1
Q
blood bottles
A
pink - group and save and crossmatch
blue - coag
yellow/gold - immunology, microbiology, biochemistry, endocrinology, toxicology, oncology, U+E and liver function.
grey - glucose and lactate
rust - viral immunology
2
Q
What is this?
A
Nasopharyngeal airway
3
Q
What is this used for?
A
Can be used in pts with reduced level of consciousness where there is a reduced gag reflex. NPAs work well when pt is clenching their jaw, as oral airways become difficult to insert.
4
Q
What are the contraindications for this?
A
- Facial fractures
- Active epistaxis
5
Q
How do you use this?
A
- Select appropriate size (7.0mm for adult male, 6.0mm for adult female approximately)
- Right nostril is sometimes larger and therefore easier to insert into
- Safety pin through the flange end prevents displacement
- Lubricate airway with water/water-soluble lubricant
- Insert into one nostril, advance posteriorly aiming at tragus of ear
- Never force. Should slide in easily.
6
Q
What is this?
A
Oropharyngeal airway (Guedel airway)
Colours relate to sizes
Deflects tongue
7
Q
What is this used for and where (in the hospital) would you see it?
A
Used to provide an airway for a pt when there is an impaired level of consciousness
Found in ED/ITU/wards by recovery, in surgery when pt waking/falling asleep
8
Q
What are the complications of using this?
A
- Too big -> laryngospasm
- Too small -> catches tongue
- Damage to teeth/gums/palate
- Coughing/vomiting/aspiration if not unconscious (gag reflex)
- Not adequately positioned so airway not patent
- Doesn’t improve pt’s own respiratory drive
9
Q
What is this?
A
Laryngoscope
Device that allows inspection of the larynx & vocal cords
Used in conjunction with ET tube for intubation, held in L hand usually
Enables direct laryngoscopy (direct visualisation of larynx), compared to camera (indirect laryngoscopy) e.g. videolaryngoscope
10
Q
What are the types of this?
How is it sized?
A
2 varieties
- Straight blades e.g. ‘Miller blades’ - positioned posterior to epiglottis thereby ‘trapping’ it - preferred in infants
- Curved blades e.g. ‘Mac(intosh) blades’ - positioned anterior to epiglottis lifting it out of the way
Sizing
4 = Large adult
3 = Small adult
2 = Paediatric
1 = Infant
0 = Neonate
11
Q
What are the complications of using this?
A
- Trauma to soft tissues including larynx/pharynx
- Risk of scarring/ulceration
- Tooth damage
12
Q
What is this?
A
Adult endotracheal tube
= E.g. of definitive airway (i.e. below vocal cords + balloon to prevent aspiration) & can be used for long operations e.g. laparotomies, during cardiac arrest, or for critical care pts
13
Q
How do you use this?
A
- The size of ETT used depends on the patient’s body size. They come in a range of sizes from 2 to 10.5mm internal diameter.
- Inserted using a laryngoscope through the vocal cords, usually using the right hand in a right-to-left direction towards the larynx, the tip’s bevel is left-facing to make the pass through vocal cords easier.
- Can use a introducer/bougie/Eschmann introducer as a guide device for the ETT.
- The end of the tube should lie just above the carina to allow ventilation of both lungs. (Markings along the tube to indicate distance from tip)
- The Murphy eye allows ventilation in the event of obstruction of the end of the tube.
- After inserting the tube a balloon at the end of the tube is inflated with air through the blue side port - protects airway
- Tube is then tied into place
14
Q
How do you confirm this is placed correctly?
A
- Symmetrical rising of chest on ventilation
- Bilateral breath sounds
- No gurgling over epigastrium indication oesophageal intubation
- Radio-opaque line for X-ray detection
15
Q
What are the complications of using this?
A
- Sore throat
- Bronchospasm
- Trachea/oesophagus perforation
- Vocal cord weakness
16
Q
What is this?
A
Laryngeal mask airway (LMA) - supraglottic airway
Newer version = iGel - now also used in cardiac arrests. Also has hole for suction
17
Q
When is this used?
A
Used in day case surgery
Newer version = iGel - now also used in cardiac arrests. Also has hole for suction
18
Q
Where should this be placed and how do you check for placement?
A
Placed above larynx
Check for placement:
- Know that it is sealed - can hear air leak if not fitted properly
- Chest expansion
- End-tidal CO2
19
Q
What is this?
A
Feeding nasogastric tube
NOT Ryles tube (used for ‘drip & suck’)
20
Q
What is this used for?
A
Used for long-term enteral nutrition in pts. Designed with thin bore & soft structure to make it more comfortable for pts. Made of silastic which blocks less often
21
Q
What are some contraindications/cautions when using this?
A
- Do not insert if suspect facial fracture
- Check with seniors if recent GI surgery as not good practice to push through fresh anastomosis
22
Q
How do you use this?
A
- Wash hands and wear PPE
- Explain procedure and consent the patient
- Take a new, cool (hence less flexible) tube. Have a cup of water to hand.
- Lubricate well with aqueous gel.
- Ask patient if they have a preference for which nostril, right is supposedly easier than left. Place lubricated tube in nostril with natural curve facing down.
- Advance tube directly backwards, not upwards.
- When tip is estimated to be in throat, rotate tube by 180 degrees to discourage passage into mouth.
- Ask patient to swallow water and time advancement of the tube with each swallow.
Stomach is at approximately 35-40cm, so add about 10-20cm beyond that distance. - Tape securely to nose.
23
Q
How to wean from this?
A
- Aim for <750mL/24hrs for successful weaning
- First, put on free drainage e.g. 4hrly aspirations
- Then, spigot (insert bung) with 4hrly aspirations
- Then, spigot only. If tolerated with oral intake, then probably safe to remove. If not, take a step backwards
24
Q
How to conform position of this?
A
- Test aspirate on pH paper - <5.5 (PPIs may increase this)
- Radiologically, check for radio-opaque line/tip - CXR
*Feeding into misplaced tube = never event
25
What is this?
Ryles nasogastric tube
26
What is this used for?
Primarily used for draining stomach (AKA aspiration of stomach contents for decompression; drip & suck in bowel obs), other uses include administration of drugs/feed/contrast
N.B. Doesn't prevent vomiting, just empties gastric contents
27
How to use this?
- Wash hands and wear PPE
- Explain procedure and consent the patient
- Estimate size of tube by holding it up from the mouth over the ear & down to the epigastrium of the pt
- Take a new, cool (hence less flexible) tube. Have a cup of water to hand.
- Lubricate well with aqueous gel.
- Ask patient if they have a preference for which nostril, right is supposedly easier than left. Place lubricated tube in nostril with natural curve facing down.
- Sit patient upright, consider nebulised local anaesthetic
- Advance tube directly backwards, not upwards.
- When tip is estimated to be in throat, rotate tube by 180 degrees to discourage passage into mouth.
- Ask patient to swallow water and time advancement of the tube with each swallow.
- Stomach is at approximately 35-40cm, so add about 10-20cm beyond that distance.
- Tape securely to nose.
28
What are the complications of using this?
Insertion:
- Discomfort
- Malposition
- Epistaxis
- Vomiting/aspiration
During use:
- Sinusitis
- Reflux/aspiration
- Dislodgement
- Blockage/kinking/knotting
- Chronic irritation -> oesophageal stenosis
Removal:
- Mucosal adherence/trauma
- Failure e.g. kink/knot
29
What is this?
Chest drain bottle
30
What is this used for?
Bottle to which the chest drain is attached & forms end of drainage system (can be put under suction but very rarely done as might cause damage to lung tissue)
31
How do you use this?
- Fill with sterile water to the ‘prime level’ (labelled on the side of the bottle)
- The chest drain tube connects to tubing under the sterile water thus acting as a water seal
- Bottle needs to be below level of the lungs
- Air will bubble out as the lung re-expands in the case of pneumothorax
- In the case of empyema, pleural effusion or haemothorax there will be fluid
- ‘Respiratory swing’ is useful to assess tube patency and confirms the position of the drain in the pleural cavity (= the changes in thoracic pressure)
- The system can be driven by attaching suction to the top of the bottle making it an example of an ‘active closed drainage system’
- Patients with chest tubes should be managed on wards with staff who are trained in chest drain management.
32
What are some disadvantages of using this?
- Obligatory inpt management
- Difficulty of pt mobilisation
- Risk of knocking over bottle
33
What are the complications of using this?
- Damage to thoracodorsal artery
- Damage to long thoracic nerve -> winging of scapula
34
What is this?
Redivac drain (normally, bottle = rigid plastic & has valve)
= E.g. of active closed (vacuum) drain - vacuum indicator located on top, indicator depressed when vacuum intact
35
What is this used for?
- When negative space created in surgery
- Not in abdo surgery as risk of damaging bowel
- E.g. breast i.e. subcut tissue
- Can be sent home with pts post-op for ~7-10 days but depends on amount of fluid draining - pt can be taught how to change bottles at home
- Remove when draining negligible amount e.g. 25mL/day
36
What are the complications of using this?
- Pain
- Scar (heals by secondary intention)
- Blockage
- Infection
37
What is this?
Pigtail drain
- E.g. of passive drain with small lumen & coil in shape of pigtail
38
What is this used for?
Can be used for single cavity drainage but prone to blockage.
Can be used to drain abscesses or ureters that are blocked (nephrostomy). Usually inserted by radiologist
Self-retaining & requires no suture. Patency can be maintained by flushing 1-2x daily
Must be uncoiled prior to removal, failure to do so can cause severe pain &/ tissue trauma. String that holds pigtail shape in place should be cut to release coil.
39
What is this?
Jackson-Pratt drain
Soft pliable tube with multiple perforations with bulb that can recreate low negative pressure vacuum
Designed so body tissues not sucked into tube, decreasing risk of bowel perforation
40
What is this used for?
Commonly used as post-op drain to prevent fluid build-up in closed space which may either prevent wound healing or precipitate infected abscess
41
What is this?
Penrose drain
Flat ribbon-like drain which is particularly soft & smooth thereby minimising trauma during insertion & withdrawal
42
What is this used for?
Small wounds with low volume fluid (blood, pus) drainage post-op
Pin may be inserted externally to prevent it slipping into wound. Often tube pulled out & shortened by 1-2 inches/day to facilitate drainage & healing of inner tissues, until it falls out
43
What is this?
Trocar catheter - used for blunt dissection for chest drain insertion (really long, ~3cm)
44
Indications for using this
- Pneumothorax - in any ventilated pt; tension pneumothorax after initial needle relief
- Malignant pleural effusion
- Empyema
- Complicated pleural effusion
- Traumatic haemoneumothorax
- Post-op e.g. thoracotomy, oesophagectomy, cardiac surgery
45
What is this?
Manometer - used to measure intracranial pressure during LP
46
What is this?
Triple-lumen central venous catheter
- Inserted into superior vena cava via internal jugular, subclavian, or femoral vein
- Via Seldinger technique
47
What are the indications for using this?
- Central venous pressure (CVP) monitoring e.g. in acutely ill pts to gauge fluid balance
- Administration of certain drugs e.g. amiodarone or chemo, adrenaline, dobutamine (other inotropes/vasopressors), high conc K+
- IV access (fluid, parenteral nutrition)
- Not for fluid resus as not intended for high fluid vol
48
What are contraindications for using this?
Absolute: Infection at insertion site
Relative:
- Coagulopathy
- Thrombus within vein
- Ipsilateral carotid endarterectomy
- Newly inserted pacemaker leads
- Venous stenosis
49
Where can this be inserted?
Internal jugular vein
Subclavian vein
Femoral vein (emergency setting)
Usually inserted under USS guiance, other method is 'landmark procedure' (between heads of SCM & lateral to carotid)
50
What are the complications of using this?
Bleeding (arterial puncture/cannulation)
Air embolism
Pneumo/haemo/chylothorax
Phrenic nerve palsy
Phlebitis
Bacterial colonisation
Late - scarring, thrombosis, stenosis (as line is irritant)
51
What is this?
Portacath
= Long-term central line
Reduced risk of infection as tunnelled under skin
52
What is this?
Proctoscope - both disposable & non-disposable versions exist
Consists of outer sheath with hand & inner rod (obturator)
53
What is this used for?
Visual inspection of rectum & anal canal
Aid diagnosis of haemorrhoids, anal carcinoma, fistulas, & polyps
Therapies incl. haemorrhoid injections/banding, polypectomies, or rectal biopsies
54
How is this used?
- Explain to pt & gain consent
- Pt in L lateral position or Sims' position (lying on L, L lower extremity straightened & R lower extremity flexed up towards chest)
- Perform DRE first
- Some can have light sources attached
- Lubricate proctoscope prior to insertion
55
What are complications of using this?
- Infection
- Rectal bleeding (mild is normal)
- Mild discomfort
- Perforation of rectum - rare
56
What is this?
Rigid sigmoidoscope
57
What is this used for?
Used for inspection of rectum (which is 15cm long) when investigating bleeding or pain
Can be used to obtain biopsies
Can diagnose rectal Ca
*Name is a misnomer, cannot see sigmoid, need flexible sigmoidoscope to see
Has an obturator that is removed & disposed - helps insert sigmoidoscope
58
What are the complications of using this?
- Discomfort
- Bleeding
- Rarely, perforation
59
What is this?
Robinson drain - has 3 holes in tube
Closed drainage system for gravity (passive) drainage consisting of drain (with holes in) pre-attached to collection bag
N.B.: Closed passive drainage system relies on gravity to drain
60
When is this used?
Often used following GI surgery
Used when concern of bleeding that an active system may cause or initiate
61
What is this?
3-way urinary catheter
Can be 2-way
62
What does the sizing refer to?
Diameter of catheter not length, larger number refers to wider catheter
63
What is 3-way used for compared to 2-way?
- Large bore irrigation type foley urinary catheter
- Used to irrigate bladder of pts at risk of clot retention
- E.g. after TURP
- Inflate balloon with water (not saline - can crystallise - mixed evidence about whether this is actually an issue)
64
What are the complications of using this?
- Trauma - false passage
- Urethral stricture (delayed)
- Infection
65
What is this?
Urometer
Urinary collection device used to quantify urine output at regular time intervals before draining into collection bag
I.E. for accurate input/output measurement
May have port for MSU
Normal urine output ~0.5mL/kg/hr
*If put catheter in on call, very helpful to day team to put urometer on
66
What are these?
Thromboembolic deterrant (TED) stockings
- Available in different sizes
- Used in conjugation with low-dose SC heparin
- CI in pts with arterial disease of lower limb
- Have pressure gradient that decreases proximally
- Increases venous blood flow & reduces risk of thrombus formation & helps to relieve heavy aching leg symptoms
67
What are indications for using these?
- Surgical pts especially those with iatrogenic pneumoperitoneum (where pump abdomen full of CO2) + pelvic surgery where legs up
- Immobile pts
68
What are contraindications for using these?
- Arterial disease of lower limbs
69
What is this?
Nasal cannula
Can deliver up to 4L O2 (technically, max 2L in practice as >2L is uncomfortable)
FiO2: 25-40%
For mild hypoxia
70
What is this?
Bag-valve mask
Self-inflating resuscitation device that comes in various sizes for infants, children, & adults
O2 reservoir with 2 one-way valves (inlet valve lets in room air if fresh gas flow inadequate, outlet valve allows O2 outflow if pressure excessive - can still ventilate for few breaths if O2 supply ran out)
Non-rebreathing one-way valve prevents exhaled gas to re-enter bag
Pop-off valve limits pressure of circuit - prevent barotrauma
71
When is this used?
- Administration of high-flow O2
- 15L O2, FiO2 ~85%
- Provision of controlled ventilation
- Provision of augmentation of spontaneous ventilation
72
How to use this?
- High-flow (12-15L/min) O2 attached to system
- Choose appropriate mask size
- Place over mouth & nose
- Tight fit
- 2-handed thumbs down technique better than trying with 1-hand
73
What are complications of using this?
- Easy to hyperventilate pts
- Unable to gauge lung compliance
- Gastric distension
- Aspiration
74
What is this?
Non-rebreather mask
15L, 60-90% FiO2
Bag (1-way valve) prevents rebreathing expired CO2 (1.5L bag capacity)
75
When is this used?
Used in medical emergiencies to enhance O2 delivery (60%), as long as pt can breathe unassisted & sufficient seal
76
What is this?
Nebuliser mask
Used to supply aerosilised medication with O2
77
What is this?
Venturi mask
Used to give controlled FiO2
78
What does the colour coding mean?
Colour coded according to desired FiO2 for given flow rate, so vital to set correct flow rate for individual mask
E.g.
- Blue = 24% at 2-4L/min
- White = 28% at 4-6L/min
- Yellow = 35% at 8-10L/min
- Red = 40% at 10-12L/min
- Green = 60% at 12-15L/min
However, varies so always check on valve
79
When is this used?
- COPD pts - rely on hypoxic drive to breathe so have chronically elevated CO2 (so can't rely on hypercapnic drive), so removing hypoxia will reduce resp drive
- Resp distress with high tidal vol or high RR
80
What are complications of using this?
- If flow rate too low pt may retain CO2 & inadequate FiO2 for pt's needs
- Not warmed or humidified air
- Pt may need more invasive ventilatory support, especially if tired
81
What is this?
Non-invasive ventilation mask (CPAP/BiPAP)
82
When is this used?
- Resp failure - type 1 & 2
83
What are the complications of using this?
- Pt discomfort
- Aspiration
- Ineffective
- Pt not tolerating
- Pt not making adequate resp effort
84
What is this?
Tracheostomy tube
E.g. of invasive ventilation providing definitive airway as protects lungs from aspiration with inflatable cuff
85
What types of these are there?
- Plastic or silver - silver don't have inner tube & need replacing every 5-7 days compared to 30 days in plastic
- Cuffed or uncuffed
- Fenestrated or unfenestrated - hole in outer cannula which means air can pass from lungs up to vocal cords, mouth, & nose. Pts can thus breathe normally & cough secretions out of mouth plus helps with speaking
- Double or single cannula - double cannula has inner & outer tube. Inner tube reduces lumen of outer tube thus increasing resp effort but outer tube means stoma stays open
86
What are indications for using this?
- Obstruction of upper airway (foreign body, trauma, infection)
- Impaired resp function (reduced GCS-post trauma)
- Assist weaning from ventilatory support in ITU pts
87
How are these placed?
- Percutaneously - can be done in ICU using guidewires & dilators - through cricothyroid membrane
- Surgically
88
How is this maintained?
- Artificial humidification
- Regular tracheal suctions as cough less effective
- CPAP or deep breathing exercises to prevent basal atelectasis
89
What are benefits/disadvantages compared to endotracheal tube?
Benefits:
- Reduced need for sedation
- Reduced glottis damage
- Reduced work of breathing (as reduces dead space)
Disadvantages:
- More invasive & complicated placement procedure
- Scar formation
- Insertion site can bleed/become infected
90
What are complications of this?
Immediate:
- Haemorrhage e.g. from thymoid isthmus
- Hypoxia
- Pneumothorax
Early
- Tube obstruction/displacement
- Aspiration
- Infection
Late
- Airway obstruction with aspiration
- Damage to larynx e.g. stenosis
- Tracheal stenosis
91
What is this?
Stoma bag
Stoma = artificial union between conduit & outside world.
3 main types: Colostomies, ileostomies, urostomies
92
What are reasons for having this?
GI stomas - IBD, neoplasia, diverticular disease
Urostomies - rarer but can be used for neoplasia or bladder or prostate
Bag should be checked for stoma effluent:
- Colostomies - formed stool
- Ileostomies - fluid - bilious
- Urostomies - fluid - urine
93
What are complications of having this?
Early
- Haemorrhage at site
- Stoma ischaemia - dusky grey to black
- High output (can lead to hypokalaemia, risk of AKI) - consider loperamide +/- codeine to thicken
- Obstruction secondary to adhesions
- Stoma retraction
Delayed
- Obstruction
- Dermatitis (particularly with ileostomy as fluid is irritant - for this reason ileostomy stump is spouted so reduces direct contact with skin)
- Stoma prolapse (increased risk with colostomy)
- Stomal intussception
- Stenosis
- Parastomal hernia (risk increases with time. Insertion of mesh at formation can reduce risk)
- Fistulae
- Psychosocial problems
94
What is this?
WHO surgical safety checklist
Identifies 3 phases of operation:
- Sign in (pre-op)
- Time out (before skin incision)
- Sign out (post-op)
95
What are these?
Blood culture bottles
Used to sample blood for micro cultures to detect circulating microorganisms in bacteraemia & septicaemia
96
Which is which and which needs to be filled first?
Aerobic blue, anaerobic red/purple
Anaerobic first
97
What is this (drug class)? Why is it used?
Local anaesthetic (2% xylocaine)
Reduces membrane permeability to sodium
Alters signal conduction of neurones by preventing postsynaptic neurone from depolarising
Acts on small unmyelinated C fibres (before large A fibres)
Reduces pain & temperature (before touch & power)
Duration of ~1hr
Increased to 2 with addition of adrenaline
Adrenaline should not be used with digits & appendages
Toxicity leads to effect on CNS & CVS
98
What is this?
Deaver retractor
Hand-held retractor made from stainless steel with curved retracting blade & flat handle which is slighlty curved so hand doesn't slip
99
When is this used?
Used in open abdominal surgery
Used to hold edges of incision
For exposure using traction & countertraction
Used for deep tissues e.g. liver, stomach, duodenum, etc. e.g. cholecystectomy
100
What is this? What is it used for?
5% dextrose
Used for normal daily fluid requirements.
1 L of 5% dextrose = 50g dextrose in 1L fluid
101
What are side effects of using this?
- Irritation of giving vein
- Raised blood sugar
- With excessive use - dilutational effect -> hyponatraemia
102
What is this?
Gelofusine - e.g. of colloid solution & contains succinylated gelatin
Plasma substitute used in cases of significant blood loss including haemorrhage, trauma, & dehydration
Na: 154mM
Cl: 120mM
103
What are the complications of using this?
Anaphylaxis
Urticaria
104
What is this?
Hartmann solution AKA Ringer's lactate solution
E.g. of crystalloid solution
Contains lactate which is a conjugate base (an acid which has lots H+)
Lactate metabolised in liver (Cori cycle)
HCO3 byproducts counteracts acidosis
Contains:
Na: 131mM
Cl: 111mM
K: 5mM
Ca: 2.2mM
Lactate/HCO3: 29mM
105
When is this used?
Fluid resus following blood loss due to trauma, surgery, or burns
Correcting metabolic acidosis
Washing eyes after chemical contamination
106
What are side effects of using this?
- Anaphylaxis
- Allergy
- Volume overload
- Potassium/calcium overload
107
What is this?
Hickman line
Central venous catheter inserted into central vein e.g. subclavian vein with tipe resting at junction of SVC & right artery. Remnant of line tunnelled through skin to reduce infection & line exits out anterior chest
Usually inserted by radiologists or surgeons
Lines can be flushed regularly with heparin to reduce blood clotting in line
Replace roughly every month
108
When is this used?
- Long-term parenteral nutrition
- Long-term IV abx therapy
- Chemo
- Largely superseded by PICC lines
109
What are the complications of using this?
Haemorrhage or pneumothorax
Air embolism
Phrenic nerve palsy
Thrombosis or infection
110
What is this?
Tesio line
Dual lumen for long-term haemodialysis
Tunnelled under skin to reduce risk of infection
111
What is this?
Swanz-Ganz catheter
Pulmonary artery catheterisation
- Via internal jugular, subclavian, or femoral veins
Measure pressures in heart (ITU) - diagnostic - RA, RV, & pulmonary artery
Detect heart failure, sepsis, or monitor therapy
2 lumens, inflatable tip
Rarely done as there are non-invasive alternatives
112
What are indications for using this?
Complicated MI, resp distress, shock, fluid requirement, post-op heart surgery pts, assessment of valvular heart disesae, assessment of cardiac tamponade, constriction
113
What is this?
IV cannula
Plastic tube used to give IV fluids & meds
Can also be used to take blood on insertion
Antiseptic non-touch technique
114
What is this?
Octopus lines/extension
Connects to cannula for administration of fluids & meds
Flushed & cleaned regularly
Reduces risk of infection
115
What is the difference between the tips of 1 & 2?
1: Urinary straight tip foley catheter
2: Urinary coude tip foley catheter
3: Urinary 3-way irrigation catheter
116
What is this?
Laparoscopic port
117
What is this?
Urinary leg bag
118
What is this?
20% Mannitol
Osmotic diuretic used to lower raised ICP
Also used to drive urine output in obstructive jaundice
Less effective than hypertonic saline in acute traumatic brain injury but more effective than pentobarbital
May cause hypervolaemia, headache, polydipsia
C/I in anuria & congestive heart failure
119
What is this?
Needle holders
120
What is this?
Normal saline
Crystalloid containing 153mM NaCl
121
What is this?
Catgut suture, e.g. of natural absorbable suture
Made of strands of collagen from submucous part of sheep or cow intestine which is dried out & sterilised. Absorbed by cell & tissue proteases. Chromic catgut soaked in potassium dichromate, which delays its breakdown - retains strength for 5-7 days
122
What is this?
1-0 nylon suture (non-absorbable)
Higher number, thinner diameter
- 6-0: Face
- 5-0: Hands/feet
- 4-0: Arms/legs
- 3-0: Scalp/trunk
Natural absorbable sutures (catgut) not usually needed, largely replaced by synthetics
123
What is this?
Synthetic absorbable suture
Monofilament have less infection risk but less strong & harder to knot
Vicryl 2-0 & 3-0 very versatile & commonly used
Vicryl - absorbable - braided - very versatile
PDS - absorbable - monofilament - mass closure
Prolene - non-absorbable - monofilament - vascular, hernia
Silk - non-absorbable - braided - drain stitches
124
What is this?
(Travers) Self-retaining retractor
125
What is this?
Shouldered syringe (Gabriel syringe)
Haemorrhoid needle
Shoulder - prevents inserting needle too deep
126
What is this?
Stiff neck cervical collar
Used to stabilise cervical spine in trauma pt & used in conjugation with head blocks & tape
Sized by measuring number of fingers from clavicle to angle of mandible, this is compared to measuring peg on stiff neck collar
NICE guidance state that 3 adequate views of neck are needed before removal
127
What is this?
Trucut needle (long needle, ~20cm)
Used to take histological specimens from lesions e.g. breast lumps or liver
Procedure can be performed under LA
N.B.: Lesions need to be easily accessible via external biopsy
128
What is this?
Hip hemiarthroplasty
Hip prosthesis, typically used for intracapsular fractures of NOF
Especially in >75yo
Can be cemented or uncemented
For hip replacements, think about blood supply for whether intra/extracapsular
- Profunda femoris - branch off femoral
- Circumflex retinacular vessels
129
What are complications of using this?
- Dislocation
- Osteolysis
- Metal sensitivity (especially if hip resurfacing)
- Nerve palsy
- Chronic pain
130
What is this?
Total hip replacement prosthesis
1. Acetabular shell
2. Metal insert
3. Femoral head
4. Femoral stem
131
What is this?
Intramedullary femoral nail
Really long e.g. 30cm, holes for screws
N.B. Needs radiographer during op for image guidance
Anterior bow
Proximal & distal locking screws prevent it from moving
Usually removed in 12-18mths
132
What are the complications of using this?
Complications
- Persistent pain
- Muscle atrophy
- Arthritis
133
What is this?
Fracture plate
Used in conjunction with screws to internally fix bone fracture
134
What are complications of using this?
- Malunion
- Thromboembolism
- Infection
- Need for reintervention
135
What is this?
Dynamic hip screw
For fixation of extracapsular fractured neck of femur
Dynamic in the fact that screw will move into barrel of plate allowing fracture to collapse to position of stability
136
What is this?
Dacron graft
Vascular graft e.g. for aorta, AAA repair
137
What is this?
Blood gas syringe
- Short syringe
- Capped
- With barcode/barcode syringe
138
What is this?
Embelectomy (Fogarty) catheter
139
What is this?
Magill forceps - aid for nasotracheal intubation as well as removal of foreign bodies
140
What is this?
Yankauer suction device
141
What is this?
Laerdal pocket mask
142
What is this?
Sengstaken-Blakemore tube - used to control upper GI bleed
143
What is this?
Percutaneous nephrostomy tubes
- Drain urine
- Inserted through back or flank
144
What is this?
Central venous catheter set
145
What is this?
Toothed forceps
- Allow for firm grip with less pressure (than non-toothed)
- Reduces risk of crush injury
- Used for tougher tissues, e.g. skin, SC fat, fascia, muscles, tendons
146
What is this?
Non-toothed forceps
- Used for delicate tissues e.g. nerves, vessels, bowel
- Generates greater pressure (than toothed)
147
What is this?
Scalpel
148
What is this?
Monopolar diathermy
Monopolar needs plate on pt as 2nd pole in order to close electic circuit. Don't use if don't want circuit to include pt e.g. pacemaker
Clean with "scratch pad"
Difference between monopolar & bipolar:
- Monopolar uses fixed electrode placed in contact with body e.g. leg, buttocks
- Bipolar has both electrodes mounted on "pen"
149
What are the surgical uses of this?
- Cutting modality
- Cauterising small blood vessels
150
What is this?
Spinal needle e.g. for anaesthesia (epidural, spinal blocks, LA, opiates); steroids; LP
2 main types: Bevel at end; bevel at side (AKA atraumatic - into subarachnoid space)
151
What are contraindications for this?
- For LP - raised ICP
- Infection at insertion site
- ?Thrombocytopaenia
152
What are the complications for this?
Pain, bleeding, infection -> meningitis
Post-dural headache
153
What is this?
Laparoscopic trochar
For access to abdomen
Removed leaving port in place
- Insertion of telescope & other instruments
- Size of trochar will determine what can be used e.g. size 5 (smallest) for putting in moving instruments, size 10 & 12 for larger instruments e.g. stapler
Contains small port for CO2 to be inserted
- Non-combustive
- Highly soluble in blood & tissues
- Rapidly cleared from body
Greatest risk at insertion
154
What is this?
Laparoscopic instruments
155
What are these?
Surgical drapes
156
What is this?
Nasal speculm (Thudichum)
Device used to examine anterior part of nose e.g. nasal polyps
Also remove foreign bodies/nasal packs & surgery
