II Lecture Chapter 14 Short Answer and Critical Thinking: Laparotomy pp 312

time out has been completed and the incision is made with visual oozing of blood noted, what would you pass

2 lap sponges, ESU pencil

the surgeon has reached the level of the peritoneum and the earlier retractor is not providing adequate retraction; what instrument might be passed

a larger handheld retractor is used for the initial exploration of the abdominal cavity, such as a larger Richardson

a visible blood vessel has been exposed (ties are available) what would you pass

hemostats, nonabsorbable ties, cauterization

the patient is morbidly obese with a height of five feet and a weight of 200 lb. anticipation requires planning, as you note this when the patient arrives in the operating room (OR). what type of instrumentation may be needed for emergency laparotomy surgery for patients who have a deep cavity

long and deep instruments

the tissue is deeper and retraction of about 1.5 inches of tissue is needed; what instrument might be passed

medium retractor; Richardson retractor

the surgeon has transected the peritoneum and is ready to place a self-retaining retractor for a laparotomy; a large Bookwalter is not available and this is an emergency procedure. describe how to pass the most likely self-retaining retractor

moist lap sponges may be used to pad the wound edges, and the Balfour retractor is passed with blades of sufficient length to retract the wound edges, then a bladder blade if used. the retractor bar is padded with a folded towel over the pubis.

the initial oozing is controlled and the surgeon is ready to dissect; what would you pass for dissection

scissors, electrosurgery, scalpel

assuming no one was relieved during the case, how many counts would you anticipate are made during the case

usually three—an initial count, a count at the closure of the abdominal cavity, and then a count at closure of the skin