1
Q
What is this?
A
Absorbable sutures - broken down by physiological enzymatic degradation & hydrolysis
- Monocryl - monofilament, increased throws for stable knot
- Vicryl - poly-filament, less throws but increased fraying issues & local tissue inflammation
2
Q
What is this?
A
ABG syringe
- pH – acidosis/alkalosis
- pO2 and pCO2 – identification of respiratory failure (arterial)
- Bicarbonate – renal and compensation of acidosis/alkalosis
- Lactate – poor perfusion
- Hb – anaemia
- Glucose
- Na+/K+/Ca2+ quick testing of electrolytes – handy in monitoring and treatment of hyperkalaemia.
3
Q
What are these? What is the order of draw?
A
Blood bottles are colour coded to use for different tests
- Purple – contains EDTA. Used for haematology.
- Pink – contains EDTA. Used for group and save and crossmatch.
- Blue – contains buffered sodium citrate. Used for coagulation screening.
- Yellow/gold – known as SST. Contains silica particles and serum separating gel. Used for a variety of tests that require separated serum for analysis, including immunology, microbiology, biochemistry, endo, toxicology, oncology, U+E and liver function.
- Grey – contains sodium fluoride and potassium oxalate. Used for glucose and lactate tests.
- Red – contains silica particles. Used for sensitive tests including toxicology, drug levels, antibodies, hormones and bacterial and viral serology.
- Dark green – contains sodium heparin. Used for ammonia, renin, aldosterone and insulin tests.
- Light green – Known as PST. Contains lithium heparin and a plasma separator gel. Used for routine biochemistry.
- Rust Top- Viral Immunology.
Order: blue, red, yellow, green, purple, pink, grey
4
Q
What are these? Which do you fill first?
A
Blood culture bottles - one for aerobic bacteria (blue top) and one for anaerobic bacteria (purple top)
- Blood cultures are a useful investigation in a case of pyrexia or suspected systemic sepsis.
Remember, fill the aerobic bottle first if you are using a vacutainer.
5
Q
What is this?
A
BM monitoring kit - test real-time capillary BM lvls
- Used in DM to guide insulin dosing
- Also used in DKA/HHS/hypoglycaemia and reduced GCS
- Key element to ALS & ATLS protocols (A-E)
6
Q
What are these? Complications?
A
Breast implants - a variety of shapes & sizes to suit body habitus
- Made from silicone, last for 10-15yrs, overtime degrade/can rupture
- Used for breast augmentation, breast reconstruction after mastectomy and gender reassignment
- Complications:
- Rupture, infection, capsular contracture, erosion through skin, migration
- Rare risk of ALCL (anaplastic large-cell lymphoma)
7
Q
What is this?
A
Catgut suture - natural absorbable suture
- Been replaced by newer synthetic absorbable materials but still used in stomas and circumcisions
8
Q
What is it?
A
Catheter bag - includes a flexible tube used to empty the bladder and collect urine in a drainage bag
- Urethral - inserted through the tube that carries urine out of the bladder
- Suprapubic - through a small opening made in lower abdomen
9
Q
What is it? Indications & complications?
A
Central line insertion pack
- 3-5 lumen cannula, guidewire, dilator, scalpel, and introducer needle
- Central venous catheters are placed into subclavian or internal jugular veins via USS
- Key indications include (meds that can be harmful orally/peripherally):
- Parenteral nutrition, fluid resuscitation, infusion of irritant drugs, vasopressors, inotropes
- Emergency venous access - blood tests & central venous pressures
- Complications of insertion:
- Pneumothorax
- Sepsis
- Thrombosis
- Misplacement
10
Q
What is it?
A
Chest drain bottle
- System:
- Passive drainage – underwater seal which employs a positive expiratory pressure and gravity to drain the pleural space - passive closed drainage system
- Suction drainage - active closed drainage system
- After a chest drain is inserted –> bubbling in water as the air leaves pleural space
- Bottle can also be used to collect blood, fluid and pus from the pleural space
11
Q
What is it?
A
CSF manometer - identification of opening pressures + represent ICP during LP
- Measured in cm H2O
- Accepted opening pressures = 10-18cm H2O if lying on side; 20-30cm H20 when sat up
12
Q
What is it?
A
Devers retractor - used in open abdominal surgery (hold edges open to reach underlying organs
- Different sizes & types of retractors
13
Q
What is this?
A
Disposable rigid sigmoidoscope - for inspection of rectum & lower sigmoid colon
- Explain procedure –> must attach light source + air pumping device, patient put in LLP & PR performed –> lubricated with jelly and device inserted pointing towards umbilicus
- Air pumped in to allow you to see direction of rectal lumen
- Biopsies can be taken of rectal mucosa through sigmoidoscope (e.g. in UC)
14
Q
What is this?
A
Drainage bag - connected to NG tube or a drain coming out of the abdomen
- Drainage relies on gravity = closed passive drainage system
15
Q
What is it? Indications? Process of insertion? How to check placement? Complications?
A
Endotracheal tube with tape & syringe
- Definitive airway
- Used in trauma cases/surgery with GA & GCS <8
- Process:
- Anaesthetist inserts into trachea via oropharynx with laryngoscope & Eschmann Tracheal Tube Introducer (ETTI – or otherwise known as the bougie)
- Connected to O2 for adequate O2/CO2 gas exchange
- Balloon at the end of tube is inflated with air via blue side port - maintains position and protects airway from aspiration
- How to check appropriate placement:
- Symmetrical chest rising on ventilation
- Breath sounds bilaterally
- No gurgling over epigastrium (oesophageal intubation)
- Complications:
- Oesophageal placement
- Laryngeal injury
- Pneumothorax
- Atelectasis
- Infection
16
Q
What is it?
A
Epidural insertion pack:
- Epidural needle (touhy-type) - clear depth marking for accurate insertion depth reading
- Epidural catheter - designed for short-term/long-term anaesthesia & pain-relief
- Epidural catheter adapter - safe & secure attachment to catheter
17
Q
What is it?
A
Faeces sample pot - enable identification of pathogens that are infecting the gut
- Ideally Bristol stool chart 5/6/7 warrant samples
- Possible tests:
- Rotavirus/adenovirus/norovirus - same day
- MC&S - 4 days
- Microscopy for OCP (ova, cysts, parasites) - 4 days
- H. pylori testing - 1wk
- C. diff testing
18
Q
What is it?
A
Feeding NG tube - long-term enteral nutrition
- Tube inserted into nostil after lubrication
- Advance tube after patient swallows
- Correct positioning checked with CXR (for the wire) –> wire removed once happy with positioning
19
Q
What is it?
A
A bag of 5% dextrose - can be used in conjunction with normal saline to provide the normal daily fluid requirement for a patient.
- One litre of 5% dextrose contains 50g of dextrose in 1 litre of water.
- It should be remembered that because the sugar in this fluid is metabolised to carbon dioxide and water you are essentially giving them water.
20
Q
What is it?
A
Fluid giving set - used to give IV fluids, IV fluid meds incl. abx & blood products
21
Q
What are they?
A
Forceps = non-toothed (top) & toothed (bottom).
- Used to grasp edges of tissue and the general rule is that toothed should only be used for skin
- Once in the peritoneal cavity, the general rule is that only non-toothed should be used.
- Grasp these forceps between thumb and fore-finger in a pincer grip
22
Q
What is it?
A
Fracture plate used with screws to internally fix a bone fracture
23
Q
What is it?
A
500ml of gelofusin = artificial colloid solution
- Colloid solutions raise plasma oncotic pressure –> expand intravascular compartment e.g. in shock (sepsis, hypovolemia)
- Other examples include albumin and blood
24
Q
What is it?
A
Hartmann/Plasmalyte solution
- Crystalloid solution containing Na, Cl, Bicarb, lactate
- Similar composition to extracellular fluid –> normal daily fluid requirements/supplement additional loses
- Favourite solution of anaesthetists, normally used in trauma & Advanced Trauma and Life Support (ATLS) guidelines.
25
What is it? Indication? Complication?
Hemiarthoplasty hip prosthesis
* It is used in cases of intracapsular fractures of the neck of femur
* _Avascular necrosis of the femoral head_ is a common complication
26
What is it? Indications?
Hickman line - long-term central venous line, inserted in similar way to central line (subclavian)
* Remnant of line tunneled subcutaneously --\> decreases line infection
* Indications: long-term parenteral nutrition/IV abx therapy/chemo
27
What is it? Indications? Complications?
Total hip replacement: consists of femoral stem with femoral head, acetabular cup (inserted into acetabulum)
* Indications: replace hip joint e.g. severe osteoarthritis
* Complications: DVTs, inf, dislocation (2%)
28
What is it?
Histology specimen pot - routinely used for surgery
* Biopsies, resected tumours --\> placed here + set in formalin
* Part of WHO surgical safety checklist
29
What is it? Indication?
Intramedullary femoral nail - used to internally fix femoral shaft fractures
* Interlocking screws fix nail --\> removed after 12/18 months
30
What is it? Indication?
Instillagel
* Sterile gel containing LA & lubricant
* Indication: male & female catheterisation
31
What is it? What are the different colours & sizes (x3)?
IV cannular & octopus giving set
* Multiple different cannula systems are available:
* New premade dual lumen cannula need no saline prep --\> lumens flushed after blood taken to prevent clot formation
* Old systems need pre-flushed octopus as an adjunct
* Cannulae come in different sizes:
* 22G (Blue)
* 20G (Pink)
* 16G (Grey) - fluid resus & trauma = large-bore cannula
32
What is it?
Laparoscopic port - used in laparoscopic surgical procedures e.g. laparoscopic cholecystectomy
* These ports allow the surgeon to insert a telescope and instruments in the patient
33
What is it? Benefit? Types?
Laryngeal mask airways (LMAs) & airway adjuncts (iGels)
* Supraglottic airway devices - step prior to intubation --\> good for elective procedures, cardiac arrests, prehospital airway Mx
* Benefit - reduced trauma to oropharynx (vs intubation) --\> reduce hospital stay in elective patients
* Types:
* iGels contain thermoplastic elastomer that moulds to perilaryngeal framework with patient temp
* Device tip extends into the oesophageal opening - has gastric channel to allow passing of NG tube into stomach
* Also seals off oropharyngeal opening from larynx preventing aspiration
* Can be used as conduit to intubation
* Laryngeal mask airways (LMAs) do not eliminate the aspiration risk, device inflation can also cause pressure lesions & nerve palsies
34
What is it? Indications? Complications?
Laryngoscope used to aid intubation, visualisation of the larynx to aid Dx of vocal problems & strictures
Blades:
* Curved (macintosh)
* Straight (miller)
Complications if inexperienced:
* Mild soft tissue injury
* Laryngeal/pharyngeal scarring
* Ulceration, abscess formation
35
What is it? Indication?
Leg bag - attached to urinary catheter
* Indicated for mobile patients with indwelling urinary catheter e.g. man with incontinence following sphincter damage after multiple TURPs
36
What is it? Indication?
Mannitol is an osmotic diuretic --\> lower raised ICP or drive the urine output in a patient with obstructive jaundice to prevent hepatorenal syndrome.
37
What is it? Indication?
Monopolar diathermy handle - used for coagulation & dissection of tissue during open/laparoscopic surgery
38
What is it? Complications?
**Nasal cannula** are commonly used mode of oxygen delivery both in hospital and in the community.
* It is widely used to carry 1-4L of oxygen per minute (can be up to 5L/min). This delivers between 28-44% of oxygen.
* These cannulae differ from high-flow therapy (NIV).
Complications: nasal sores, epistaxis --\> apply water-based creams to moisturise
39
What is it?
Nasal Speculum is designed to open and expand the nasal cavity
40
What is it? When is it used?
Nasopharyngeal airway - inserted into the nose using rotational action
* Provide an airway in people with decreased GCS/decreased gag reflex
* The diameter tube should be sized against the patient's little finger distal phalanx
* A safety pin is placed in the end of the tube to prevent it being inhaled.
41
What is it? Indication?
Nebuliser mask & chamber
* Used to administer all commonly prescribed bronchodilators for respiratory conditions
* Aerosol drug effectiveness depends on the quality of its delivery to the lungs.
42
What is it?
Needle holders - special forceps designed to hold the needle to allow the surgeon to suture accurately
43
What is it?
Neurology exam kit:
* 128Hz tuning fork (larger, vibration sense) - let's vibrate
* 512Hz tuning fork (smaller, Weber's & Rinne's) - I hear you
* Neurotips - blunt/sharp sensation in sensory exam (spinothalamic)
* Orange stick - babinski reflexes (plantar) - hold like a pen (thumb & middle finger)
* Tendon hammer - reflexes
* Other: snellen chart, opthalmoscope, tongue depressor
44
What is it? Indications?
Non-absorbable sutures
* **Ethilon (nylon)** is monofilament – therefore requires multiple throws to maintain a strong knot over time - limited to percutaneous closure
* **Prolene** is another example of non-absorbable suture - less likely to loosen over time
* Non-absorbable sutures are used in longer-term tissue approximation:
* Percutaneous wound closure
* Bowel anastomosis (Prolene)
* Vascular anastomosis (Prolene)
45
What is it?
Non-rebreather mask
* Used to assist in O2 delivery, requires the patient to breathe unassisted
* Covers nose & mouth, has attached reservoir bag that connects to external O2 tank/bulk O2 supply system
* Flow rate 10-15L/min - delivers up to 90% O2 conc
46
What is it? Indication?
Normal 0.9% saline - crystalloid solution containing 153mmol NaCl
* Used to provide normal daily fluid requirements for patient or to replace additional losses e.g. D&V
47
What is it?
Oropharyngeal airway - airway for patient when impaired consciousness
* Sized measuring angle of mouth to angle of jaw
* Inserted into mouth upside down and rotated in oral cavity (correct way up in children)
48
What is it? Indications?
PICC line (peripheral IV central catheter) - commonly used IV access option
* Has features of both central & peripheral venous access - suitable for long-term vascular access for:
* Blood sampling
* Chemotherapy administration
* Infusion of hyperosmolar solutions e.g. for total parenteral nutrition
49
What is it? Indications?
Proctoscope - used to visualise anal canal & lower rectum and when injecting/banding haemorrhoids
* Placed in LLP & PR exam done --\> proctoscope then attached to light source & lubricated before insertion
50
What is it? Indication? Procedure?
Ryles NG tube - used for _decompression_ (drip & suck) in bowel obstruction but can also be used to give drugs/contrast into GI tract
* Require a NG tube which has been in the fridge as it is stiffer, some lubricant, a bladder syringe, a drainage bag and pH dipstick.
* Correct position of tube checked by aspirating gastric contents & checking for acidity on pH dipstick --\> CXR to identify tube
* Once in correct position --\> bag attached & taped to patient face
51
What is it?
Types: disposable (on top) and non-disposable (below, blade must be changed).
* Blades vary by size & shape
* Used for cutting tissue during surgical procedures
52
What is it? Indications?
Seldinger chest drain insertion pack - used on wards/outpatients to insert chest drains
* Indications include:
* Pneumothorax (in ventilated patient, tension pneumothorax after needle aspiration, persistent pneumothorax or large spontaneous pneumothorax)
* Symptomatic malignant pleural effusions
* Empyema
* Traumatic haemothorax
53
What is it?
Self-retaining retractor to hold wounds open e.g. during hernia repair or appendicectomy
54
What is it?
Self-inflatable bag valve mask
* Very useful to deliver high O2 lvls even at low-flow rates
* Can deliver 100% O2 with flows above 10L/min
55
What is it? Indication?
Shouldered syringe - used to inj haemorrhoids w/ 5% phenol in almond oil
* Injection done via proctoscope - carried out above dentate line as insensitive
56
What is it? Types depending on indication?
Urinary catheter - sizes measured in french (Ch). 14Ch is normal starting point (large Ch is larger diameter)
Types:
* Foleys catheter (centre) - short-term up to 28 days (latex)
* Long-term catheter (left) - up to 3 months (silicone)
* Three-way catheter (right) - in cases of _haematuria_ for bladder washout & irrigation (larger Ch needed as 3 lumens)
57
What is it?
Single lumen CVP cannula - inserted in the superior vena cava (via internal jugular/subclavian veins)
* Can be single/triple lumen lines, mainly used to measure central venous pressure but can be used for drugs e.g. amiodarone, dopamine, chemo
58
What is it? Indications?
Specimen swabs
* Indications:
* Used routinely in MRSA screening (nasopharyngeal/rectal)
* Bluetop transwab amies - recover aerobes, anaerobes & fastidious organisms
* Excellent to aid gram stains
* Take specimens from wounds, skin, urogenitalia, throat
59
What are they?
Spinal needles
* Types:
* Traumatic needles = cutting needles (top picture)
* Increased risk of post-LP headaches, severe headaches that may require blood patching to help Tx Sx and additional hospital visits for pain
* Pencil-point (atraumatic) needles (bottom pic) = blunt-tipped, allowing for blunt dissection of anatomy rather than cutting
* Needle of choice for LP (not for epidural) --\> much lower risk of post-LP headaches and backache.
60
What is it? Indication?
Stiff neck cervical collar
* Used to stabilise the cervical spine in a trauma patient when used in conjunction with 2 sand bags and tape (Triple Immobilisation).
* They are sized by measuring number of fingers from the clavicle to the angle of the mandible, compared to the measuring peg on the stiff neck collar.
61
What is it? Indications?
Stoma bag
* Prosthetic medical device for collection of waste from surgically diverted bowel
* Pouching systems are most commonly associated with colostomies, ileal conduits and ileostomies.
62
What is it? Indications?
Surgical Chest Drains (thoracostomy) are used as an emergency procedure
* Differ from seldinger chest drains which can be inserted by trained physicians
* Sizing is measured in French (Ch) – smaller calibre drains used for pneumothorax, larger calibres needed for haemothorax, effusion and empyema.
* Indications include: Pneumothorax, Malignant Pleural Effusion, Empyema, Traumatic pneumothorax or haemothorax, peri-operative.
* ATLS guidelines should be followed in emergencies.
63
What is it? Indications?
Swan-ganz catheter
* Used to measure pressures in heart, pul wedge artery pressure, cardiac output
* Used in intensive care & typically inserted into central vein
64
What are they? Indications?
Thromboembolic deterrent stockings - for all patients undergoing surgery + those immobile to help prevent DVT
* Available in different sizes + used with LMWH
* C/I if arterial disease of lower limb
65
What is it? Indications?
Tracheostomy = definitive airway (protects patient's lungs from aspiration)
* Indications:
* Most commonly used on patient being ventilated on ICU
* Allows more efficient ventilation of patient with decreased dead space + allows more effective suctioning of the airways
* Upper airway obstruction/after laryngeal surgery.
66
What is it? Indication?
Trucut biopsy needle - used to take histological specimens from lesions, e.g. breast lumps or liver.
* Can be done under LA
67
What is it? Indications?
Urine dip + universal sterile container
* Very useful in acute clinical environment & primary care
* Assesses blood (haematuria), protein (renal disease), nitritis/leukocytes (inf), glucose (DM), ketones (DKA), bilirubin/urobilinogen (haemolysis & liver pathology)
* +ve nitrites & leukocytes --\> urine MC&S
* Positive blood & protein --\> urine protein: creatinine ratio (PCR)
68
What is it? When to use?
Urometer drainage bag - allows monitoring of urine collection as has clear graduation scheme
* Reflects accurate UO/hr
* Used in surgery, post-op & monitor fluid status
69
What are they? Indications? Types?
Venturi mask - used in T2RF (COPD), when don't want to over oxygenate
* Deliver 24-60% O2, flow rate depends on colour:
* Blue - 2-4L/min 24%
* White - 4-6L/min 28%
* Yellow - 8-10L/min 35%
* Red - 10-12L/min 40%
* Green - 12-15L/min 60%
y6
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