Instruments for PACES station Flashcards
1
Q
What is this?
A
Absorbable sutures
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
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)
4
Q
What does the tensile strength of sutures depend on?
A
Diameter of thread
The more 0’s the finer the thread
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)
6
Q
What is this?
A
Arterial blood gas syringe
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+
8
Q
What does the purple blood bottle contain, and what is it used for?
A
EDTA
Haematology
9
Q
What does the pink blood bottle contain and what is it used for?
A
EDTA
Group + Save and cross match
10
Q
What does the blue bottle contain and what is it used for?
A
Buffered sodium citrate
Used for coagulation screening
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
12
Q
What does the grey blood bottle contain and what is it used for?
A
Sodium fluoride + potassium oxalate
Used for glucose + lactate
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
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
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
16
Q
What is the rust top blood bottle used for?
A
Viral immunology
17
Q
What are these?
A
Blood culture bottles
Aerobic = Blue top (fill first)
Anaerobic = Purple top
Blue = Before
18
Q
What is this? What is it used for?
A
Blood glucose monitoring kit
Test real-time capillary blood glucose
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
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
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)
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
23
Q
What is this?
A
Catheter bag
Urethral or Suprapubic
24
Q
What is this? List the contents
A
Seldinger central line insertion pack:
3-5 lumen cannula
Guide wire
Dilator
Scalpel
Introducer needle
25
Which veins might a central line be inserted into?
Subclavian
Internal jugular
26
What can central lines be used for?
1. Delivery of medications/ fluids that may be harmful orally or peripherally
2. Blood tests + central venous pressures
27
Give 4 indications for a central line
Parenteral nutrition
Emergency venous access
Fluid resuscitation
Infusion of irritant drugs, vasopressors, inotropes
28
Recall 4 possible complications of central line insertion
Pneumothorax
Sepsis
Thrombosis
Misplacement
29
What is this?
Chest drain bottle
30
Give 6 indications for a chest drain
Pleural effusion
Pneumothorax
Haemothorax
Empyema
Talc pleurodesis
Post-thoracic cavity procedures e.g. cardiac surgery
31
What are the 2 types of chest drain bottle?
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.
32
Where does the chest drain act?
It drains air/ blood/ pus etc from the pleural space
33
What can be seen once a chest drain has been inserted?
Bubbling as air leaves pleural space
34
Instructions to pt about chest drain?
- 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
35
What is this?
CSF manometer
36
What is a CSF manometer used for?
Identification of opening pressures- represent intracranial pressure in LP
Measurement is in cm H2O
37
What are the ranges of normal opening pressures on LP?
10-18cm H2O lying on their side
20-30cm H2O when sat up
38
What is this and what is it used for?
Devers retractor
Retraction in abdominal surgery
39
What is this? What is it used for?
Diathermy (monopolar)
Coagulation + dissection of tissue
40
What are the possible complications of diathermy?
- Risk of burning hands
- Risk of fire if alcohol wash used
41
What is this? What is it used for?
Disposable rigid sigmoidoscope
Inspection of rectum + lower sigmoid colon
Can take biopsies of rectal mucosa
42
Describe use of disposable rigid sigmoidoscope
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
43
What is this?
Drainage bag that may be attached to NG tube/ abdo drain
(closed passive drainage system, relies on gravity)
44
What is this? When is it used?
Endotracheal tube with tape and syringe
= definitive airway
used in trauma cases, surgery with GA + patients with GCS <8
45
How is an endotracheal tube inserted?
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
46
How is positioning of an endotracheal tube checked?
Looking for symmetrical rising of the chest on ventilation, breath sounds bilaterally + no gurgling over the epigastrium indicating oesophageal intubation
47
List 5 complications of endotracheal tube usage
Inappropriate placing (oesophageal)
Injury to larynx
Pneumothorax
Atelectasis
Infection
48
What is this?
Epidural insertion pack (needle, catheter, catheter adaptor)
49
What type of needle is used for epidurals?
Touhy needle with clear depth marking for accurate insertion depth reading
50
What is the epidural catheter specially designed for?
Short + long term anaesthesia + pain relief
Adaptor for safe + secure attachment to catheter for convenience of procedure
51
What is this?
Faeces sample pot
52
What tests can be used on a stool sample? How long does it take for results to come back?
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
53
What is this? What is it used for?
Feeding NG tube (clinifeed tube)
Long term enteral nutrition
54
How is a feeding NG tube specially designed?
Thin bore + soft: more comfortable
Silastic: blocks less often
55
How is an NG tube inserted? How is correct positioning checked?
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
56
What is this?
5% dextrose solution
57
What does 1L of 5% detrose contain?
50g dextrose in 1L water
Sugar in the fluid is metabolised to CO2 + water, you are essentially giving them water
58
What is this?
Fluid giving set
59
What are these?
Toothed Forceps (bottom)
Non-toothed Forceps (top)
60
What are dissecting forceps often known as? What are they used for?
Ramsay Forceps
Used for grasping tissue
General rules:
* tooth only used for skin
* in peritoneal cavity, only non-tooth used
61
What is this?
Fracture plate
Used in conjunction with screws to interally fix a bone fracture
62
What is this? What is it an example of? When are these useful?
Gelofusin (artificial colloid)
Colloids raise plasma oncotic pressure + expand intravascular compartment
Natural: blood + albumin
Useful in shock due to sepsis/ hypovolaemia
63
What is this? What is it an example of? When is this used?
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
What is this?
Hemiarthroplasty
(hip prosthesis)
65
What is a hemiarthroplasty used for?
Cases of intracapsular fractures of the NOF (avascular necrosis of femoral head is a common complication)
66
What is this? How is it inserted?
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
What is a Hickman line most often used for?
Long term parenteral nutrition/ IV abx therapy/ chemotherapy
68
What is this? What does this consist of?
Total hip replacement
2 distinct parts:
1. Femoral stem with femoral head
2. Polyethylene acetabular cap that is inserted into the acetabulum
69
Give an indication for a total hip joint replacement.
List 3 complications of THR
Severe osteoarthritis
DVT
Infection
Dislocation
70
What is this?
Histology specimen pot
71
What is placed in histology specimen pots? Why are these significant?
Biopsies
Resected tumours
Ensuring correct labelling forms part of WHO "sign out" checklist
72
What is this? What is it used for?
IM femoral nail
Used to internally fix femoral shaft fractures
73
How do IM femoral nails stay in place? For how long?
Interlocking screws fix nail
Removed after 12-18 months
74
What is this? What is it used for?
Instillagell: sterile gel containing LA + lubricant gel
Used for catheterisation
75
Recall the guage of blue, pink and grey IV cannulas
Blue = 22G (wards)
Pink = 20G (wards)
Grey = 16G (fluid resus + trauma)
76
How do you interpret cannula size?
The smaller the gauge size, the larger the diameter
Determined by how many cannulae fit into a tube with inner diameter 1 inch
77
Describe the cannula you need to use to give fluid quickly
Short + large bore
78
What is this? What is it used for?
Laparoscopic port
Used to insert a telescope + instruments into the patient
79
What is this? What is it used for? What are the different types?
Laryngoscope
Used to aid intubation, visualisation of larynx + aid dx of vocal problems + strictures
Different blades: curved (Macintosh- seen here) + straight (Miller)
80
Give 4 complications of laryngoscope use
Mild soft tissue injury
Laryngeal + pharyngeal scarring
Ulceration
Abscess formation
81
What is this?
Laryngeal mask airway (LMA)
82
What are these?
Airway adjuncts (i Gels) = supraglottic
83
What are laryngeal airway masks and iGels used for?
Supraglottic airway devices used as a step prior to intubation
Good for elective procedures, cardiac arrests + pre-hospital airway Mx
84
Name a benefit of using laryngeal airway masks and iGels
Reduced trauma to oropharynx (seen with intubation)
Therefore reduce length of hospital stay in elective patients
85
What is the main difference in function between a laryngeal airway and an iGel?
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
Name 2 benefits of the designs of iGels
Gastric channel: allows passing of NG tube for gastric emptying
Can be used as a conduit for intubation
87
Recall 2 risks of laryngeal airways
Inflation can cause pressure lesions + nerve palsies
88
What is this and what is it used for?
Leg bag
For mobile patients with catheters
89
What is mannitol? Recall 2 uses for mannitol
Osmotic diuretic
1. Lower raised ICP
2. Drive the urine output in a patient with obstructive jaundice to prevent hepato renal syndrome.
90
How much oxygen can be delivered by nasal cannulae? What do nasal cannulae differ from?
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
Recall 2 complications of nasal cannulae. What are patients advised to avoid these?
Nasal sores
Epistaxis
Use water-based creams to moisturise
92
What is this and what is it used for?
Nasal speculum: open + expand nasal cavity for examining inside nose
| Thudichum Nasal Speculum
93
What is this and what is it used for?
Nasopharyngeal airway
Used as an airway in people with decreased GCS/ decreased gag reflex
94
How should nasopharyngeal airway be sized and inserted?
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
What is one important contraindication for nasopharyngeal airway?
Suspected basal skull fracture
96
How do you prevent inhalation of nasopharyngeal airway?
Put a safety pin at the end
97
What is this? What is it used for?
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
What are these?
Needle holders
99
What is this? Describe the function of each piece
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
Neurology: What size tuning fork is used for vibration of joints vs Rinne's and Weber's?
Joints: 128 Hz
Rinne's/ Weber's: 512 Hz
101
What are these? Name another example
Ethilon (nylon) non-absorbable sutures: monofilament
Require 9 throws to maintain strong knot
Prolene
102
What are non-absorbable ethilon sutures usually used for and why?
Percutaneous wound closure as more likely to loosen over time than prolene non-absorbable sutures
103
Recall 2 uses of prolene sutures
Vascular anastamosis
Bowel anastamosis
104
What is this? What is it used for an when?
Non rebreather mask (NRB)
Used in delivery of O2 therapy
It requires patient can breathe unassisted
105
What is the flow rate of a non-rebreather mask and what % oxygen can it deliver?
10-15 L/min
Up to 90% oxygen
106
What do non-rebreather masks attach to?
External oxygen tank
Bulk oxygen supply system
107
What type of solution is normal saline?
Crystalloid
108
What is this? When is it used?
Oropharyngeal airway
Used to provide an airway for a patient where there is impaired consciousness
109
How should oropharyngeal airways be sized?
Measure size from angle of mouth to angle of mandible
110
How should oropharyngeal airways be inserted?
Upside down then rotated (apart from in children, where it is inserted the right way up)
111
What is this?
Peripheral IV Central Catheter (PICC) line
Inserted peripherally + advanced into a central vein
112
Recall 3 uses of PICC lines
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
What is this? What is it used for?
Proctoscope
Used to visualise anal canal + lower rectum
Used when injecting or banding haemorrhoids
114
What is this?
Ryles NG tool
115
What is a Ryles NG tool used for?
- Primarily used for drip + suck
- Can also be used to insert drugs or contrast into the GIT
116
How is position of Ryles NG tube checked?
Aspirate gastric contents; check for acidity on dipstick
XR
117
What is this? What are the 2 types?
Scalpel
Disposable
Non-disposable (blade changed)
118
What is this?
Seldinger chest drain insertion pack
119
List 4 indications for use of seldinger chest drain insertion
PTX: in ventilated patient. tension PTX after needle relief, persistent PTX or large spontaneous PTX
Symptomatic malignant pleural effusions
Empyema
Traumatic haemothorax
120
What is this and what is it used for?
Self-retaining retractor
Holds wounds open for surgery
121
What is this? What is it useful for?
Self-inflatable bag valve mask
Useful for delivering high levels of O2 even at low flow rates
122
How much oxygen can a bag valve mask deliver?
100% oxygen at >10L/min
123
What is this?
Shouldered syringe
124
What is a shouldered syringe used for?
Injection of haemorrhoids with 5% phenol in almond oil
Injection aided by protoscope
Performed above dentate line as it is insensitive
125
What is this? What is it made of and used for?
Silastic Urinary Catheter
Made of silicone
More appropriate than latex for long term catheterisation
126
What is this?
Single lumen central venous catheter
Used for measuring central venous pressure + administration of drugs
127
Recall 3 drugs/ drug classes that need to be inserted via a central line
Amiodarone
Chemotherapy
Dopamine
128
What are these?
Specimen swabs
Bluetop: recover aerobes, anaerobes + fastidious organisms
129
What are these?
Spinal needles
130
What are these each used for?
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
What is this and how is it used?
Stiff neck cervical collar
Used in conjunction with 2 sand bags + tape to immobilise neck in trauma patients (triple immobilisation)
132
How are stiff neck cervical collars sized?
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
What is this? Recall 3 associated procedures
Stoma bag; collects waste from surgically diverted bowel
Ileostomy, colostomy or ileal conduit
134
What is this? When is it used?
Surgical chest drain
(Thoracostomy)
Used as emergency procedure
135
Give 5 indications for a surgical chest drain
Pneumothorax
Malignant pleural effusion
Empyema
Traumatic pneumo-/ haemothorax
Peri-operative
136
What is this?
Swan-Ganz catheter
137
What can Swan Ganz catheters be used to measure?
Pressures in heart
Pulmonary artery wedge pressure (PAWP)
Cardiac output
| Used in intensive care setting
138
What is this? What is it used for?
Synthetic absorbable suture
Used for bowel anastomosis or tying off vessels
139
What are these? In which patients should they be used?
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
In which patients are TEDS contraindicated?
Patients with arterial disease of the lower limb
141
What is this? What type of airway does this provide?
Tracheostomy
Definitive airway as protects lungs from aspiration
142
Give 3 benefits/ uses of tracheostomies
Allow more efficient ventilation with decreased dead space
More effective suctioning of airways
Can be used in upper airway obstruction/ after laryngeal surgery
143
What is this?
Triple lumen central venous catheter
144
What is this and what is it used for?
Trucut needle
Used to take histological specimens from lesions
Can be performed under LA
145
What are these?
Urinary catheters
LHS: Long-term, usually silicone (up to 3 months)
Centre: Foley, short-term (up to 28 days)
RHS: three-way
146
What is this and what is it used for?
Three way catheter
Used in haematuria for bladder washout + irrigation
Larger diameter required due to containing 3 lumens
147
What is this? What does each element indicate?
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
What urine dip results warrant sending for MC+S?
Positive Nitrites + Leukocytes
149
What urine dip results warrant sending for urine protein : creatinine ratio?
Positive blood + protein
150
What is this and what is it used for?
Urometer drainage bag
Measures urine output
Used during surgery, post-op + to monitor fluid status
151
What is this? What does it do?
Venturi mask and valves
Delivers 24-60% O2
Flow rate varies depending on colour
152
Recall the flow rate and % oxygen for each venturi valve (blue, white, yellow, red + green)
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
In what clinical scenario are venturi masks often used?
In COPD where it is important not to over-oxygenate the patient
154
VAC drain?
