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MRCS part B- JMB > Periop Care & Surgical Texhnique > Flashcards

Periop Care & Surgical Texhnique Flashcards

(57 cards)

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1
Q

Phases of a clinical trial?

A

1- small group- safety and PK and PD
2- 50-300- side effects and effectiveness
3 multi enter Rct
4 post marketing study, benefits and optimal use

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2
Q

Levels of clinical evidence

A

A= systematic review of b

1 rct
2 cohort stud
3 case control study (retrospective, compares disease to controls)
4 case series
5 expert opinion
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3
Q

Methods of thromboprophylaxsis

A

Conservative- hydrate well, leg exercises, vte stockings, early mobilisation, TEDs

Medical- IVT, lmwh, stop COCP 4 weeks prior

Surgical- vena cava filter, avoid GA

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4
Q

Reasons for patient positioning and complications?

A

Surgical access, anaesthetic access, prevent harm

Air embolus
Join dislocations
Skin damage
Neuropathies
Eye compression
Decreased lung capacity
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5
Q

Common neuropathies?

A 
Ulnar
Radial
Common peroneal
Sciatic
Saphenous
Obturator
Brachial plexus
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6
Q

What is laminar flow?

A

Unidirectional flow of air

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7
Q

What is acceptable air flow targets in theatre

A

20-40 air changes per hour
<35/m3 of bacteria carrying particles
<1 colony per m3 of clostridium/staph a

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8
Q

Sterilisation equipment?

A

Steam
Dry heat
Ethylene oxide- scopes
Irradiation

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9
Q

What does laser stand for?

How does it work?

A

Light amplification by stimulated emission of radiation

Excitation of a medium by energy leading to photon production

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10
Q

Types of lasers

A

Co2- haemostasis
Argon- photocoagulation
Ruby- tattoo removal

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11
Q

Indications for tourniquet’s?

A 
Bloodless op
Stop bleeding
Biers block
Isolated limb chemo
Cannulation
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12
Q

Principles of safe tourniquet use?

A

Size of cuff- width >1/2 diameter of limb
Padding
No fluid

Exaguinate
Pressure limits-
Lower limb- SBP + 70-130 (max 350)
Upper limb- SBP + 50-100 (max 250)

Max 2 hours

Check NVI post op

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13
Q

Complications of tourniquets

A 
Skin changes
Lactic acidosis
Post tourniquet syndrome- swollen, stiff, pale limb with weakness but no paralysis usually after 1–6 weeks of tourniquet application
Bleeding/haematoma
Muscles ischaemia
Nerve injury- radial
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14
Q

What is diathermy?

A

Passage of high frequency AC (400-10) through body which creates high temperatures of 1000

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15
Q

Why high frequency for diathermy?

A

Low frequency causes muscle stimulation/vf/cardiac stimulation.

Means a higher amp can be used

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16
Q

Different types of diathermy

A

Mono polar- pad on patient is the other pole. High power, less precise

Bipolar- low power, current between forceps, safer for end arteries / pace makers

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17
Q

Complications of diathermy use?

A 
Burns- patient/surgical team
Explosions
Channeling
Capacitor coupling- think lap ports
Direct coupling- buzz forceps
Pacemakers- reprogramming of pacemakers/myocardial burn
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18
Q

How can you classify sutures?

A

Composition- natural/synthetic
Structure- braided (vicryl) vs monofilament (monocryl)
Absorbable

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19
Q

How are sutures absorbable?

A

Proteolytic enzyme

Hydrolysis

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20
Q

Requirements of a perfect suture?

A 
Sterile
Hypoallergenic
Carcinogen free
Uniformity
High tensile strength
Pliable
Predictable absorption pattern
Cost effective
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21
Q

Types of absorbable sutures

A

Vicryl rapide- 42 days
Vicryl- 60 days
Monocryl- 100 days
PDS- 200 days

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22
Q

Needles shape and geometry

A 
Straight vs curved vs j vs compound
Geometry
Round body- friable tissues
Cutting- tough surfaces- skin/sternum
Reverse cutting- on convex edge- subcuticular suture/tendons

Blunt vs sharp

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23
Q

Types of drains

Study These Flashcards
A

Passive drains- penrose drain

Active drain- vac/redivac

24
Q

Indications for dressings?

Dressing if in doubt?

Study These Flashcards
A

Granulating tissue- aquacel/jelonet
Sloughy- aquacel
Necrotic- aquacel
Cavity- simple packing

AQUACEL

25
Leeches indication | Maggots
Leeches- encourage vasodilation, anticoagulant and anaesthesia via secreting substances Maggots Digests necrotic and sloughy tissue
26
Indication for negative pressure dressings
Promote granulation | Remove excess fluid/blood/pus
27
Needlestick transmission rate of HIV, Hep B and C?
HIV 0.3% Hep B 30% Hep C 3%
28
Timing of needlestick bloods?
At time of event for you and patient | 6 weeks and 3 month post event
29
Post renal causes of anuria?
Bilateral renal stones | Bladder/Prostate/Urethral blockage
30
Describe steps of chest drain insertion?
Intro and wash hands Consent, allergies/anticoagulation Prep equipment- 11 blade, 24 Fr chest drain, silk suture LA Incision and blunt dissection Insert chest drain (upwards air, downwards blood) Suture and connect seal system- bubbles
31
What are the indications for inserting a chest drain?
Trauma/tension haemopnuemothorax Large spontaneous pneumothoax Symptomatic/large 2o pneumothoax
32
When to refer a pneuomothotax to the cardiothoracic surgerons?
``` Spontaneous haemothorax Bilateral pnuemothorax First ContraL pneumothorax 2nd IpsiL pnuemothorax Failure of lung to re-expand after 5 days Pregnant ```
33
What to do if chest drain stops bubbling?
A2E Disconnected/dislodged CXR Prepare to remove
34
Technical considerations for skin lesion excision?
``` Mark at least 3:1 length to width, 2mm excision width 15 blade for incision 3/0 monocryl for intradermal 4/0 prolene for skin Histology +- marking stitch ```
35
What excision margin is needed for SqCC/BCC/Melanoma?
4mm for SqCC/BCC at least 1cm at least for melanoma
36
What is the histology of a SqCC?
Keratin pearls Atypical keratinocytes Dermal invasion
37
Where should a diathermy plate be placed?
>70cm2 covered | Dry, shaved skin, away from bony prominence
38
What is diathermy?
Alternating current generates high localising heat temperatures that result in coagulation or cutting
39
LA toxicisty management?
A2E, CCRISP No more infusion Intralipid 20% LA is a negative inotrope and vasodilator
40
What makes up a pacemaker pre op check and peri operative management?
``` Model, indication and date of insertion Degree of HF Placed in basic mode Post op check Continous ECG monitoring Pacing available Limit monopolar- make sure current does not pass through monopolar ```
41
Pre op warfarin management?
As per haem/trust guidelines Stop 5 days before High risk will need bridging LMWH/unfractionated heparin Restart Warfarin post op when eating and drinking (haemostais achieved) Stop heparin when INR in range
42
What is C diff? and risk factors?
Nosocomial GI infection Gram +ve bacilli Associated with Cephlasporin, co amox, clindamycin, ciprofloxacin Treat with vanc/met
43
How to manage a diabetic patient peri operatively?
Pre op- optimise, anaesthetic/ DSN appointment, lose weight, echo, ecg, cxr Peri op- 1st on list, 1 missed meal- reduce insulin/VRIII- trust guidelines Post op monitor BMs, aim for early feed and restarting of regular insulin
44
Risk of cardiac complications if pre op MI?
Within 30 days- 30% risk Within 1 -3 months- 15% 3-6 month- 5%
45
Long term steroid use and operative risk?
Addisonian crisis Poor wound healing Infection risk Pre and post op hydrocortisone
46
Difference between chlorahexdine and betadine (iodine)
Chlorhex- NICE recommended, better bacterial coverage, some viral and poor fungal/spore coverage. Works for >4 hours Betadine- potent against bactera, fungi, viral and TB, <4 hours, skin irritator
47
Important points of scrubbing in?
Pre scrub wash First scrub of the day 5 minutes Next ones can be 3 minutes
48
Difference between cleaning, disinfection and sterilisation?
Cleaning- gross removal of debris and dirt Disinfection- reduction in microorganisms Sterilisation- Eradication of microorganisms
49
Types of sterilisation?
Heat/dry (autoclaving) Chemical- ethlene oxide, glutaraldhyde Irradiation
50
How to rank operative emergency and co-morbities?
``` NCEPOD 1- immediate/life threatening/limb threatening 2- Urgent 3- Expedited 4- Elective ``` ``` ASA 1- fit and well 2- mild systemic disease 3- severe systemic disease 4- severe uncontrolled systemic disease of constant risk to life 5- moribund ```
51
What is the use of a paramedian incision?
Splenic access?
52
How to classify wounds?
Location Depth Contamination Mechanism- abrasion, incision, laceration, de gloving (morell-lavelle)
53
Rate of suture absorption?
``` This is for complete suture absorption Vicryl rapide- 42 Vicryl 70 days Monocryl 90 days PDS 180 days ```
54
Suture type used for deep tissue closure, stoma formation, face laceration, bowel anastomosis?
PDS PDS Nylon/prolene PDS
55
Different types of diathermy settings?
Coagulation- pulsing low temp current which leads to cell death Cutting- continous high temp current which leads to cell vaporising Blended- mixed Spray- coag over a wide area
56
Principles of wound debridement-talk through procedure?
``` Intro, consent, mark, anaesthetic Drape and clean Gross removal of debris Wound toilet Deep exploration Excision of dead skin/deep tissue/bone Photos Pack and dress Reinspect in 48-72 hours Abx and tetanus Confirm no bony injuries/vascular injuries ```
57
Describe an I&D of an abscess

MRCS part B- JMB (10 decks)

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