Midterm

Question 1

How long should sutures stay in: the face, the thigh

Answer 1

Face: 3-5 days
High tension areas, eg Thigh: 10-14
Low tension areas: 6-10 days
Trunk: 6-12 days

Question 2

What suture materials are used internally?

Answer 2

Vicryl or Gut

Question 3

What sutures are absorbable? Non absorbable?

Answer 3

Absorbable: vicryl, gut
Nonabsorbably: silk, nylon, cotton, etc

Question 4

What are the different types of nerve blocks? What might they be used for?

Answer 4

Field block, digital block, IV anesthesia, Spinal/ Epidural anesthesia…

Question 5

When might we use a digital block? What kind of anesthetic would we use?

Answer 5

Toenail removal; Lidocaine with Marcaine (longer lasting anesthetic effect)

Question 6

What type of anesthetic are marcaine and lidocaine?

Answer 6

amides

Question 7

When would we use a vertical mattress suture?

Answer 7

closing deep dead spaces (eg. after lipoma/cyst removal)

Question 8

When would we use other stitches?

Answer 8

Subcutaneous: close deep dead spaces
Vertical mattress: as a stay, and to close dead spaces
Horizontal mattress: as a stay for wounds under tension

Question 9

What is the most common cause of anaphylaxis during minor surgery procedures?

Answer 9

Accidental injection of anesthetic into central circulation (vein/artery)

Question 10

What are signs/Sxs of an adverse reaction to anesthetic?

Answer 10

coma, convulsions, syncope, LOC, bradycardia, hypotension etc

Question 11

Nerve block vs. Field block vs. Infiltration

Answer 11

Field block: uses less anesthesia to get effect, surrounds the area of use
Nerve Block: inject into peripheral nerve roots directly
Infiltration: Inject underneath the area of interest (causes distortion of area and may require more anesthesia to gain desired effect)

Question 12

What is infiltration? What might it be used for?

Answer 12

Injection at or underneath a lesion to be removed.

Question 13

What are the major solutions we use for sterile prep?

Answer 13

Betadine, Provoiodine, Hebiclense

NOTE: alcohol not effective, as sterility doesn’t last very long

Question 14

What is the most important step in creating a sterile field/environment?

Answer 14

GLOVES!

Question 15

What medications are contraindicated in minor surgery?

Answer 15

MAOI

use caution with antidepressants

Question 16

What are the best tools for undermining?

Answer 16

dull (iris) scissors, hemostat, use care/caution with pointed scissors

Question 17

How far do we undermine around a wound?

Answer 17

1/2 the distance of the wound

Question 18

At what temperature and how long at that temperature is required to sterilize tools?

Answer 18

Autoclaving: 250degF at 15lb/sq.in. for 30 minutes

Dry Sterilization: 450degF for 30 minutes

Question 19

What kills spores on tools?

Answer 19

quick release/snap (sudden decompression)

Question 20

What is the progression of pain/numbness with anesthetic?

Answer 20

1. pain sensation lost
2. cold/warmth sensation
3. sense of touch lost
4. deep pressure sense lost
5. motor fxn lost

Question 21

What are the pros/cons of using betadine?

Answer 21

Betadine: requires 2 minutes contact to be effective. Some patients may be allergic to components of the product

Question 22

Is it better to have wound closure with inversion or eversion?

Answer 22

EVERSION

Question 23

What channel does lidocaine block?

Answer 23

sodium channels

Question 24

What instruments are in a suture pack?

Answer 24

curved iris or dull scissors
needle holder/hemostat
forceps (toothed and flat)
gauze
may have a scalpel handle

Question 25

Which forcep is best to grab tissue?

Answer 25

toothed

Question 26

1:100,000 epinephrine is used in:

Answer 26

when mixed with lidocaine for topical anesthesia

Question 27

1:1000 epinephrine is used in:

Answer 27

Epipens Adults dose: 0.3ml Ped. dose: 0.15ml

Question 28

1:10,000 epinephrine is used in:

Answer 28

in an IM injection for MI

Question 29

What size needles do we use for drawing up lidocaine?

Answer 29

18g

Question 30

What size needles do we use for injection of lidocaine?

Answer 30

25g

Question 31

In what order would you want to draw up anesthetic materials?

Answer 31

Bicarb 1cc, Lidocaine, then Epinephrine 9-10cc | Bicarb, then Lido+Epi, if they're already mixed

Question 32

What size scalpel would we want to use most often? (eg: for cutting elliptical areas around a biopsy)

Answer 32

15 blade

Question 33

What size scalpel would we want to use for lancing boils?

Answer 33

11 scalpel

Question 34

What size scalpel would we want to use for a shave biopsy?

Answer 34

10

Question 35

What are the pros/cons of using topical anesthetics?

Answer 35

CONS: can't apply to deep wounds- may be absorbed systemically

Question 36

Who (what type of pt) is more prone to infection and why?

Answer 36

Immunocompromised

Question 37

Does injection do long term damage to the nervous system?

Answer 37

No- there is no evidence to support this

Question 38

How long does it take Lidocaine and Marcaine to take effect? How long do the effects last?

Answer 38

Lidocaine: onset 1 minute, lasts 45-60 minutes with Epi: lasts 2-6 hours Marcaine: onset 5 minutes, lasts 2-4 hours