Surgical Semiology

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1

asepsis

measures that prevent germ contact with patient, status free of germs

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2

antisepsis

curative measure to destroy germs in wound or enviro

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3

status of asepsis is produced by

sterilization

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4

antiseptic principle

applying carbolic acid and wound dressing to prevent infection, by Pasteur

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5

methods of asepsis in OR

washing hands disinfecting operating field sterilization of materials

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6

humid heat sterilization is called

autoclave

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7

sterilization by dry heat is called

poupinel (double wall chamber, for metal instruments)

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8

sterilization by irradation

by gama rays, highly efficient but expensive, for packaged materials

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9

ethylene oxide sterilization is for which equipment

special equipment, soft materials

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10

diff bw formaldehyde and glutaraldehyde solution sterilization

both for bio materials glutha is more stable

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11

__________ methods use changing of colour of test

chemical

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12

_________ methods use bacteriological cultures from samples

biological

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13

desinfectant vs antiseptic

fluid which removes microbes from inanimate objects

antiseptic - on tissue

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14

prep before operation

patient washes with antiseptic, hair removed by clipping

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15

prep in operating room

cleaning with antiseptics, skin prep w/ iodine, draping of operative field

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16

antisepsis of hands of surgeons

dressing, surgical scrubbing

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17

method of performing antisepsis

desinfection

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18

antiseptics

bactericidal chemical products

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19

chlorhexidine

organic compounds - antiseptics

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20

role of OR circulators

verifies equipment, charts etc

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21

scrub technicians vs surgical assistants

scrub technicians - deal w/ tools

surgical assistants help them

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22

bowel prep

fasting liquids 2 hrs, solids 6 hrs

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23

patient prep involves

bowel prep, atb use, cessation/administration meds (anticoags)

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24

Postoperative Pathway - recovery area for complex surgeries is called

ICU

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25

screening done before surgery

  1. Full blood count - Hb, coagulation screen, leukocytes

  2. Biochem - urea, creatinine, electrolytes

  3. Urinalysis

  4. Microbio

  5. Cardiac - ECG

  6. Lung fxn

  7. cross matching blood

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26

objectives for patient preop

  1. establish diagnosis

  2. diagnose other comorbidities

  3. screening common disorders

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27

sensitivity

ability of clinical test to identify patient with abnormality

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28

specificity

ability of test to identify healthy patient who doesn’t have abnormality

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29

+/- predictive value

probability that individual who tested pos/neg does/not have abnormality

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30

patient flow: patient handed to ____ staff to confirm identity → theatre trolley → _____ ______operating table

theatre

anesthetic room

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31

methods of infection control

  • sterilization equipment

  • skin prep + draping

    • prep of operating team

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32

effects of ventilation control and sterilization

infection control

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33

__________ must be divided, stable, highly adjustable w/ rubber padding

operating table

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34

most used position for patient on operating room

supine

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35

Trendelenburg position

patient on operating table supine but head down (reverse in up)

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36

prone position of patient on operating room is for

spinal surgeries

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37

jackknife position is used for

access to anus/rectum

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38

complications of patient position in surgery

ischemia, pressure ulcers, n injury, compartment syndrome

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39

why is trendelenburg position used

organs go towards head - better view for lower gi surgeries

increased v return, intracranial + ocular p, pul compliance, myocardial work

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40

what must be used for a patient in reverse trendelenburg

compression stockings

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41

lateral position - requirements

cushions, secure fastening

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42

precautions when positioning patients on operating table

unintentional contact w/ metal, padding around pressure points, legs down positions preferred (to avoid compartment syndrome)

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43

common nerves at risk during surgery

brachial plexus, ulnar nerve, radial nerve, common peroneal nerve

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44

routine cases - vascular access

one peripheral IV line

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45

vascular access in more complex cases

2+ large-bore IVs, central v catheters (for patients w/ comorbidities)

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46

fxns arterial lines

monitoring BP & ABG

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47

if regional anesthesia, what airway management is used?

nasal/facial canule

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48

if general anesthesia, what airway management is used?

endotracheal tube

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49

when is bag-mask ventilation used?

short procedures

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50

lines of langer

cleavage lines of skin in parallel with fibers, indications for incisions → nicer scar

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51

median sternotomy

exposure for thoracic surgeries, from sternal notch to xiphoid process

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52

thoracotomy

incision for open thoracic surgeries, into pleural space

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53

thoracoabdominal incision

good exposure but increases postop complications

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54

upper midline incisions

from xiphoid process to umbilicus

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55

lower midline

from umbilicus to pubic symphysis, good exposure

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56

paramedian incision

2cm either side of midline depending on organ to be operated on, avoiding linea alba

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57

chevron incision

exposes upper abd, from midaxillary line under ribs

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58

flank incision

for retroperitoneum access, from rib to anterior midline, risk flank bulge postop

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59

transverse abd incision - why is it unnatural

must cut muscle

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60

phannenstiel incision

1-2cm above pubic symphysis, for c section

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61

right subcostal Kocher incision

from xiphoid process → costal inf margin, for liver/gallbladder access

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62

thoracoscopy vs laparoscopy

thoracoscopy has free passage of air into the chest & for pleural space, laparoscopy has peritoneal cavity is distended with a gas

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63

invasive monitoring

to maintain adequate hemodynamic status in an anesthetized patient

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64

After the induction of general anesthesia, the patient’s ability to ___________ is lost

maintain the airway

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65

how is stomach aspiration prevented under anesthesia

fasting, endotracheal tube

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66

indications nasogastric tube

vomiting, gastric dilatation, prevent gastro-esophageal reflux/damage

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67

indications urethral catheterisation

before any surgery or to assess urinary output (retention), incontinence

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68

how to help male catheterisation

pull penis upwards first, then down

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69

Allen test

ulnar collateral supply checked before getting access to radial artery, ask patient to make tight fist

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70

seldinger technique

for central venous catheterisation, needle placed in vessel and guide wire inserted into veie first,

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71

int jugular, femoral and median basilic veins are sites of choice for

central venous catheterisation

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72

central venous pressure

measure of p in vena cava, assessment hemodynamic statush

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73

high vs low CVP levels (normal 8-12mmHg)

  • high is hypervolemia, RV failure, tamponade

  • low is hypovelemia, decreased v return

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74

swan-ganz catheter

pulmonary artery flotation catheter to measure wedge p, bp, cvp, co

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75

low vs high levels paco2 associated w/ low pao2

low is hyperventilation, high is RF

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76

low vs high values paco2

low is hyperventilation, metabolic acidosis/resp alkalosis

high is hypoventilation, RF

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77

local host factors causing an infection

foreign body, necrosis, ischemia (reduces phagocytes + increases anaerobes), hematoma, DM (hyperglycemia, vasc + neuro pathies)

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78

host defense system of skin

mechanical, acidic sebum

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79

why is the proximal small bowel mostly sterile

stomach acid + peristaltic movement

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80

how do skin + GI flora prevent infection

prevents adherence and chemical barrier

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81

___________ are responsible for high morbidity + mortality and prolonged stay in hospital

postop infections

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82

what surgeries have high infection risk

perforated bowel, pus at site (perforated appendicitis)

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83

disinfectants

substances that kill most pathogens (not spores or slow viruses), cleans instruments + surfaces

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84

antiseptics

disinfectants used on living tissue

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85

sterilization

complete destruction of all organisms, for surgical instruments

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86

personal protective equipment for staff

double gloving if HIV, HCV, gowns during operation

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87

maintaining normothermia and hemostasis prevents what

postop infection

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88

aim of prophylactic use of antibiotics

high conc of drug at the surgical site at the time of incision

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89

doses of prophylactic atb

single IV (same as multiple doses), if surgery >4h → 2nd dose

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90

which types of infections are in early postop period (<48h)

resp or urinary

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91

when do wound infections clinically manifest postop

48h

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92

how many days postop of GI anastomosis leakage pccur

5-6

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93

when do implant-related infections manifest postop?

weeks or months

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94

signs of postop infection

cough, dysuria, abd pain, tachycardia, shock, wound tenderness

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95

blood count if postop infection

raised WBC, low + anemia if severe infection

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96

general measures for postop infection management

resuscitation, analgesia, anti-emetics, antipyretics

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97

specific measures for postop infection management

atb, drainage

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98

management of infected wounds

open wound, debride necrosis, take swab + mark cellulitis, dress + antiseptic gauze, secondary closure

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99

when are stoma wound bags and vacuum dressing used

complex/large infected wound

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100

methods of drainage of infected wounds

needle aspiration (leaves no scar), guided drainage, surgical drainage

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