Instruments Made Simple For NRE NLE Step 2 – BilalMD

In the Instruments section of the NRE Step 2 examination, examiners commonly ask about the name of the instrument, its uses, and its contraindications.

The following are some of the most frequently shown instruments that you should be familiar with during the examination.

1. Foley catheter
2. Proctoscope
3. Sponge holding forceps
4. Babcock forceps
5. Oropharyngeal airway (Guedel airway)
6. Allis forceps
7. Kocher forceps
8. Cusco’s speculum
9. Episiotomy scissors
10. Chest tube (chest drain)
11. NG tube
12. Philadelphia collar
13. Copper T device
14. Nasal speculum
15. Crocodile forceps
16. Endotracheal tube
17. Wrigley outlet forceps
18. Lumbar puncture needle
19. Morris retractor

1. Foley catheter

Indications:

1. Urinary Retention
2. During Surgery
3. Urinary Incontinence
4. Atonic Bladder

Contraindications:

1. Meatal Stenosis
2. Blood At the meatus
3. Evidence of Urethral Infection Refusal of Patient
4. Urethral Trauma (Absolute)

2. Proctoscope

PARTS:

1. Sheet
2. Handle
3. Obturator

Indications:

1. Rectal Polyp
2. Source of inflammation
3. Hemorrhoids

Disadvantage:

1. Slight discomfortness
2. Bleeding

Contraindications:

1. Anal Fissure

Sterilization:

1. Autoclave

3. Sponge Holding Forceps

Features:

1. Straight forceps
2. Bilateral fenestration
3. Serration

Uses:

1. During surgical procedure to hold sponges and swab.
2. Used to clean operative field.

Sterilization:

1. Autoclave

4. Babcock Forecep

Bilateral fenestrated and non-traumatizing forcep

Uses:

1. Hold appendix during appendectomy
2. Also to hold stomach or intestine
3. Hold delicate visceral organ

5. Oropharyngeal airway (Guedel airway)

Uses:

1. Unconscious and airway obstruction
2. Anesthesia – to keep airway open
3. CPR To facilitate and support ventilation

Contraindication:

1. Patient conscious with intact gag reflex
2. Foreign body aspiration

6. Allis forceps

Features:

• Straight forecep
• Having teeth on end
• Non fenestrated

Uses:

1. Used to grosp heavy tissue
2. Used to grasp tissue like Breast and Bowel tissue

7. Kocher forceps

1. Hold superior thyroid vessel (Thyroidectomy)
2. To hold blood vessel
3. Hold Rib during Rib Resection

8. Cusco’s speculum

Uses:

1. Introducing IUCD
2. Taking Pap smear
3. Colposcopy examination

Note:

1. It is self-retaining bivalve speculum.

9. Episiotomy scissors

A planned surgical incison on the perineum and posterior vaginal wall in the second stage of labour.

Indications:

1. Big Baby (macrosomia)
2. Ragid Perineum
3. Breach Presentation
4. Forecep delivery

Ideal Time:

When the perineum is thin of bulging with peak of contraction.

Types:

1. Mediolateral (Most common)
2. Median
3. Lateral
4. J-Shaped

Benefits of Mediolateral:

1. Do not involve rectum.

Layer’s to Cut in Episiotomy

1. Skin
2. Subcutaneous tissue
3. Pudendal vessel
4. Transverse Perineal Muscle
5. Vaginal Mucosa

Repair:

1. Vaginal mucosa suture first
2. Skin and subcutaneous tissue

10. Chest Tube (Chest Drain)

A Surgical drain is inserted through chest wall and into pleural space. The incertion of tube in sometime life saver. The tube drainage system below patient level.

Indication:

1. Pleural effusion (Remove fluid)
2. Pneumothorax (Remove air)
3. Empyema (Remove Pus)
4. Hydrothorax (Senous Fluid)

Chest Tube Care:

Suction Controll Chamber:

• Gentle, steady and continuous bubbling is working fine.

Water Seal Chamber & Air Leak Monitor:

• Steady Rise and falling “Tidaling” is good.

11. NG TUBE

A thin flexible that inserted through nose into stomach.

Uses:

1. Feeding: It is used to provide nutrition and hydration. Who are unable to eat or drink.
2. Medication: It is used to give medicine in those who are unable to take orally.
3. Draining: It is also used to drain liquid from stomach.
4. Note: It is usually used for six weeks.

12. Philadelphia collar

1. Also known as cervical collar.
2. It is a neck brace that immobilize the neck and prevent movement while neck heal.

Indication:

1. Fractured Neck
2. Cervical Neck Injury
3. Trauma
4. Neck instability

Work:

1. Support Neck muscles
2. Gives spinal cord and ligaments times to heals
3. Prevent neck flexion, extension.

13. Copper T Device

Copper T (Paragard) A device to put in uterus to prevent pregnancy. It work for about 10 years.

Effectiveness: More than 99%

Mode of action:

1. Create inflammatory reaction
2. Spermicidal in nature
3. Prevent sperm entry into fallopian tube.

Side Effects:

1. Cramping & back pain
2. Spotting in first three month
3. Perforation

14. Nasal speculum

There are two types of speculum;

1. Thudecum Nasal Speculum
2. Kallian Nasal Speculum

Uses:

1. Rhinoscopy
2. To see a foreign body
3. To see a nasal polyp
4. To see a nasal hematoma

15. Crocodile forceps

It is used in ENT OPD to see and remove foreign body. (Ear & nose)

16. Endotracheal Tube

A hollow tube that is inserted into the trachea through the mouth to provide oxygen & protect the lungs.

1. When patient unable to breath
2. It is also used to administer medication
3. Used during risk of aspiration

Intubation require laryngoscope to view upper part of trachea.

17. Wrigley Outlet Forcep

It is used during assisted forecep delivery.

18. Lumbar Puncture Needle

Needle Size:

1. For adults 9 cm long
2. For children 6 cm long

19. Morris Retractor

Uses:

1. Widen incision edges & wound border during surgery
2. Improve visibility and access to the surgical side
3. Retract or hold tissue and organ during surgical procedure