Surgery Marrow Pg 1-10 (General Surgery)
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Questions and Answers

What is a key advantage of using active space techniques in surgery?

  • Difficult to control
  • Used for incision only
  • Safe near vital structures (correct)
  • Requires a cautery pad

    • The Harmonic Scalpel operates by using direct heat to achieve coagulation.

    False

    Describe the primary function of the Ligasure device in surgery.

    To seal and divide using heat and pressure, utilizing body collagen and elastin.

    The cutting current generates heat that results in __________ of cell water.

    <p>explosion</p> Signup and view all the answers

    Match the surgical techniques with their descriptions:

    <p>Cutting current = Cell water explosion Coagulation current = Dehydration and protein denaturation Ligasure = Sealing using collagen and elastin Harmonic Scalpel = Ultrasonic oscillation for coagulation</p> Signup and view all the answers

    What is a primary disadvantage of monopolar cautery?

    <p>It can cause thermal damage to nearby structures.</p> Signup and view all the answers

    Bipolar cautery should be avoided in patients with cardiac pacemakers.

    <p>True</p> Signup and view all the answers

    What type of cautery uses a cautery pad placed over a well-vascularized area?

    <p>Monopolar cautery</p> Signup and view all the answers

    Bipolar cautery is primarily used for __________ and coagulation.

    <p>cutting</p> Signup and view all the answers

    Match the cautery type with its characteristic:

    <p>Monopolar = Interferes with cardiac conduction Bipolar = Avoided in CNS surgeries</p> Signup and view all the answers

    Which patient position is used for posterior cranial fossa surgery?

    <p>Sitting/Fowler's Position</p> Signup and view all the answers

    The Jackknife position is currently considered the standard surgical position for hemorrhoid surgeries.

    <p>False</p> Signup and view all the answers

    What is a major risk factor for air embolism during surgery?

    <p>Sitting/Fowler's position</p> Signup and view all the answers

    Air embolism involves air entering the vein, disrupting cardiac function, often during surgeries involving the ______.

    <p>thyroid or head and neck</p> Signup and view all the answers

    Match the following surgical positions with their uses:

    <p>Prone Position = Spinal surgery Sitting/Fowler's Position = Posterior cranial fossa surgery Lloyd Davies Position = Rectal cancer surgery Jackknife Position = Obsolete for hemorrhoid surgeries</p> Signup and view all the answers

    Which of the following is a disadvantage of the CUSA?

    <p>Time-consuming</p> Signup and view all the answers

    The Thunderbeat S integrates features of both Ligasure and the Harmonic Scalpel.

    <p>True</p> Signup and view all the answers

    What type of tumors is RFA primarily used for?

    <p>Liver tumors up to 3 cm</p> Signup and view all the answers

    The CUSA is particularly better in a __________ liver.

    <p>non-cirrhotic</p> Signup and view all the answers

    Match the surgical methods with their advantages:

    <p>CUSA = Precise cuts and use near vital structures RFA = Requires grounding pad Microwave = No grounding pad required Thunderbeat S = Combines two surgical technologies</p> Signup and view all the answers

    Which position is primarily used for abdominal surgeries?

    <p>Supine Position</p> Signup and view all the answers

    The Trendelenberg Position is commonly used in upper abdominal surgeries.

    <p>False</p> Signup and view all the answers

    What is a common complication of the Reverse Trendelenberg Position?

    <p>Right shoulder tip pain</p> Signup and view all the answers

    The __________ position is associated with obstetric and gynecologic procedures.

    <p>Lithotomy</p> Signup and view all the answers

    Match each surgical position with its usage:

    <p>Supine Position = Abdominal and breast surgeries Trendelenberg Position = Pelvic surgeries Lateral Position = Nephrectomy and thoracotomy Lithotomy Position = Obstetric and gynecologic surgeries</p> Signup and view all the answers

    What is one of the components of the consents necessary for a surgical procedure?

    <p>Diagnosis</p> Signup and view all the answers

    A yellow 24G IV cannula has a maximal flow rate of 31 ml/min.

    <p>False</p> Signup and view all the answers

    What is the most common complication associated with IV lines?

    <p>Superficial thrombophlebitis</p> Signup and view all the answers

    An IV cannula with a gauge of 16G is indicated for __________.

    <p>high flow rates</p> Signup and view all the answers

    Match the IV cannula colors with their corresponding gauges:

    <p>Yellow = 24G Blue = 22G Pink = 20G Green = 18G Gray = 16G Orange = 14G</p> Signup and view all the answers

    Which type of drain is specifically avoided in the abdomen due to the risk of perforation?

    <p>Romovac suction drain</p> Signup and view all the answers

    The Jackson Pratt drain uses negative pressure and can be used in the abdomen.

    <p>True</p> Signup and view all the answers

    Name one type of closed drain that is used after a sentinel lymph node biopsy.

    <p>Minivac drain</p> Signup and view all the answers

    A __________ drain empties into a container or bag and can include devices like the Jackson Pratt or Romovac.

    <p>closed</p> Signup and view all the answers

    Match the following drains with their descriptions:

    <ol> <li>Romovac suction drain = A. Closed drain used after mastectomy and thyroidectomy</li> <li>Minivac drain = B. Used after sentinel LN biopsy</li> <li>Jackson Pratt drain = C. Negative pressure drain that can be used in the abdomen</li> <li>Abdominal drain = D. Closed drain without negative pressure</li> </ol> Signup and view all the answers

    Which of the following actions is involved in the prevention of air embolism in Fowler's position?

    <p>Ligate vein before cutting</p> Signup and view all the answers

    A near miss is an incident that results in harm to the patient.

    <p>False</p> Signup and view all the answers

    What maneuver should be performed if air embolism is suspected while a patient is in the Durant position?

    <p>Aspirate air using direct puncture/central line.</p> Signup and view all the answers

    An incident that reaches the patient but results in no injury is referred to as a __________.

    <p>no-harm event</p> Signup and view all the answers

    Match the types of patient safety events with their definitions:

    <p>Adverse event = An incident that results in harm to the patient Near miss = An incident that could have resulted in harm but did not No-harm event = An incident that reaches the patient but results in no injury</p> Signup and view all the answers

    Which blade is primarily used for incision and drainage (I&D) of an abscess?

    <p>No. 11 Blade</p> Signup and view all the answers

    Langer's lines should be considered when planning an incision to minimize scarring.

    <p>True</p> Signup and view all the answers

    What is the main purpose of the No. 12 Blade?

    <p>Suture removal</p> Signup and view all the answers

    The _____ of the blade is considered the sharpest part.

    <p>belly</p> Signup and view all the answers

    Match the surgical blade numbers with their primary uses:

    <p>No. 10 = Make Incisions No. 15 = Make Incisions No. 11 = Incision &amp; Drainage (I&amp;D) No. 12 = Suture removal</p> Signup and view all the answers

    Which of the following is NOT included in the 'Sign in' phase before the induction of anaesthesia?

    <p>Specimen labelling</p> Signup and view all the answers

    The 'Sign out' phase includes confirming the instruments, sponge, and needle count.

    <p>True</p> Signup and view all the answers

    What are the two methods mentioned for estimating the actual amount of blood loss during surgery?

    <p>Blood in suction minus irrigation fluid or wet mop weight minus dry mop weight.</p> Signup and view all the answers

    The _____ zone includes the operating room where sterile conditions are maintained.

    <p>aseptic</p> Signup and view all the answers

    Match the following OT zones with their descriptions:

    <p>Protective Zone = Pre &amp; post op rooms, Transfer bay Clean Zone = Connects protective zone to aseptic zone Aseptic Zone = Operating theatre Disposal Zone = Waste storage and disposal</p> Signup and view all the answers

    Study Notes

    Active Space

    • No cautery pad is required.
    • Safe close to vital structures and end arteries.
    • Used for coagulation only.

    Cutting Current

    • Heat causes cell water explosion.

    Coagulation Current

    • Dehydration and protein denaturation result in cell death.

    Ligasure

    • Combines heat and pressure.
    • Uses body collagen and elastin to seal and divide tissues.
    • Utilizes feedback mechanism to regulate energy delivery.
    • Automatically discontinues on seal closure.
    • Used up to 7mm diameter.
    • Cannot be used close to vital structures.

    Harmonic Scalpel

    • Uses ultrasonic principle.
    • Oscillatory blade oscillates between 2000–50000 Hz.
    • Protein denaturation and coagulation occur without heat production.

    Bleeding Control: Energy Sources

    • Monopolar Cautery

      • Current flows from the machine through the tip (Bovie tip) to the body and back to the machine.
      • Requires a cautery pad placed over a well-vascularized area for circuit completion.
      • Lateral spread of current can lead to thermal damage to nearby structures.
      • Current interferes with cardiac conduction.
      • Avoid in patients with cardiac pacemakers.
      • Pedicle (channelisation of current) should be avoided near end arteries.

    • Bipolar Cautery

      • Uses two prongs to complete a local circuit.
      • Used for cutting and coagulation.
      • Avoid in CNS, parotid/thyroid, ear lobule, penile regions, and patients with pacemakers.

    Patient Positions

    • Prone - Used in spinal and pilonidal sinus surgeries.
    • Sitting/Fowler's - Used in posterior cranial fossa surgeries.
      • Advantages: Decreased blood loss, Increased exposure.
      • Disadvantages: Increased risk of air embolism.
    • Jackknife - Obsolete, previously used for hemorrhoid and fissure surgeries.
      • Associated with positional asphyxia.
    • Lloyd Davies - Combination of Trendelenberg and Lithotomy.
      • Used in rectal cancer surgery.

    Air Embolism

    • Air enters the venous system, then the circulatory system.
    • Disrupts cardiac function.
    • Risk factors: Thyroid, head and neck surgeries, sitting/Fowler's position.
    • Clinical features: Sudden desaturation, dyspnea, hypotension.

    CUSA (Cavitron Ultrasonic Surgical Aspirator)

    • Can be used close to vital structures.
    • Precise cuts.
    • Cut through scar tissue.
    • Time-consuming.
    • Used for liver resection.
    • Aspirates gases.

    Thunderbeat S

    • Combines features of Ligasure and Harmonic Scalpel.

    RFA (Radio Frequency Ablation)

    • Uses high-frequency alternating current.
    • Similar to electrocautery, requiring a grounding pad.
    • Used for liver tumor resection up to 3 cm.

    Microwave

    • Electromagnetic waves between infrared and radio waves.
    • Generates oscillation and frictional heat.
    • No grounding pad required.
    • Less time-consuming than RFA.
    • Creates a homogeneous ablation zone.

    OT Positions

    • Supine/Neutral - Most common position, used in abdominal and breast surgeries.
    • Trendelenberg - Used in pelvic surgeries.
    • Reverse Trendelenberg - Used in upper abdominal surgeries and laparoscopic cholecystectomy with the right side up.
      • CO2 collects below the right dome of the diaphragm.
      • Right shoulder tip pain is a common complication.
    • Lithotomy - Used for obstetric, gynecologic, urologic procedures, and hemorrhoid surgeries.
      • Common peroneal nerve injury can occur if legs are not properly supported.
    • Lateral/Kidney - Used for thoracotomy, pyelolithotomy, nephrolithotomy, nephrectomy, and breast reconstruction (Latissimus Dorsi Flap).
      • Increased risk for brachial plexus injury due to hyperextended arm.

    Consents (Components)

    • Patient Identification
    • Diagnosis
    • Procedure planned
    • Surgeon
    • Description
    • Procedure specific complications
    • Patient specific complications (Any complication > 1% incidence)
    • Benefits
    • Alternate procedure
    • Signatures: Patient, Surgeon, Witness

    IV Lines

    • Color Coding:

      • Yellow (24G)
      • Blue (22G)
      • Pink (20G)
      • Green (18G)
      • Gray (16G)
      • Orange - Used in shock (14G)

    • IV Lines Size and Width:

      • Narrow to Wide (22G to 14G)

    Complications: IV Lines

    • Superficial thrombophlebitis (most common) - Tender, cord-like swelling
    • Management: Topical heparinoid.

    Prevention of Air Embolism in Fowler's Position

    • Ligate vein before cutting.
    • Irrigate field.

    Management of Air Embolism

    • Durant position (Right side up, left lateral, legs up)
    • Aspirate air using direct puncture or central line if suspicion of air embolism (+).

    Events in Patient Safety

    • Adverse Event: An incident resulting in harm to the patient.
    • Near Miss: An incident that could have resulted in harm but did not, either due to chance or timely intervention.
    • No-Harm Event: An incident that reaches the patient but causes no injury due to chance or mitigating circumstances.

    Types of Blades and Incisions

    • Blade Numbers:
      • No. 10, No. 15, No. 22, No. 23 - Used for making incisions.
    • No. 11 Blade:
      • Pointed/Stab blade.
      • Used for incision and drainage (I&D) of abscesses and arteriotomy.
    • No. 12 Blade:
      • Curved blade.
      • Used for suture removal.

    Important Considerations: Blades and Incisions

    • Belly of the Blade: Sharpest part of the blade.
    • Blade Placement: Passed in a kidney tray, pointed end facing towards the self, mounted on a Bard Parker handle.
    • Incisions: Perpendicular to the skin, go from far to near.
    • Factors While Planning an Incision:
      • Langer's lines (relaxed tension lines): Orientation of dermal collagen fibers; incision placed parallel to them for good scar formation.
      • Muscle fiber action is perpendicular to the incision.
      • Avoid injury to anatomical structures.
      • Cosmetic Factor: Parallel to Langer's lines or hidden in skin creases.
      • Adequate access.

    Surgical Safety Checklist

    • Before Induction of Anaesthesia (Ward to OT Complex)

      • Sign in:
        • Confirm patient identity, site, procedure, written consent, and known allergies.
      • Time out:
        • Confirm patient, site, procedure, and time.

    • Before Skin Incision

      • Sign Out:
        • Instruments, sponge, and needle count.

    • Before Patient Leaves Operating Room

      • Sign Out:
        • Instruments, sponge, and needle count.

    • Post Procedure

      • Specimen labelling (including patient name).
      • Antibiotic prophylaxis given within the last 30 minutes.
      • Anticipated blood loss estimated by surgeon.
      • Actual blood loss measured by the anaesthetist.
      • Radiopaque line picked up on x-ray.

    OT Zones

    • Protective Zone:
      • Change rooms, Transfer bay, Pre & post op rooms, ICU/PACU.
    • Clean Zone (Connects Protective Zone to Aseptic Zone):
      • Equipment store room, Maintenance workshop.
    • Aseptic Zone: OT.
    • Disposal Zone: For waste disposal.

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    Description

    Explore the various energy sources used in surgery for bleeding control and tissue sealing. This quiz covers active space, monopolar cautery, Ligasure, and harmonic scalpel techniques. Understand the principles behind coagulation and cutting currents.

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