surgery osce

OBJECTIVE STRUCTURE OF CLINICAL EXAMINATION

1 | P a g e

SUMITH & HASHAN

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)

x

Blunt end


2 | P a g e

SUMITH & HASHAN

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

through airway.

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 X-

ray

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)

Around this there is a rubber tube


3 | P a g e

SUMITH & HASHAN

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


4 | P a g e

SUMITH & HASHAN

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.

e.g.:-halothane

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 TUBE

a

a


5 | P a g e

SUMITH & HASHAN

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?

Suction.

Humidification.

Change of the inner tube & remove mucous plugging.

Physiotherapy.

Position the tube & the Pts.

5. What is “a” & what is the use of it?

Introducer.

Used to insert the tube – reduce tissue damage |& insert to the tracheal hold more easily.


6 | P a g e

SUMITH & HASHAN

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

IV CANULA

Use to establish IV drips, Blood

transfusion, Fluid transfusion,

Nourishment


7 | P a g e

SUMITH & HASHAN

LARYNGOSCOPE

Use to examine the larynx, intubation( placing of tube in to hollow organ), removal of foreign

bodies obstructing fro m 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

A

Pt


8 | P a g e

SUMITH & HASHAN

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?

5th 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”?

The filter

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


9 | P a g e

SUMITH & HASHAN

OROPHARYNGEAL AIRWAY

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

NASOPHARYNGEAL TUBE

Keep to pt’s airway empty

Indication

Epileptic pt(don’t put in mouth)

Contraindication

Fracture of skull (Bone septa may

damaged)

Berman airway


10 | P a g e

SUMITH & HASHAN

LARYNGEAL MASK

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)


11 | P a g e

SUMITH & HASHAN

TONGUE DEPRESSOR

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

2. Advantages

Large amount can insert rapidly

Haemodialysis- Use a machine in chronic renal failure


12 | P a g e

SUMITH & HASHAN

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

Needle:-

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

Disadvantages

Can not suture tough tissue like bone and cartilage, can not use in tension tissues like skin

Inflammatory tissue elicit a high tissue reaction


13 | P a g e

SUMITH & HASHAN

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

Distil water output


14 | P a g e

SUMITH & HASHAN

DEXTROSE

What are the indications of this?

5% dextrose

To replace water deficits post operatively (Dehydration)

Fluid management

Fasting

50% dextrose

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.

This kind of tumors are mostly metastases of thyroid carcinoma , breast cancer.


15 | P a g e

SUMITH & HASHAN

1. Name two natural & synthetic osmotic products. Natural:-

o Fresh Frozen Plasma (FFP)

o Albumin 25%

Synthetic:-

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%

NaCl

HS

Hartman’s

solution


16 | P a g e

SUMITH & HASHAN

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.

25% D

25%D 25%D


17 | P a g e

SUMITH & HASHAN

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.

e.

I. 30 g ×1.5 used for infuse,

Insulin

Reduce pain

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:-

Lumbar puncture.

Aspiration fluid from cavities.

To withdraw blood.

Biopsy.


18 | P a g e

SUMITH & HASHAN

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

SUMITH & HASHAN

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

Na+ 1-2mmol/kg/g

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 suxamethonium

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

Use in pneumothorax for emergency


20 | P a g e

SUMITH & HASHAN

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

Arrhythmias


21 | P a g e

SUMITH & HASHAN

n.

I. What are the complications of giving dextrose?

Infections

Thrombosis

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 12 hours = 4470 + 1117.5ml


22 | P a g e

SUMITH & HASHAN

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

Ampule Vial

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

=1750 Kcal

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

=35 vials


23 | P a g e

SUMITH & HASHAN

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

surgery osce

Documents