Lecture 2 Flashcards
5 methods of sterilisation
dry heat autoclave ionising radiation chemical sterilisation (ethylene oxide, glutaraldehyde, formaldehyde, OPA) plasma sterilisation
Principles of Halsted
handle tissue gently control haemorrhage aseptic technique preserve blood supply eliminate dead space appose tissues with minimal tension
Classification of Operative surgeries according to
Purpose Efficacy Typical/atypical Urgency (CEPOD) Severity (BUPA) Anaesthetic risk (ASA)
BUPA
British United Provident Association
minor (cyst), IM (haemorrhaphia), major (gastrotomy), major plus (gastrectomy), complex major (cardiac).
ASA 1
healthy. 6weeks-5years
ASA 2
mild systemic disease. 3days - 6 weeks or 5-8years
ASA 3
severe systemic disease. non life threatening but visible functional impairment. 8-10 years.
ASA 4
severe systemic disease, constant threat to patients life. 0-3 days or >10years.
ASA 5
moribund status - will likely die in 24hours with/without surgery.
Congenital coagulopathy
Von Willebrandt, haemophilia
Acquired coagulopathy
trauma-shock, immune mediated thrombocytopenia, DIC, SIRS, splenic torsion, hepatopathy, uraemia.
Breeds dispositioned for coagulopathy disorders (4)
doberman, boxer, basset hound, cavalier king charles.
Coagulation tests
Primary haemostasis: platelet count, bleeding time
Secondary Haemostasis: APTT (intrinsic, normal is 20-30 seconds. decalcinated plasma with reagent silimat), PTT (extrinsic. Prothrombin time normal 10-15 seconds, sample with 3.8% sodium citrate in 9:1 dilution and centrifuged)
Increased APTT but normal PT?
Problems with intrinsic path:
Haemophilia A, B or von Willebrands disease
Increased PT but normal APTT?
Extrinsic pathway problems such as
Factor VII deficiency’ (shortest half-life)
Dicumarol Toxicosis
Increased APTT and PT?
Common Pathway problem like liver disease (decreased production of coagulation factors), DIC, dicumarol toxicosis stage 2, Factor X, V, II, I or XIII deficiency.
Intraoperative Surgical Haemostasis
physical compression
coagulation - electrocautery, gelatin sponge (spongostan), oxidated cellulose mesh: surgicel, electronic tissue sealing device, argon spray, laser)
Monitoring for PostOp Bleeding
check mucosal colour, CRT, RBC and platelet count, PCV and TPP
Natural absorbable suture materials
Catgut and collagen
Synthetic absorbable suture materials
polyglycolic acid
polygalactin
polydioxanone (PDS)
Natural nonabsorbable suture materials
silk and cotton
Synthetic nonabsorbable suture materials
polyamide, polyesther, polyolefins
Surgical needle shapes
3/8 (circle), 5/8, 1/2, J shape, compound curve
Surgical needle types
taper point, blunt, cutting (traditional, reverse)
