Minor Surgery Flashcards
(111 cards)
1
Q
_______ fluids of ALL patients should be considered infectious.
A
blood and bodily
2
Q
_______ is the most frequently occurring work-related infectious disease.
A
Hepatitis B
3
Q
Anesthetics are dividided into 2 groups:
A
esters and amides
4
Q
2% Glutaraldehyde has a (low/high) tissue toxicity.
A
Low
5
Q
Name 2 required universal precautions (OSHA):
A
Use barriers (gloves, ppe) Sharps management
6
Q
Use sterilization for _____, disinfecting for ______.
A
S - tools
D - living tissue
7
Q
2% Glutaraldehyde takes how long to work?
A
10 mins to disinfect
10 hours to sterilize
8
Q
Boiling can effectively sterilize at:
A
> 30 mins
9
Q
Dry heat can effectively sterilize at:
A
160C / 320F x1 hour
10
Q
Autoclave rules:
A
15 psi at 121c for 15 mins
11
Q
Intact skin can be disinfected with:
A
10% betadine x3
0.4% chlorhexidine gluconate
12
Q
Why do we irrigate with normal saline instead of H2O2 or other antiseptics?
A
ineffective at disinfecting
slows wound healing
promotes tissue necrosis
13
Q
If skin is punctured, and large items are still in the skin, you should:
A
Secure and refer
14
Q
Let puncture wounds heal by ___ intention.
A
second or third - in case something is still inside
15
Q
Dont suture wounds older than:
A
8-12 hours, up to 24 if very clean
24 hours on the face/neck (good blood supply)
16
Q
If you can’t rule out these kinds of damage, you should always refer:
A
nerve
tendon
vasculature
bone
17
Q
Normal scar healing is called ______, while extending beyond the original area is called ________.
A
hypertrophic
keloid
18
Q
Healing stages:
A
1 - hemostasis/coagulation
2 - inflammation
3 - proliferation (granulation)
4 - remodeling
19
Q
Healing stages - Hemostasis is also called _______, and is characterized by _____ and formation of a _______.
A
coagulation
platelet aggregation
fibrin clot
20
Q
Healing stages - Inflammation occurs on days ______. Cytokines are secreted by ________, complement cascade is triggered, and _______ arrive in 5-6 hours, staying 3-4 days to destroy bacteria.
A
1-4 (immediately)
platelets
neutrophils
21
Q
Healing stages - Inflammation:
__________ remove dead neutrophils, necrotic tissue, and microbial pathogens on days _______.
A
macrophages
1-4
22
Q
Healing stages - Inflammation:
re-epithelialization
A
fibroblasts and epithelial cells bridge across the wound, finished bridging by days 3-4
23
Q
New keratinocytes proliferate ____ days after injury.
A
1-2
24
Q
Neovascularization is:
And occurs during what healing phase?
A
angiogenesis, brings oxygen and nutrients
proliferative
25
Remodeling strength at 3-4 weeks:
30-40%
26
Remodeling strength at 1 year:
80%
27
Bromelain can help increase _______ formation.
collagen
28
Healing intention - primary:
suture a clean wound
| bandage and let heal
29
Healing intention - secondary: full thickness, into subQ
left open, healed by granulation
| used with significant tissue loss or contamination
30
Healing intention - tertiary:
without significant tissue loss -> clean, pack, cover, leave open 3-5 days, then suture if non-infected
* dog bite
* puncture with contaminated tool
> you may want to reopen if the skin starts healing over too soon
31
3 important stitches to be comfortable with if you want to do minor surgery:
Simple interrupted
Vertical mattress
SubQ
32
Simple interrupted stitching may cause _______ scarring
railroad
33
Vertical mattress is (easy/hard) to evert under tension.
easy
| better for cosmesis
34
Horizontal mattress is good for (high/low) tension wounds and (fragile/dense) tissue
high
| fragile (thin skin)
35
Deep or buried stitches - use ______ suture.
absorbable (vicryl or dexon)
| for large or deep wounds
36
What are some indications for using subcuticular/intradermal running stitches:
dermal layer
not visible
eliminates tracts
linear wounds with little tension
37
Running stitches are:
less secure
high risk of infection
quick to put in
not cosmetic
38
3-point, half-buried stitches are good for:
triangular flaps without strangulation
39
Two main classes of suture materials:
absorbable (natural, synthetic)
| non-absorbable
40
Natural absorbable sutures are digested by:
| Examples?
body enzymes
| Catgut, chromic catgut
41
Are natural or synthetic absorbable sutures less reactive?
Synthetic (vicryl, dexon)
42
_______ sutures are hydrolyzed and easy to tie.
synthetic
43
Characteristics of silk sutures:
high tissue reactivity
| easy to tie
44
Characteristics of stainless steel:
minimal tissue reactivity
| permanent
45
Characteristics of polyester/polybutester:
high tissue reactivity
46
Characteristics of nylon/ethilon:
low tissue reactivity, low risk of infx
slips easily
monofilament
47
Staples:
minimal tissue reactivity, low risk of infx
fast
uncomfortable
48
Use ____ knots per gauge:
one knot over gauge (5 knots for a 4-0)
49
Suturing face/neck - gauge, remove:
5-0, 6-0
| 3-5 days
50
Suturing arm/hand - gauge, remove:
4-0, 5-0
| 7-10 days
51
Suturing trunk/leg/foot/scalp - gauge, remove:
3-0, 4-0
| 7-14 days
52
Reverse cutting is (most/least) common
most common for procedures
53
Dress wounds for:
absorption of drainage
support
moisture for epithelialization
limits movement
54
Post-op, keep wounds + dressing dry for _____ hours.
24-48
55
Infections occur ____ days post-procedure, and the most common pathogen is ___________
4-10 days (normal inflammation occurs before day 4)
| staph aureus
56
Blood collection following surgery is called ______, happens _____ hours after surgery, and may lead to infection or ______.
hematoma
24-72 hours
dehiscence
57
Wound rupture along the incision after suture is closed is called ______. You can re-suture within ____. After that window, you want to:
dehiscence
48-72 hours
let it heal by secondary intention
58
Local antisthetics block ___ reuptake, to prevent:
sodium
| depolarization and propagation of pain stimuli
59
10cc of 1% lidocaine = __ mg
100mg lidocaine
60
IM injection angle:
90 degrees
61
SubQ injection angle:
30-45 degrees
62
Intradermal injection angle:
5-10 degrees
63
Amides are metabolized in the _____, and true allergies are (common/rare).
liver
| rare
64
Lidocaine/xylocaine has a ___ min onset, ___ min duration.
1-10 mins to onset
| 30-60 min duration
65
Max dose of lidocaine in a child:
3.3-4.5 mg/kg, not to exceed 75-110mg
66
Max dose of lidocaine in an adult:
4.5 mg/kg, not to exceed 300mg (30cc of 1%)
67
Bupivacaine/marcaine has a ___ min onset, ___ hour duration. Indicated for:
8-12 min onset
3-4 hour duration
digital block
68
Max dose of bupivacaine/marcaine:
4 mg/kg of 0.25%, not to exceed 200mg
69
Esters are metabolized in ________ by pseudocholinesterase
peripheral plasma
| more reactions
70
3 ingredients in TAC:
Tetracaine (ester)
Epinephrine
Cocaine
71
3 ingredients in TAC:
Tetracaine (ester)
Epinephrine
Cocaine
72
We pull back on the plunger before injecting to avoid what adverse reaction?
Inadvertant intravascular injection
| excessive dose
73
Too much anesthetic, give:
oxygen
| CNS depressant may cause hypotension, then bradycardia or arrest
74
Treat mild allergic reactions with _____.
| Treat severe allergic reactions with ______.
diphenhydramine (15 mins)
| epinephrine and oxygen
75
Allergy is mc with what type of anesthetic?
esters
76
In true anaphylaxis reaction, how do pulse and BP change?
HR up / BP down
| [vs. autonomic response - both go up]
77
Uses of epinephrine: (vasoconstriction)
* decrease oozing
* prolong duration by limiting absorption into tissues
* decreasing risk of toxic reactions by reducing circulating anesthetic
78
Side effects of epinephrine:
```
anxiety
restlessness
tremor
palpitations
tachycardia
```
79
Epinephrine dose for anesthetic use:
1:200,000
| < 0.2 mg
80
Epinephrine dose for anaphylaxis:
1:1000
81
Contraindications of epinephrine use:
End-arteries (fingers, nose, toes, penis, clitoris, ears)
MAOIs, TCAs, thyrotoxicosis, severe CAD
caution with PVD, HTN
82
3 parts of the sterile field:
* physician - gloves, washing, mask
* patient - sterile drape, incision area
* tray - tools, materials
83
Contraindications to ND PCP doing minor surgery
* location - lesion on nose, eye, axilla, groin, post neck
* large size / blood supply
* depth - lipomas can be intertwined in mm/bone
* young children
* pt on anti-coags / with bleeding disorder
* pt on a corticosteroid
* pulsating lesion
* keloid forming pt
* systemic illness with depleted immune system
84
Tissue destruction methods:
| Never use if:
cryotherapy
electrosurgery
** if you want to biopsy! **
85
Cryotherapy - freezing with _______, which leads to anoxia and death.
"cryogen"
* HistoFreeze - aerosol
* Dry ice
* Nitrous oxide
* liquid nitrogen - MC
86
If you are going to freeze warts, start by:
using #10 scalpel blade to shave it down to black dots or pin-prick bleeding, THEN cryo
87
Cryotherapy is indicated for:
* warts
* skin tags (acrochordon)
* seb keratosis
* actinic keratosis
88
Dry ice isn't used much anymore, because:
it's simple, cheap, but not very effective
89
Transport liquid nitrogen in a:
| Never use straight from bottle, risk of:
Dewar bottle
| HPV transmission
90
Liquid nitrogen - freeze, thaw, refreeze, with ___mm zone around lesion.
May cause __________
2-3 mm
| depigmentation
91
Types of electrosurgery:
* Electrocautery - indirect, precise
| * Hyfrecation - direct
92
Describe proper excisional biopsy technique:
3:1 elliptical excision with 30 deg corners
#15 scalpel
parallel to Langer's Lines
93
Punch biopsy technique:
traction perpendicular to Langer's Lines
1-2mm beyond edge of lesion
full thickness of dermis
94
When do you use #10, 11, and 15 scalpels?
11 - puncture abscess, incision, stabbing
15 - blunt dissection, excision, trimming
10 - like 15, thick skin
95
When do you use non/toothed forceps?
Toothed adson - does not crush skin
| Toothless - crushes skin, foreign body removal
96
When do you use iris vs metzenbaum scissors?
Iris - fine dissection, not for sutures
| Metzenbaum - blunt dissection
97
Healing stages - Proliferation occurs on days _____. ______ deposit ______, in order to strengthen the wound.
5-20
Fibroblasts
Type III collagen
98
Healing stages - Wound Remodeling occurs from day ______ onwards. ______ formed during proliferation is broken down.
21
| Type III collagen
99
Healing stages - Wound Remodeling
| Type III collagen is replaced by _______, and collagen fibers are ______.
Type I collagen
| Cross-linked
100
Healing stages - Proliferation
| Fibroblasts differentiate into _______, and cause contracture.
Myofibroblasts
101
Which injectable anesthetics are amides?
Lidocaine
Mepivacaine
Bupivacaine
102
Which anesthetics are esters?
Procaine
Tetracaine
Benzocaine
103
Indications for electrocautery:
− Obtaining hemostasis
− Removing acrochordons
− Draining subungual hematomas
− Removing actinic + seborrheic keratosis
− Removing other benign lesions often combined with curettage
104
Esters metabolize into ______, which is associated with true allergic reactions.
PABA
105
If a patient is allergic to PABA, they may also be allergic to _______, which is included in amide anesthetics (unless single use).
Methylparaben
| Use a preservative-free amide for pts allergic to esters/PABA
106
1cc of of 1% lidocaine solution = __ mg
10mg
107
Empirical antibiotic tx of an infected wound?
Cephalexin 500mg tid-qid
-or-
Clindamycin 300mg tid if pt is allergic to penicillin or if they have a known hx of MRSA
108
3 reaction types to local anesthetics:
Toxic
Allergic or hypersensitive
Autonomic
109
Signs of toxic rxn to local anesthetics?
| Tx?
CNS: tinnitus, numbness of the lips, light-headedness, N/V
Cardio: hypotension, bradycardia
Tx: oxygen
110
Signs of allergy rxn to local anesthetics?
| Tx?
Rash, erythema, urticaria, angioedema
Hypotension, bronchospasm
Tx: diphenhydramine, if severe epinephrine and oxygen
111
Signs of autonomic rxn to local anesthetics?
| Tx?
Tachycardia, sweating, dizziness, faintness, syncope
| Tx: pt should lie down
