Flashcards in Intro to Surgery (lec 2) Deck (49):
Preop Nurse duties? (3)
Signatures of surg/anesthesia staff
Start IV w/ ordered meds
Anesthesiologist duties? (3)
Preop pt consult
Appropriate anesth type
Sleep, analgesia, airway, breathing, circulation
Circulating Nurse duties? (5)
Gets supplies, sterile equip
Pt ID, positioning
Sterility of suite
Scrub Nurse duties? (2)
(Sterile staff member)
Hands off sterile instruments/supplies
Attending physician while pt in OR
First Assistant duties?
Surgical handling of tissue/instruments
1) provide counterforce
2) help w/ visualization
Inflation of peritoneum w/ CO2 gas,
Small incisions for instrument ports,
Why CO2 gas for laparoscopy?
soluble in blood
Laparoscopy advantages? (5)
1) shorter hospitalization
2) less pain
3) less scarring
4) lower cost
5) lower risk of ileus (obstruction)
Laparoscopy Veress Needle used for?
CO2 insufflation (blown into gut) how?
Hasson technique for Laparoscopy?
Cut down/place trocar (tube) using direct visualization
Typical Laparoscopy procedures?
Inguinal hernia repair
Ventral hernia repair
Laparoscopy post-op shoulder pain caused by?
referred pain from CO2 stretch of diaphragm
Laparoscopic camera driving rules? (6)
1) Watch all trochars enter and exit
2) Watch all instruments enter/exit trochars
3) Ensure camera orientation
4) FRED (de-fog solution) lens
5) No contact w/ large bowel
6) Keep action centered
surgical incision into abdominal cavity
Exploratory Laparotomy performed when?
Acute, unexplained abd pain/pathology
Surgical Risk Assessment includes?
1) Prior hx (traditional risk factors)
2) Fxnl capacity
3) Procedural risk
4) ECG?? slide 28
Procedural Risk Mortality percentages:
High > 5%
Low < 1%
Post Op considerations when managing meds?
Heightened SNS response ∆s metabolism, gut motility, absorption
With surgery, what type of meds should be continued? (4)
1) Meds w/ significant w/drawal sxs that do not affect anesthesia (esp alcohol)
2) CV meds
4) Meds that control glycemic levels
With surgery, what meds should be d/c'd?
7-10 days preop
Surgical Care Improvement Project:
standards for abx use to ↓ surgical infections
SCIP rules for prophylactic use?
1) Prophy abx given w/i one hr PRE-incision
2) Prophy abx d/c'd w/i 24 hrs of surgery completion
Positioning Patient, purpose?
Positioning Patient: Supine?
flat, face up
U for general surgery
Positioning Patient: Trendelenburg?
supine w/ head lowered below feet
↑ exposure to pelvic organs
placing central lines
Positioning Patient: Reverse Trendelenburg?
supine w/ head raised above feet
↑ exposure to abdominal viscera
Positioning Patient: Sitting?
Legs extended, hands in lap
cervical spine surgery
Positioning Patient: Lithotomy?
supine w/ knees raised in stirrups
Uro, gyn, rectal procedures
Positioning Patient: Prone?
face down w/ arms bent 90°, feet propped w/ knees bent
Positioning Patient: Lateral?
on side w/ hips/legs lowered ~ -30°
thoracotomies, nephrectomies, retroperitoneal procedures
Situational Awareness includes? (3)
1) perception of environment
2) comprehension of current situation
3) projection of future status
Degraded Situational Awareness caused by?
Precursors (lack of data/systems)
Humans (lack of judgement, training, skill or misinterpretation, distraction)
Intraoperative Improvement Initiative goal?
Intraoperative Improvement Initiative purposes? (3)
1) capture near misses
2) fix holes in system
3) ↓ chances of adverse events
Intraoperative Improvement Initiative categories of events? (9)
1) pt instability
2) physical injury to pt
3) communication failure
4) ∆ of plan
6) blood products
7) equipment misuse or fail
9) everything else
Crew Resource Mgt/Mismgt due to? (5)
2) personal readiness
4) organization culture/resources/process
5) safety vs cost
Structured Communication: Briefings purpose?
formulate and share op plan
U w/ checklist
Structured Communication: Sterile Cockpit is?
High risk period needing absolute team concentration
Structured Communication: Debriefings purpose?
Eval performance of system/people/procedure etc
Identify areas for improvement
Risks of surgery?
Decubitus (bed sore)