12: Hemostasis - Bennett Flashcards

1
Q

how should anatomical dissection be done?

A

identification of tissue planes and the use of atraumatic technique

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2
Q

preferred type of hemostasis

A
  • 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
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3
Q

what mmHg should not be exceeded with thigh cuffs?

A

500 mmHg

ankle should not exceed 250

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4
Q

what is exsanguination?

A
  • 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
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5
Q

contraindications to using pneumatic cuffs

A
  • infection
  • malignancy
  • thrombo-embolic disease
  • prior endovascular procedure
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6
Q

proper inflation of cuff

A
  • approx. 100 mgHg above systolic for ankle

- approx 200 mmHg above systolic for thigh

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7
Q

max time for torniquet or pneumatic cuff

A
  • 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
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8
Q

physiological changes with tourniquet use

A
  • increasing acidity
  • decrease oxygen partial pressures
  • increase carbon dioxide
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9
Q

mimics natural catecholamines that bind to alpha adrenergic receptors

A

vasoconstrictors

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10
Q

describe the use of epinephrine with hemostasis

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

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

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11
Q

evithrom

A
  • 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
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12
Q

gelfoam

A
  • 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
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13
Q

avitene

A
  • microfibrillar collagen
  • attracts platelets
  • may be used in pts undergoing heparin and aspirin therapy *
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14
Q

surgicel

A
  • oxidized regenerated cellulos
  • absorbed
  • hemostasis based on physical properties - binds to bleeding areas to coagulate vessels, compreses ara
  • bactericidal properties**
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15
Q

floseal

A
  • 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
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16
Q

human thromin

A

evicel

17
Q

bone wax

A
  • refined bees wax
  • physical barrier
  • inhibits bone healing