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SUMITH &
HASHAN
SURGERY – OSCE
FOLEY’S TWO WAYS URINARY CATHETER
Blunt end
x
Balloon(Prevent self retaining)
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OBJECTIVE STRUCTURE OF CLINICAL EXAMINATION
SUMITH &
HASHAN
A NASOGASTIC TUBE
1. What is the use of this? 2. Why is the end of the tube blunt?
For nasogastric feeding. o To make the tube easy to pass
To aspiration gastric secretions or through airway.
contents before emergency o To prevent mucous entering the
surgeries & in bowel obstruction. tube & blocking the way – use
Gastric empty because emergency of two opening in suction tube.
surgery( Road traffic accident)
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
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OBJECTIVE STRUCTURE OF CLINICAL EXAMINATION
SUMITH &
HASHAN
THE AMBU BAG
a
c
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OBJECTIVE STRUCTURE OF CLINICAL EXAMINATION
SUMITH &
HASHAN
CUFFED ENDOTRACHEAL TUBE
What are the uses of this tube? What is the use of “a”?
To maintain Pt. air way in injured or Inflation of “a” with air helps to
unconscious Pts. keep the tube in position & prevent
To ventilate unconscious Pts. aspiration.
To give anesthetic drugs. How does this tube an adult differ from
that of a young child?
e.g.:-halothane In children’s endotracheal tube is a
To ventilate pts. In intra oral 3.5 mm area which is radio opaque
surgeries. that help to detect the position of
To prevention by use of cuff. the tube in x-rays.
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OBJECTIVE STRUCTURE OF CLINICAL EXAMINATION
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.
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OBJECTIVE STRUCTURE OF CLINICAL EXAMINATION
SUMITH &
HASHAN
ANESTHESIA MASK & OXYGEN MASK
IV CANULA
Use to establish IV drips, Blood
transfusion, Fluid transfusion,
Nourishment
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OBJECTIVE STRUCTURE OF CLINICAL EXAMINATION
SUMITH &
HASHAN
LARYNGOSCOPE
Use to examine the larynx, intubation( placing of tube in to hollow organ), removal of foreign
bodies obstructing from larynx
B Pt
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OBJECTIVE STRUCTURE OF CLINICAL EXAMINATION
SUMITH &
HASHAN
FLEXIBLE SUCTION CATHETER/ TUBE
1. Used for
A 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
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OBJECTIVE STRUCTURE OF CLINICAL EXAMINATION
SUMITH &
HASHAN
OROPHARYNGEAL AIRWAY
What are the uses of it?
Berman airway
NASOPHARYNGEAL TUBE
Keep to pt’s airway empty
Indication
Contraindication
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OBJECTIVE STRUCTURE OF CLINICAL EXAMINATION
SUMITH &
HASHAN
LARYNGEAL MASK
To keep a pt’s airway
Ex: In an emergency
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OBJECTIVE STRUCTURE OF CLINICAL EXAMINATION
SUMITH &
HASHAN
TONGUE DEPRESSOR
It is used for lowering down the tongue during oral surgeries or when the need is to visualize oropharynx
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OBJECTIVE STRUCTURE OF CLINICAL EXAMINATION
SUMITH &
HASHAN
PACK OF SUTURE MATERIALS WITH NEEDLE
Sterile 4/0 cat gut absorbable suture material with round body needle 18G contain conditioning fluid
Cat gut:-
Needle:-
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
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OBJECTIVE STRUCTURE OF CLINICAL EXAMINATION
SUMITH &
HASHAN
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OBJECTIVE STRUCTURE OF CLINICAL EXAMINATION
SUMITH &
HASHAN
DEXTROSE
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
This kind of tumors are mostly metastases of thyroid carcinoma , breast cancer.
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OBJECTIVE STRUCTURE OF CLINICAL EXAMINATION
SUMITH &
HASHAN
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.
Hypertensive patients.
Cardiac failure
Renal failure
When crystalloid given only 20% of fluid remains in the vascular comportment after 10 minutes.
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OBJECTIVE STRUCTURE OF CLINICAL EXAMINATION
SUMITH &
HASHAN
a. By using 25% dextrose how to make 500 ml of 15% dextrose solution.
500ml vial
100ml-25g
500ml-125g
25% D
500× 75=300
125
Needed
15g- 100ml
75g-500ml
b. How do you make 500ml at 20% dextrose out of this vial using both?
20% dextrose in 500ml
100ml – 29g 500 – 100g
25%D 25%D
Take blood for testing & cross matching. Check for Hb , WBC, platelets.
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OBJECTIVE STRUCTURE OF CLINICAL EXAMINATION
SUMITH &
HASHAN
d. Pre- operative management of Diabetic pt.
e.
I. 30 g ×1.5 used for infuse,
Insulin
Reduce pain
Minimized mescal damage.
II. 19G × 1.5 used to transfuse blood reduce rupturing of cells for rapid infusion.
To give large amount.
e.g.
In LA
Insulin
Vaccines.
Adrenaline.
Large needle used for:-
Lumbar puncture.
Aspiration fluid from cavities.
To withdraw blood.
Biopsy.
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OBJECTIVE STRUCTURE OF CLINICAL EXAMINATION
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HASHAN
f. Describe a malignant ulcer
Site Floor
Size Base
Shape Regional lymph nodes
Margie Surrounding areas
Edge
Green in color
h. A 40 year old man patient presented with an ulceration lesion on his right leg above the ankle
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OBJECTIVE STRUCTURE OF CLINICAL EXAMINATION
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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?
Pt at ICU does not give K because due to tissue destruction it can be released to out
BUTTERFLY NEEDLE
What is used for?
To deliver IV drug to children
Use in pneumothorax for emergency
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OBJECTIVE STRUCTURE OF CLINICAL EXAMINATION
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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
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.
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
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OBJECTIVE STRUCTURE OF CLINICAL EXAMINATION
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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
=2 X 70 kg (18+6+1+9+9+9)
=2 X 70 X46 9%
=8940ml
= 8940ml
=4470ml
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OBJECTIVE STRUCTURE OF CLINICAL EXAMINATION
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
=35 X 50
=1750 Kcal
=35 vials
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OBJECTIVE STRUCTURE OF CLINICAL EXAMINATION
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HASHAN
s. What are the differences between crystalloids and colloids?
Eg mandible
D/07/023 D/07/091
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