minor surger brainscape

Question 1

universal precautions (3)

Answer 1

• blood and body fluids of all patients should be consider infections
• barriers and sharps
• Hep B is most commonly transimitted infection

Question 2

what is the most commonly transmitted infection?

Answer 2

Hep B

Question 3

autoclave sterilization method

Answer 3

15 PSI @ 121 degrees C for 15 min

Question 4

Dry heat

Answer 4

320 degrees F for 60 min

Question 5

boiling

Answer 5

> 30 min

Question 6

2% glutaraldehyde

Answer 6

• 10 min to disinfect

* 10 hr to sterilize

Question 7

how is intact skin disinfected?

Answer 7

• 10% betadine three times OR

* 0.4% chlorhexidine gluconate

Question 8

how are open wounds disinfected?

Answer 8

irrigation with normal saline

Question 9

name the types of wounds

Answer 9

• puncture
• abrasion
• laceration

Question 10

when to refer a puncture wound?

Answer 10

when any nerve, tendon, joint, or chest/abdomen involved

Question 11

what do you do if a large item is involved with a puncture wound?

Answer 11

• leave item
• stabilize
• secure and refer

Question 12

normal procedures with a managable puncture wound

Answer 12

• clean
• debride
• leave open with sterile dressings
• consider tetanus shot

Question 13

normal procedures with abrasions

Answer 13

• clean
• debride
• dress

Question 14

time frames when not to suture a laceration

Answer 14

• 8-12 hours on body

* 24 hours on face

Question 15

what is a keloid scar?

Answer 15

scarring that occurs beyond area of wound

Question 16

name the stages of healing?

Answer 16

• 1. hemostasis
• 2. inflammation
• 3. proliferation
• 4. remodeling

Question 17

characteristics of hemostasis

Answer 17

coagulation and formation of fibrin clot

Question 18

characteristics of healing, time frame

Answer 18

• hemostasis, begins immediately
• inflammation, proceeds from days 1-4
• proliferation days 3-21
• remodeling 3 weeks to 18 months

Question 19

characteristics of healing, name cellular involvement

Answer 19

• platelets (secrete cytokines)
• neutrophils within 5-6 hours, last 3-4 days to destroy bacteria
• macrophages (inflammation to repair and phagocytize)
• basal cells migrate to wound within 24-48 hours
• keratinocytes proliferate 1-2 days after injury

Question 20

characteristics of healing, proliferation

Answer 20

• post hemostasis, inflammation
• days 3-21
• granulation tissue = new capillaries + fibroblasts

Question 21

characteristics of healing, remodeling

Answer 21

• 30-40% strength at 3 weeks

* 80% at 1 year

Question 22

what is contracture in regards to healing?

Answer 22

abnormal formation of tight scar due to excessive contraction.

Question 23

suture type: difficult to evert skin, “railroad track”

Answer 23

simple interrupted

Question 24

suture type: better to evert skin and cosmesis

Answer 24

vertical mattress

Question 25

suture type used for larger deeper wounds

Answer 25

deep / buried

Question 26

suture type with high risk of infection

Answer 26

continuous running

Question 27

absorbable sutures reactivity

Answer 27

plain catgut > chromic catgut > synthetic sutures

Question 28

half life of plain catgut

Answer 28

7-10 day

Question 29

suture types with 2-3 week half life

Answer 29

* chromic catgut * polyglactic/vicryl * polyglycolic/dexon

Question 30

suture with longest half life

Answer 30

* 4-6 weeks | * polydioxanone/PDS

Question 31

remove sutures on face / neck after

Answer 31

3-5 days

Question 32

remove sutures on arm / hands after

Answer 32

7-10 days

Question 33

remove sutures on trunk / legs after

Answer 33

7-14 days

Question 34

remove sutures on feet / scalp after

Answer 34

7-14 days

Question 35

10 cc of 1% = ___ mg

Answer 35

100 mg

Question 36

1 cc of 1% = ___ mg

Answer 36

10 mg

Question 37

metabolizes amide anesthetics

Answer 37

liver

Question 38

amide anesthetics

Answer 38

* lidocaine * bupivacaine * mepivacaine

Question 39

onset and duration of lidocaine

Answer 39

* 1-10 min onset | * 30-60 min duration

Question 40

max dose for lidocaine

Answer 40

* child 3.3-4.5 mg/kg max 75-110 mg | * adult 4.5 mg/kg max 300 mg

Question 41

onset and duration bupivacaine

Answer 41

* 8-12 min onset | * 3-4 hour duration

Question 42

onset and duration of mepivacaine

Answer 42

* 8-12 min onset | * 2-2.5 hour duration

Question 43

metabolizes ester anesthetics

Answer 43

peripheral plasma

Question 44

topical esters

Answer 44

* benzocaine * proparacaine * cocaine * tetracaine

Question 45

infiltrative esters

Answer 45

procaine / novocaine

Question 46

toxic adverse reactions of anesthetics

Answer 46

CNS depressant > hypotension > bradycardia > cardiac arrest

Question 47

TX for toxic amounts of anesthetic

Answer 47

O2

Question 48

adverse reactions are more common in type of anesthetics

Answer 48

esters * benzocaine * proparacaine * cocaine * tetracaine * procaine/novocaine

Question 49

why use epinephrine?

Answer 49

* decrease oozing/bleeding * prolongs duration / decreases absorption * risk toxic reaction

Question 50

dose of epinephrine

Answer 50

1 : 200,000, max of 0.2 mg

Question 51

antidote to epinephrine

Answer 51

Magnesium and B6 to push COMT metabolism

Question 52

never use epinephrine with

Answer 52

* end-arteries * MAOi * TCAs * thyrotoxicosis * severe CVD

Question 53

minor surgery procedures NDS cannot perform

Answer 53

* locations: eyes, nose, axilla, groin, neck * large size / blood supply * depth * young children * patient taking anti-coagulant or bleeding d/o * pulsating lesion * keloid formers * immunocompromised

Question 54

blade used in excisional biopsy

Answer 54

#15

Question 55

length ratio in excisional biopsy

Answer 55

3 to 1

Question 56

degree angle of ends of excisional biopsy`

Answer 56

30 degrees

Question 57

space necessary for punch biopsy

Answer 57

1-2mm beyond border

Question 58

blunt dissection, excision, trimming

Answer 58

* #15 * #10 for thick skin * metzenbaum for blunt dissection

Question 59

puncture abcess and stabbing

Answer 59

#11