Intro to Surgery (lec 2) Flashcards Preview

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Flashcards in Intro to Surgery (lec 2) Deck (49):
1

Preop Nurse duties? (3)

Pt prep
Signatures of surg/anesthesia staff
Start IV w/ ordered meds

2

Anesthesiologist duties? (3)

Preop pt consult
Appropriate anesth type
Sleep, analgesia, airway, breathing, circulation

3

Circulating Nurse duties? (5)

Gets supplies, sterile equip
Pt ID, positioning
Sterility of suite
OR manager
Final counts

4

Scrub Nurse duties? (2)

(Sterile staff member)
Supply setup
Hands off sterile instruments/supplies

5

Surgeon duties?

Attending physician while pt in OR

6

First Assistant duties?

Knowledge requirements?

Assist surgeon

Anatomy/phys
Surgical procedures
Surgical handling of tissue/instruments

7

Retraction purposes?

1) provide counterforce
2) help w/ visualization

8

Laparoscopy is?

Inflation of peritoneum w/ CO2 gas,
Small incisions for instrument ports,
Camera guidance

9

Why CO2 gas for laparoscopy?

soluble in blood

10

Laparoscopy advantages? (5)

1) shorter hospitalization
2) less pain
3) less scarring
4) lower cost
5) lower risk of ileus (obstruction)

11

Laparoscopy Veress Needle used for?

CO2 insufflation (blown into gut) how?

Blind entrance

thru needle

12

Hasson technique for Laparoscopy?

Cut down/place trocar (tube) using direct visualization

13

Typical Laparoscopy procedures?

Cholecystectomy
Appendectomy
Inguinal hernia repair
Ventral hernia repair
Nissen fundoplication

14

Laparoscopy post-op shoulder pain caused by?

referred pain from CO2 stretch of diaphragm

15

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

16

Laparotomy/Celiotomy is?

surgical incision into abdominal cavity

17

Exploratory Laparotomy performed when?

Acute, unexplained abd pain/pathology

18

Surgical Risk Assessment includes?

1) Prior hx (traditional risk factors)
2) Fxnl capacity
3) Procedural risk
4) ECG?? slide 28

19

Procedural Risk Mortality percentages:

High?

Intermediate?

Low?

High > 5%

Interm 1-5%

Low < 1%

20

Post Op considerations when managing meds?

Heightened SNS response ∆s metabolism, gut motility, absorption

21

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
3) Statins
4) Meds that control glycemic levels

22

With surgery, what meds should be d/c'd?

Antiplatelets
7-10 days preop

23

SCIP is?

Surgical Care Improvement Project:
standards for abx use to ↓ surgical infections

24

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

25

Positioning Patient, purpose?

protect pt

26

Positioning Patient: Supine?

Use?

flat, face up
palms down

U for general surgery

27

Positioning Patient: Trendelenburg?

Use?

supine w/ head lowered below feet

↑ exposure to pelvic organs
placing central lines

28

Positioning Patient: Reverse Trendelenburg?

Use?

supine w/ head raised above feet

↑ exposure to abdominal viscera

29

Positioning Patient: Sitting?

Use?

Legs extended, hands in lap

craniotomies
cervical spine surgery

30

Positioning Patient: Lithotomy?

Use?

supine w/ knees raised in stirrups

Uro, gyn, rectal procedures

31

Positioning Patient: Prone?

Use?

face down w/ arms bent 90°, feet propped w/ knees bent

spinal surg

32

Positioning Patient: Lateral?

Use?

on side w/ hips/legs lowered ~ -30°

thoracotomies, nephrectomies, retroperitoneal procedures

33

-otomy is?

incision into

34

-ectomy is?

removal of

35

-ostomy is?

new opening

36

-plasty is?

repair

37

-plexy is?

fixation

38

-rrhaphy is?

suturing

39

Situational Awareness includes? (3)

1) perception of environment
2) comprehension of current situation
3) projection of future status

40

Degraded Situational Awareness caused by?

Precursors (lack of data/systems)

Humans (lack of judgement, training, skill or misinterpretation, distraction)

41

Intraoperative Improvement Initiative goal?

Effect outcomes
↓ morbidity/mortality

42

Intraoperative Improvement Initiative purposes? (3)

1) capture near misses
2) fix holes in system
3) ↓ chances of adverse events

43

Intraoperative Improvement Initiative categories of events? (9)

1) pt instability
2) physical injury to pt
3) communication failure
4) ∆ of plan
5) meds
6) blood products
7) equipment misuse or fail
8) access
9) everything else

44

Crew Resource Mgt/Mismgt due to? (5)

1) communication
2) personal readiness
3) supervision
4) organization culture/resources/process
5) safety vs cost

45

Structured Communication: Briefings purpose?

formulate and share op plan
U w/ checklist

46

Structured Communication: Sterile Cockpit is?

Reviewed when?

High risk period needing absolute team concentration

during debriefing

47

Structured Communication: Debriefings purpose?

(done immediately)

Eval performance of system/people/procedure etc

Identify areas for improvement

Sustain/grow improvements

48

Risks of surgery?

Wound/line infection
UTI
DVT/PE
PNA
GI ulcers
Decubitus (bed sore)
MI
Arrhy
Stroke
Bleeding

49

VTE Prevention: low risk surg?

Mod - high risk surg?

mechanical prophy

anticoag prophy