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errors and drugs > Surgical iatrogenesis > Flashcards

Surgical iatrogenesis Flashcards

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

A

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

24
Q

How quickly do opposed axons repair

A

1mm per day

25
Q

What nerves are repaired

A

Important motor nerves for function (if sensory left)

26
Q

How to repair a nerve

A

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
Q

How to communicate a complication to a patient

A

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
Q

Managing pain after surgery

A

Analgesic ladder
Patient controlled anaesthesia
Local anesthesia block/spinal

29
Q

Respiratory compromise what do after op

A

Breathing exercises/physio
Pre hab

30
Q

AW compromuse after op

A

Prolonged intubation
Tracheotomy (if exceeding 48 hrs post surgery)

31
Q

Uro/GI compromise in surgery

A

Urinary catheter
NGT - drainage
Flatus tube - gas pass prevent volvulus
Enteral vs parenteral feeding

32
Q

Treatment for anaemia, sepsis, VTE

A

transfusion/preload
Antibiotics prophylaxis (clean or contaminated)
VTE prophylaxis

33
Q

Whrere go if close observation or multiple organ support needed

A

ICU

34
Q

What are surgical NEVER events

A

Significant patient safety incidents considered preventable

35
Q

Examples of NEVER events in surgery

A

Wrong site surgery - wrong side or incorrect procedure
Wrong implant/prosthesis
Retained foreign objects

36
Q

Why do things go wrong in surgery - individual factors

A

Situational awareness
Decision making
Training issues eg unfamiliar procedure or equipment

37
Q

Situation awareness surgical failings

A

Failure to gather/review appropriate information
Anomalies ovdrlooked ie anatomical variants
Failure to recofnise increased risks

38
Q

Decision making failures surgery

A

Failure to double check if uncertain, reliance upon assumptions not checking

39
Q

INstitutional factors

A

Team work/communcaiton
Organisation and management factors
Patient factors

40
Q

Team work/communication factors in surgery

A

Failure of team members to speak up
INadequate exchange of information prior to case

41
Q

Organsiation and management factors surgical iatrgoensis

A

Pooled operating lists
Poor dcoumentation

42
Q

Patient factors -> surgical iatrogenesis

A

Bilateral lesions
Anatomical complexity
Patient instability creating urgency

43
Q

Where did the WHO checlist originate from

A

Global safety challenge - safe surgery save lives
500,000 deaths from surgery a year preventable world wide

44
Q

What is on teh surgical safety cheklist - before induction of anaesthesia

A

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
Q

Surgical safety checklist before skin incision

A

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
Q

Srugical safety checklist fater op before patient leaves room

A

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
Q

What are NatSSIP and LocSSIP

A

National standards and local standards for safety in invasive procedures

48
Q

What procedures under local/regional anaesthesia are performed outside of theatre

A

Line insertion
Interventional radiology
Endoscopic procedures
Still do equipment count

49
Q

Situational awareness CIA

A

Collect information
Interpret information
Anticipate future state

50
Q

STAR tool

A

Stop
Think
Assess
Review
Respond

51
Q

Closed loop communication

A

Sender initiates message
Receiver accepts message, provides feedback confirmation
Sender verifies messaeg received

52
Q

Books to read

A

Safety sharp end - a guide to non technical skills
The invisible gorilla and other ways our intuition deceives us

53
Q

Primary vs secondary post tonsilectomy bleeding

A

1 - 24 hrs
2 - up to 2 weeks after

54
Q

Damage to what nerve causes a hoarse voice?

A

Recurrent laryngeal

55
Q

What can thyroid haematoma cause

A

AW obstruction - pressure and prevents venous drainage of larynx -> upper AW oedema

56
Q

Immediate anagement of thyroid haemotoma

A

open wound to relieve AW pressure

57
Q

What is the immediate management of thyroid haematoma with worsening breathing difficulty

A

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.

errors and drugs (8 decks)

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