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absolute contraindications to laparoscopy - CORRECT ANSWER: - unable to tolerate
laparotomy
- hypovolemic shock
- lack of surgeon training
- no support @ hospital
benefits of bipolar energy - CORRECT ANSWER: lower energy, producing less lateral
tissue damage and necrosis
- DONT need a grounding pad
CO2 - CORRECT ANSWER: readily absorbed, easily eliminated
increase end tidal CO2, increase arterial CO2 concentration, decrease serum pH,
greatest change is seen in the first 20 minutes
do you discontinue aspirin the day of surgery? - CORRECT ANSWER: no
gas embolus - CORRECT ANSWER: rare but can occur
seen less than 1 percent of the time
diagnose with severe hypotension, JVD, tachycardia, mill wheel murmur
* need to rule out other sources of hypotension
how to enter in patient with bowel obsturction - CORRECT ANSWER: direct
visualization
, most common sources of unrecognized bleeding - CORRECT ANSWER: trocar injury
of abdominal vessels,
nitric oxide - CORRECT ANSWER: less acid base issues, can be tolerated in
cardiopulmonary patients, slightly less postoperative pain
postoperative nausea/vomiting risk factors - CORRECT ANSWER: female, young,
previous issues, morning sickness, nonsmoker, procedural length, lower ASA
classification, preoperative anxiety, prevention involves using anti emetics, limiting
opioids if possible
relative contraindications to laparoscopy - CORRECT ANSWER: - can't tolerate general
anesthesia
- long standing peritonitis
- large abdominal/pelvic mass
- massive hernia
- severe cardiopulmonary disease
risks of bipolar energy - CORRECT ANSWER: risk of cutting patient vessels before
adequate sealing, device doesn't work if metal between the jars
risks of monopolar - CORRECT ANSWER: current can be diverted through
unintentional pathways, leading to inadvertent tissue injury
- don't use hybrid ports that mix metal with plastic
risks of ultrasonic dissection (harmonic) - CORRECT ANSWER: active blade can injure
something due to high frequency (50 MHz)
visceral artery aneurysm - CORRECT ANSWER: risk of injury w/ trocar insertion