12: Hemostasis - Bennett Flashcards Preview

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Flashcards in 12: Hemostasis - Bennett Deck (17)
1

how should anatomical dissection be done?

identification of tissue planes and the use of atraumatic technique

2

preferred type of hemostasis

- pneumatic thigh cuffs
- causes pain due to high pressure and will require general or spinal anesthesia
- ankle can be used with all forms of anesthia or not sedated, but causes higher incidence of complicaitons

3

what mmHg should not be exceeded with thigh cuffs?

500 mmHg
ankle should not exceed 250

4

what is exsanguination?

- elevation of extremity before elevating the cuff pressure
- 45 degrees 3 min, 60 degrees 2 min
- or use esmarch or ace wrap up to cuff level

5

contraindications to using pneumatic cuffs

- infection
- malignancy
- thrombo-embolic disease
- prior endovascular procedure

6

proper inflation of cuff

- approx. 100 mgHg above systolic for ankle
- approx 200 mmHg above systolic for thigh

7

max time for torniquet or pneumatic cuff

- 2-3 hours
- breathing times 5-10 min
- ideally max torniquet time 1.5 hrs with 5-10 min reperfusion interval allowed for complete cellular recovery

8

physiological changes with tourniquet use

- increasing acidity
- decrease oxygen partial pressures
- increase carbon dioxide

9

mimics natural catecholamines that bind to alpha adrenergic receptors

vasoconstrictors

10

describe the use of epinephrine with hemostasis

- Reduces vascularity locally
- Permits a higher allowable dose of local
- Increases the duration of the block


permissible concentration: 1:100,000-200,000

11

evithrom

- topical thrombin
- bovine origin
- clots fibrinogen of blood
- rate of coagulation dependent upon concentration
- 500 units will clot 5 ml in less than 1 sec

12

gelfoam

- purified animal protein
- mechanical matrix promotes clotting and its a physical barrier
- absorbs many times its own weight in blood
- absorbed in 4-6 weeks

13

avitene

- microfibrillar collagen
- attracts platelets
- may be used in pts undergoing heparin and aspirin therapy *

14

surgicel

- oxidized regenerated cellulos
- absorbed
- hemostasis based on physical properties - binds to bleeding areas to coagulate vessels, compreses ara
- bactericidal properties**

15

floseal

- combo of tow hemostatic agents [acts at beginning of coagulation cascade to promote contact activation; acts at end of coagulation cascade to facilitate fibrin formation]
- stops bleeding within 2 minutes
- effective on soft tissue and bone

16

human thromin

evicel

17

bone wax

- refined bees wax
- physical barrier
- inhibits bone healing

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