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Surgical iatrogenesis Flashcards

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1
Q

What is surgical iatrogenesis

A

Causation og harm or disease by medical intervention

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2
Q

What does surgical iatrogenesis encompass

A

Recognised risk of surgery
Medical/surgical error
Expected sequelae of surgery
Pscyhological/social/cultural effects of surgical procedure

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3
Q

How are surgical complucations classified

A

Timing
Anatomical
Severity

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4
Q

Examples of immediate complications in surgery

A

Bleeding
Nerve injury
Perforated viscus

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5
Q

What are early surgical complications (when) and what

A

<30 days post
Sepsis or wound dehiscence
Anaemia
Shock
Pain
Neuropraxia (will recover)

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6
Q

Late complications of surgery

A

After 30 days
Stenosis
Adhesions
Fistulae
Weakness/loss of funciton

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7
Q

What are local surgical complications

A

Nerve palsy/paralysis
Wouna dehiscence
infection
Haemotoma

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8
Q

What are systemic complications of surgery

A

Resp compromise
Anaemia
Hypocalcaemia/thyroidism from thyroid surgery
Shock/CVS instability
Sespsis
VTE
Delirium

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9
Q

Classifications of surgical complications

A

I-V
I - no treatment but deciation
V - death

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10
Q

What is grade II surgical complication defined as

A

Pharmacological treatment needed

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11
Q

What is grade III surgical complication defined as

A

Surgical/endoscopic/radiological intervention
eg haematoma, perforation, bleed

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12
Q

What is grade IV surgical intervention

A

Life threatening complication eg multi organ failure or CVS instability

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13
Q

What do when unsure of complication

A

Revise steps of procedure so far
Double check anatomical landmarks
Verbalise thought process to assistants/colleagues
Ask for help

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14
Q

How to manage a surgical bleed

A

Pressure
Washout - saline
Fix source of bleed
Transfusion
Prophylactic antibiotics
Check haemostasis once bleed controlled

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15
Q

Small vs large vessel bleed management

A

Small - cautery
Larger - ligate vs repair

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16
Q

If can’t control a bleed from a vessel

A

Get help
Pack
Stabilise patient + leave 24 -48 hours before 2nd look

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17
Q

Managing a perforation in surgery

A

Suction/wash to clean leakage, assess damage
Repair depends on location
Antibiotic prophtlaxis

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18
Q

What do with pharynx/cervical oesophagus perforation

A
  • most left to heal, rest with NGT
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19
Q

How to manage a small vs large thoracic oesophagus

A

Small - endoscopic glue
Large - endoscopic stent or surgical repair

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20
Q

How to manage bowel perforation

A

Small - endoscopal mucosal clipping
Large - open surgery

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21
Q

Ureter vs bladder perforation repair

A

ureter stent or repair
Bladder - surgical repair

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22
Q

What consider post perforation

A

Bowel - feeding enteral vs parenteral - need to rest area
Antibiotic prophylaxis - if faecal contents into abdomen

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23
Q

What to assess for nerve complications

Study These Flashcards
A

Assess nerves for deficit to identify nerve
Complete or partial transection (unlikely need repair)

24
Q

How quickly do opposed axons repair

25
What nerves are repaired
Important motor nerves for function (if sensory left)
26
How to repair a nerve
Ensure nerves left in opposing position for spontaneous repair Suture peri-neurium (one either side of nerve) Microscopic surgery - pllastic srugery Unlikely to regain full function
27
How to communicate a complication to a patient
HONESTY explain events to patient and relatives Apologise for outcome Discuss impact of injury arrange physio/rehab/psych support Discuss with colleagues and reflect - individual or system error
28
Managing pain after surgery
Analgesic ladder Patient controlled anaesthesia Local anesthesia block/spinal
29
Respiratory compromise what do after op
Breathing exercises/physio Pre hab
30
AW compromuse after op
Prolonged intubation Tracheotomy (if exceeding 48 hrs post surgery)
31
Uro/GI compromise in surgery
Urinary catheter NGT - drainage Flatus tube - gas pass prevent volvulus Enteral vs parenteral feeding
32
Treatment for anaemia, sepsis, VTE
transfusion/preload Antibiotics prophylaxis (clean or contaminated) VTE prophylaxis
33
Whrere go if close observation or multiple organ support needed
ICU
34
What are surgical NEVER events
Significant patient safety incidents considered preventable
35
Examples of NEVER events in surgery
Wrong site surgery - wrong side or incorrect procedure Wrong implant/prosthesis Retained foreign objects
36
Why do things go wrong in surgery - individual factors
Situational awareness Decision making Training issues eg unfamiliar procedure or equipment
37
Situation awareness surgical failings
Failure to gather/review appropriate information Anomalies ovdrlooked ie anatomical variants Failure to recofnise increased risks
38
Decision making failures surgery
Failure to double check if uncertain, reliance upon assumptions not checking
39
INstitutional factors
Team work/communcaiton Organisation and management factors Patient factors
40
Team work/communication factors in surgery
Failure of team members to speak up INadequate exchange of information prior to case
41
Organsiation and management factors surgical iatrgoensis
Pooled operating lists Poor dcoumentation
42
Patient factors -> surgical iatrogenesis
Bilateral lesions Anatomical complexity Patient instability creating urgency
43
Where did the WHO checlist originate from
Global safety challenge - safe surgery save lives 500,000 deaths from surgery a year preventable world wide
44
What is on teh surgical safety cheklist - before induction of anaesthesia
Confirm identity of patient, site, procedure, consent Is site marked Anaesthesia machine nad medication check complete Pulse oximeter on patient and functioning Known allergies Difficult AW, aspiration risk Risk of >500ml blood loss, 7ml/kg in children
45
Surgical safety checklist before skin incision
Confirm all team members have introduced themselves by name and role Confirm patients name, procedure and where incision will be made Antibiotic prophylaxis in last hour? Surgeon - critical or non routine steps, how long will take, anticipated blood loss Anaesthetist - patient specific concerns Nursing team - sterility incl indicator results been confirmed? equipment issues or concerns? Essential imaging displayed?
46
Srugical safety checklist fater op before patient leaves room
Nurse verbally confirms - name of procedure completion of instrument, sponge and needle counts Specimen labelling - read aloud and patients name Whether equipment problems adressed Key concerns for recovery and management from surgeon and naesthetist
47
What are NatSSIP and LocSSIP
National standards and local standards for safety in invasive procedures
48
What procedures under local/regional anaesthesia are performed outside of theatre
Line insertion Interventional radiology Endoscopic procedures Still do equipment count
49
Situational awareness CIA
Collect information Interpret information Anticipate future state
50
STAR tool
Stop Think Assess Review Respond
51
Closed loop communication
Sender initiates message Receiver accepts message, provides feedback confirmation Sender verifies messaeg received
52
Books to read
Safety sharp end - a guide to non technical skills The invisible gorilla and other ways our intuition deceives us
53
Primary vs secondary post tonsilectomy bleeding
1 - 24 hrs 2 - up to 2 weeks after
54
Damage to what nerve causes a hoarse voice?
Recurrent laryngeal
55
What can thyroid haematoma cause
AW obstruction - pressure and prevents venous drainage of larynx -> upper AW oedema
56
Immediate anagement of thyroid haemotoma
open wound to relieve AW pressure
57
What is the immediate management of thyroid haematoma with worsening breathing difficulty
Call for help, ask the nurse to bring the emergency trolley. Increase O2 to 15L via non-rebreathe mask. Open neck wound immediately – do not worry about bleeding, releasing the pressure upon the airway is the priority (A comes before B). Prepare for emergency front of neck access to stabilise airway if needed.

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