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SURGERY – OSCE
FOLEY’S TWO WAYS URINARY CATHETER
1. What is the use of this object? Drainage of urine from bladder. Fluid management of patient. Measure urine output. 2. What is x for?
Passage of distil water through x & inflate the balloon located at the end of the tube in order
to keep the catheter inside the bladder. So we call it “self retaining catheter.”(silastic
catheter change every 3 months.)
3. What are the indications?
Gastrostomy Pt, loss of ANS functions, in cardiac failure. 4. Disadvantages: -
Connect the external and internal environment. Therefore infection can be spread to exterior to interior.
Have to change daily 5. Advantages:-
Balloon prevent self retaining
Blunt end prevent irritation to mucous membrane x
Balloon(Prevent self retaining)
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A NASOGASTIC TUBE
1. What is the use of this? For nasogastric feeding.
To aspiration gastric secretions or contents before emergency surgeries & in bowel obstruction. Gastric empty because emergency
surgery( Road traffic accident)
2. Why is the end of the tube blunt? o To make the tube easy to pass
o To prevent mucous entering the tube & blocking the way – use of two opening in suction tube.
o There are metal boalls in the end to ensure the tube in correct place by using
o By applying air we have to auscultate the bubbling sound to ensure the possition
INTERCOSTAL DRAINAGE WITH TROCAR
1.What is the use of this?
To do intercostals drain in pneumothorax, haemothorax, haemopneumothorax, pleural effusion & for peritoneal dialysis.
2. What are the advantage of “a” ?
“a” is the trocar . a can be pass through a small cut in the skin to pleural space without damaging much tissues.
3. What is location you introduce it? 4th
intercostals space in mid axillary line.
a Air tube (metal tube)
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THE AMBU BAG
1. What are “a “s indications?
To give oxygen to a Pt. in emergencies lick, Pulmonary oedema.
Acute asthmatic attack. Post operative Pt. Pt. with chest injuries.
E.g.:- pneumothorax Anaphylactic shock Pt. Head injury Pt.
To rehabilitees asthmatic Pt.
To ventilate Pt. with respiratory depression. Eg: Morphine overdose
To recover from anesthesia. 2. What is “b” for?
To connect the ambu bag to the oxygen cylinder. 3. What is “c”?
It is face mask it is use to give O2 from the cylinder or ventilate from the ambu bag and also to obtain a good seal.
4. Name “d” & “e”
d- Valve to put air into the mask to it inflates. To obtain a good seal around the mouth. e- Connecter. a b c d e
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CUFFED ENDOTRACHEAL TUBE
What are the uses of this tube?
To maintain Pt. air way in injured or unconscious Pts.
To ventilate unconscious Pts. To give anesthetic drugs.
To ventilate pts. In intra oral surgeries.
To prevention by use of cuff.
What is the use of “a”?
Inflation of “a” with air helps to keep the tube in position & prevent aspiration.
How does this tube an adult differ from that of a young child?
In children’s endotracheal tube is a 3.5 mm area which is radio opaque that help to detect the position of the tube in x-rays.
THE TRACHEOSTOMY TUBEa
5 | P a g e 1. What are the indications?
Acute airway obstruction. e.g.:-forging body.
To ventilate Pts following surgeries including oral cavity. To protect the lower airway
e.g.:-aspiration of saliva in unconscious Pts.
For Pt requiring artificial respiration – respiratory insufficiency. Who has dead space depression 2. What are the advantages?
Anatomical dead space is reduced. Work of berating is reduced. Alveolar ventilation is increases.
Level of sedation needed for Pts comfort, is reduced. Conscious pts also can apply
Not damage to the vocal cords 3. What are the disadvantages?
Loss of heat & moisture exchange performed in upper airway. Desiccation of tracheal epithelium.
Loss of ciliated cells & metaplasia. Over production of mucous.
Mucocilliary stream arrested.(Mucous secretion increase due to irritation) Increase mucous may block the tube.
Splitting of the larynx prevent normal swallowing and lead to aspiration. 4. How do you manage tracheostomy post operatively?
Change of the inner tube & remove mucous plugging. Physiotherapy.
Position the tube & the Pts. 5. What is “a” & what is the use of it?
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ANESTHESIA MASK & OXYGEN MASK
Anesthesia mask Oxygen mask
Its color is black. It is green and translucent
(Simple mask / open mask)
What are the uses of each?
To give oxygen from cylinders and inhalation anesthetics (Halothane) To ventilate a pt in an emergency (to a breathing Pt)
ex: pulmonary oedema, head injury, shock
Use to establish IV drips, Blood transfusion, Fluid transfusion, Nourishment
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Use to examine the larynx, intubation( placing of tube in to hollow organ), removal of foreign bodies obstructing from larynx
THREE WAY TAP
What are the use of this tap?
To aspirate blood from the pleural cavity as well as fluid without leaving any where.
To give 2 IV drips together
To measure central venous pressure To measure arterial blood gases To drain liver abscesses
To drain pleural effusion
Can be A = Saline, B= Drugs or can be closed one tap B
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FLEXIBLE SUCTION CATHETER/ TUBE
1. For what is it use?
To suck out secretion from trachea and bronchi To remove the secretion in post operative sites
2. What is the location you introduce it?
6th 7th intercostals space in the mid axillary line Bulbous end present
BLOOD TRANSFUSION SET
1. Used for
Transfusion of blood
2. What is “a”?
3. What is the advantage?
Remove clot and clump formed due to breakdown of cells and rouleux (stock of RBC/ blood clot) formation
4. What is empty chamber?
Estimate the rate A
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What are the uses of it?
To depress the tongue preventing the tongue falls back To maintain a pts airway
To keep air way pt until recovering from anesthesia
Keep to pt’s airway empty
Epileptic pt(don’t put in mouth)
Fracture of skull (Bone septa may damaged)
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To keep a pt’s airway
Ex: In an emergency
IV DRIP SET/INFUSION SET
1. What is it usage?
To give electrolytes, colloids, antibodies
2. What is the use of empty chamber?
To observe and estimate the amount going in a period of time
3. Why do you an IV drip?
To keep the circulating volume constant (roughly 15 drop for 1ml)
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It is used for lowering down the tongue during oral surgeries or when the need is to visualize oropharynx
PERITONEAL DIALYSIS SET
1. What is the use?
To dialysis the peritoneum (semi permeable membrane) in poisoning, acute renal failure, snake bite
Large amount can insert rapidly
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PACK OF SUTURE MATERIALS WITH NEEDLE
Sterile 4/0 cat gut absorbable suture material with round body needle 18G contain conditioning fluid
1. What are the uses of it? Cat gut:-
Soft tissue suturing Tracheostomy Mucous membranes Intestine
Highly vascular tissue
Soft tissue suturing Blood vessel Oral tissue
2. What are the advantage and disadvantage of suture material? Advantages
Can use in tissues where removal of suture is not done, in young children
Can not suture tough tissue like bone and cartilage, can not use in tension tissues like skin Inflammatory tissue elicit a high tissue reaction
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A SYRINGE WITH A NEEDLE
Giving drug by injection
Subcutaneously or intradermally Withdrawing blood
URINARY THREE WAY CATHETER
Used for irrigation of the bladder by using normal saline after surgery Metal catheter used in maternal ward
Also used as gastrostomy tube Distil water to inflate Distil water input
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What are the indications of this?
To replace water deficits post operatively (Dehydration) Fluid management
To produce with parental nutrition
Infuse through CV catheter (Central venous catheter) to ovoid thrombosis, hypoglycemia, hyperkelemia, with insulin
To reduce cerebral edema
Identify this described abnormality?
This is a skull x ray of a man with a bone eating malignant tumor.
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1. Name two natural & synthetic osmotic products.
o Fresh Frozen Plasma (FFP) o Albumin 25%
o gelatin solutions.
E.g.:- gelafundin, haemocoal. o Dextrans.
a. what are the indication for use? Sevier burns.
Hypovolemic shock. Hemorrhage.
b. What are the disadvantages?
FFP; risk of disease transmission.
Gelatin; allergic reactions. So that>2.5 l/d not infused. Dextrans: interferes with cross matching of blood.
2. What are the indications?
Hypovolemia.GI losses. Vomiting. Diarrhea.
Contra indications: Hypertensive patients. Cardiac failure Renal failure Colloid: crystalloid = 1:3
When crystalloid given only 20% of fluid remains in the vascular comportment after 10 minutes. 0.9%
16 | P a g e a. By using 25% dextrose how to make 500 ml of 15% dextrose solution.
500ml vial 100ml-25g 500ml-125g 500× 75=300 125 Needed 15g- 100ml 75g-500ml -300ml contains 75g -Dilute until 500ml
b. How do you make 500ml at 20% dextrose out of this vial using both? 20% dextrose in 500ml
100ml – 29g 500 – 100g
c. How do you manage an anemic pt.? Pre operative.
Take blood for testing & cross matching. Check for Hb , WBC, platelets. Normal Hb level:-10-15 mg/dl
Blood film:- MCV, MCHC, PCV Treat according to the cause:-
Nutrients – Fe deficiency anemia Drugs FeSO4 200mg 8 hly 4-10 weeks orally
Normal Hb level continue for 6 months.
B12 & Folic acid can be given for emergency surgery. Can give blood packed cells emergency surgery blood grouping & cross matching – transfusion.
17 | P a g e d. Pre- operative management of Diabetic pt.
Blood – check for sugar levels.
If oral hypoglycemic – convert to iv short acting insulin Take first for surgery.
Admit before few days.
Maintain blood glucose above normal. Control with drugs. Before surgery give small amount glucose as liquid. Emergency- give insulin IV with dextrose & maintain it.
I. 30 g ×1.5 used for infuse, Insulin
Minimized mescal damage. Reduce risk of touching other vessels.
Used to give subcutaneously or intradermally.
II. 19G × 1.5 used to transfuse blood reduce rupturing of cells for rapid infusion. To give large amount.
III. 25G*1.5 fine needle aspiration (biopsy)
when the gauge increases the needle become smaller. e.g.
In LA Insulin Vaccines. Adrenaline. Large needle used for:-
Aspiration fluid from cavities. To withdraw blood.
18 | P a g e f. Describe a malignant ulcer
Site Size Shape Margie Edge Floor Base
Regional lymph nodes Surrounding areas
g. O2 & N2O cylinder
O2 cylinder N2O cylinder
Green in color
h. A 40 year old man patient presented with an ulceration lesion on his right leg above the ankle Take history Onset Duration Pain Fever Associated diseases
19 | P a g e i. 70 kg man had an operation to remove a part of his mandible due to cancer. How do you
maintain fluid and electrolyte balance for the second day after surgery? Fluid and electrolyte balance and fluid replacement
For 1st 10kg=100ml/kg
So 1st 10kg require 100X10=1000ml For 2nd 10kg =50ml/kg
So 10-20 kg require 50X10=500ml Rest of the body weight require 20ml/kg For 50kg 20X50=1000ml
Total fluid requirement =25000ml Electrolyte balance
70kg = 1-2X 70 = 70mmol/d 0.9%NaCl 500ml contains 70mmol of NaCl
So 5000ml of 0.9%NaCl is enough to replace Na+ requirement Remain fluid requirement is replaced by 5% dextrose 2000ml KCl 80-100need
KCl comes as vials which contain 20mmol of KCl given for 500ml Total vial requirement = 4 vial for 2000ml dextrose
Pt at ICU does not give K because due to tissue destruction it can be released to out
j. How do you insert an endotracheal tube? 1st
Give emla cream or lignocaine spray
Depress the tongue with the use of the laryngoscope Turn the tongue to left lateral position
Then put the endotracheal tube and inflate the cuff
BUTTERFLY NEEDLE What is used for?
To deliver IV drug to children
20 | P a g e k.
I. What is and what are the use of this? o Monnitol is a diuretic
Used to replace depleted volume specially a head injury pt where there is increased intra cranial pressure- to keep the fluid in the intravascular compartment
After a crush injury there is extensive muscle damage and release of myoglobins from tissues. they can block the renal tubules. Monnitol push the myoglobin and relieves obstruction.
o To measure glomerular filtration rate. II. What are the contraindications?
o Less than 5 month babies
o Because Monnitol tend to accumulate in the body.
l. Adrenaline-1:8000 concentration I. What are the uses?
Cardiac arrest pt 1:1000 Anaphylactic shock pt 1:1000
Local anesthesia 1:8000 (dental procedure) As a treatment of glaucoma
Hypertensive pt are not given II. How it give?
IM III. Why?
IV administration cause arrhythmias
m. Atropine-Antimuscarinic parasympathetic blocker
What are the uses?
Premedication for anesthetic procedure to reduce secretion Organophosphate poisoning
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I. What are the complications of giving dextrose? Infections
Electrolyte imbalance II. How do you prevent them?
(IV drip infections)
Do not give only for one hand Change the site other hand
Should give IV nutrition or vitamins o. Ulcer
Site Margin Base
Discharge- present, absent, color, smell Size Edge Surrounding areas- lymph nodes Shape Floor
p. Calculate the 1st 12 hours fluid requirement in this pt Normal daily requirement = 2.5l
Fluid loss from burns =2 X bodyweight X surface area of burns =2 X 70 kg (18+6+1+9+9+9)
=2 X 70 X46 9% =8940ml
Total requirement per day = 25000+ 6440 38% = 8940ml
For the 1st
8 hours = ½ X 8940ml 9% 1% 9% =4470ml
Next ½ is for the next 16 hours
So for the next 4 hours = 4470/16 X 4 = 1117.5ml 18% 18% So for 1st
22 | P a g e q. How many calories do 25ml of 5% dextrin caries energy?
100ml of dextrose =5g
So in 25ml = 5/100 X 25 = 1.25g 1g of sugar carries 4 Kcal So 1.25g = 1.25 X 4 = 5 Kcal
r. How many vials do you need to replace daily requirement of calories for a 50kg weight pt? 5Kcal/kg/day needed
Total daily calorie requirement =calories /kg/day X weight =35 X 50
One vial of 50% dextrose carries o 50g dextrose in 100ml
o In 25ml – 50/100 X 25 = 12.5g o 1g = 4 Kcal
o So that 12.5g = 50Kcal
Require number of vials = 1750Kcal/50Kcal
23 | P a g e s. What are the differences between crystalloids and colloids?
Crystalloids (normal saline) Colloids ( Monnitol)
o Cheap o Expensive
o No allergic reaction o Elicit allergic reaction o Do not interfere with blood o Interferes with blood
o Grouping and direct testing o Get blood and match before infusion
o Require volume is more o Fever amount needed
o Risk of pulmonary edema o No risk of pulmonary edema
t. How to recognize a fracture? Eg mandible
See along lower border and upper border If there is any discontinuing of the border There is a fracture
Sumith Ruwan Gunawardane D/07/023
Hashan Lakshitha Wijethunge D/07/091