used for measuring central venous pressure + administration of drugs

127
Q

Recall 3 drugs/ drug classes that need to be inserted via a central line

A

Amiodarone
Chemotherapy
Dopamine

128
Q

What are these?

A

Specimen swabs
Bluetop: recover aerobes, anaerobes + fastidious organisms

129
Q

What are these?

A

Spinal needles

130
Q

What are these each used for?

A

Top: Traumatic needle “cutting” for epidural.
Higher risk post-LP headaches/ severe headaches that may require blood patching

Bottom: ‘pencil top’ (atraumatic) needle ; blunt tipped, allow for blunt dissection rather than cutting. Needle of choice for LP as much lower risk of post-LP headache + backache

131
Q

What is this and how is it used?

A

Stiff neck cervical collar

Used in conjunction with 2 sand bags + tape to immobilise neck in trauma patients (triple immobilisation)

132
Q

How are stiff neck cervical collars sized?

A

By measuring the number of fingers from the clavicle to the angle of the mandible
This is then compared to the measuring peg on the stiff neck collar

133
Q

What is this? Recall 3 associated procedures

A

Stoma bag; collects waste from surgically diverted bowel
Ileostomy, colostomy or ileal conduit

134
Q

What is this? When is it used?

A

Surgical chest drain
(Thoracostomy)

Used as emergency procedure

135
Q

Give 5 indications for a surgical chest drain

A

Pneumothorax
Malignant pleural effusion
Empyema
Traumatic pneumo-/ haemothorax
Peri-operative

136
Q

What is this?

A

Swan-Ganz catheter

137
Q

What can Swan Ganz catheters be used to measure?

A

Pressures in heart
Pulmonary artery wedge pressure (PAWP)
Cardiac output

Used in intensive care setting

138
Q

What is this? What is it used for?

A

Synthetic absorbable suture
Used for bowel anastomosis or tying off vessels

139
Q

What are these? In which patients should they be used?

A

TED Stocking
(Thromboembolic deterrent)
Used in all patients undergoing surgery + those who are immobile to prevent DVTs

Used in conjunction with low dose SC heparin

140
Q

In which patients are TEDS contraindicated?

A

Patients with arterial disease of the lower limb

141
Q

What is this? What type of airway does this provide?

A

Tracheostomy
Definitive airway as protects lungs from aspiration

142
Q

Give 3 benefits/ uses of tracheostomies

A

Allow more efficient ventilation with decreased dead space
More effective suctioning of airways
Can be used in upper airway obstruction/ after laryngeal surgery

143
Q

What is this?

A

Triple lumen central venous catheter

144
Q

What is this and what is it used for?

A

Trucut needle
Used to take histological specimens from lesions
Can be performed under LA

145
Q

What are these?

A

Urinary catheters
LHS: Long-term, usually silicone (up to 3 months)
Centre: Foley, short-term (up to 28 days)
RHS: three-way

146
Q

What is this and what is it used for?

A

Three way catheter
Used in haematuria for bladder washout + irrigation
Larger diameter required due to containing 3 lumens

147
Q

What is this? What does each element indicate?

A

Urine dip + universal sterile container
Blood: microscopic/ macroscopic haematuria
Protein: Renal disease
Nitrites: Active infection
Leukoyctes: Inflammatory processes
Glucose: Diabetes
Ketones: DKA
BR + Urobilinogen: Haemolysis + liver pathology

148
Q

What urine dip results warrant sending for MC+S?

A

Positive Nitrites + Leukocytes

149
Q

What urine dip results warrant sending for urine protein : creatinine ratio?

A

Positive blood + protein

150
Q

What is this and what is it used for?

A

Urometer drainage bag
Measures urine output
Used during surgery, post-op + to monitor fluid status

151
Q

What is this? What does it do?

A

Venturi mask and valves
Delivers 24-60% O2
Flow rate varies depending on colour

152
Q

Recall the flow rate and % oxygen for each venturi valve (blue, white, yellow, red + green)

A

BLUE = 2-4 L/min = 24% O2
(Blue rhymes with two, 2-4L –> 24%)

WHITE = 4-6L/min = 28% O2
(White = 5 letters = 4-6L/min)

YELLOW = 8-10L/min = 35% O2
(Yellow is a happy colour= on cloud 9= 8-10L/min)

–RED = 10-12L/min = 40% O2
(Red = colour of raspberries = 11 letters = 10-12L/min)

GREEN = 12-15L/min = 60% O2
(Green rhymes with fifteen)

153
Q

In what clinical scenario are venturi masks often used?

A

In COPD where it is important not to over-oxygenate the patient

154
Q

VAC drain?

A

YR6 Images + Instruments (21 decks)

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