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NPLEX botanical > Minor surgery > Flashcards

Minor surgery Flashcards

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1
Q

what is the most commonly transmitted infection

A

hep b

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2
Q

disinfect versus sterile

A

Disinfect people: they still have some bugs

sterilize equipment: they don’t have bugs

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3
Q

Autoclave pressure, time and temp

A

15 psi x 15 minutes @ 121 deg Celcius

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4
Q

How to steralize in solution/disinfect in what solution?

A

2% glutarladehyde
Disinfect x 10 minutes
sterilize x 10 hours

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5
Q

how long to boil something to dininfect

A

30 minutes

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6
Q

how long to dry heat to steralize

A

160c/320F x 1 hour

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7
Q

Disinfect a wound/open skin?

A

Normal saline 0.9%

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8
Q

disinfect intact skin

A

10% betatine x 3

0.4% chlorhexidine gluconate

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9
Q

when should you refer a puncture?

A

If any nerve, tendon, joint or penetrates chest or abdommen. Secure and refer if large item.

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10
Q

how should you treat a puncture you don’t refer

A

Clean, debride and leave open with sterile dressing. 3rd intention.

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11
Q

after how many hours should you not suture a wound

A

after 8-12 hours on body

after 24 hours on face

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12
Q

simple vs complex wounds

A

rated on about of tissue loss andd contamination.
Complex: road rash
Simple: cut with kitchen knife

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13
Q

Keyloid healing

A

healing that extends beyond the original area of wound

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14
Q

Hypertrophic healing

A

Normal healing that remains in the original area of wound

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15
Q

What are the stages of healing?

A
  1. Hemostasis: coagulation
  2. Inflammation
  3. proliferation (granulation)
  4. remodeling
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16
Q

what happens stage 1 hemostasis

A

Coagulation and formation of fibrin clot

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17
Q

what happens stage 2: inflammation

A

Begins immediatiely from 1-4 days

  • clot formation triggers complement, with cytokines
  • Neutraphils show up and kill bacteria within 5 hours and last 3-4 days
  • macrophages repair and phagocytize
  • Basal cells show up in 1-2 days to repair wound
  • kerationcytes 1-2 days proliferate
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18
Q

what happens stage 3: proliferation

A

also called granulation, it lasts from 3-21 days

  • granulation tissue around new capilaries and fibroblasts.
  • angiogenesis neurovascularizations
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19
Q

what action brings oxygen and nutrients to the new tissue in stage 3 of healing

A
  • angiogenesis

- neurovascularizations.

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20
Q

what happens stage 4, remodeling of healing

A

3 week - 18 months:

  • 3-4 week = 20-30% strength
  • 1 year = 80%
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21
Q

difference between contraction and contracture of a scar

A

contraction: normal with orientaiton of collagen and myofibroblasts
contracture: abnormal: tight stcar from excessiv contraction.

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22
Q

what are the healing intestions

A

1st: clean wound and suture: <12 hours
2nd: This is when it cant really be closed or cleaned adequately like in road rash and the full thickness is scraped. So its cleaned and covered
3rd: Super contaminated; can be cleaned, and packed with something to make sure its not getting infected. Finally close it 3-4 days later. can only be done it there hasn’t been tissue lost: ie for a cut rather than a scrape

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23
Q

what suture can cause a rail road tract scarring?

A

Simple interupted: it may be hard to get good eversion

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24
Q

what suture is easy to evert under tension?

A

Verticle matress : better cosmetically

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25
what sutue for high tension or fragile skin?
Horizontal mattress: IE palms or soles
26
what sutre requires absorbable suture
Deep or burried suturs. this is for large deep wounds
27
what suture would you use to make invisable sutures
subcuticular/transdermal running | Absorbable or not
28
what suture increases risk of infection
COntinuous running: Rapid and non cosmetic
29
how do you sew a 3 corner flap without strangulatino
3 point/half burried
30
major categories of absorbable suture
Natural: SYnthetic:
31
what are the natural absorbable sutures
Natural - Plain cat gut: most likly to cause reaction: 7-10 day 1/2 life - chromic cat gut: middle reaction: 2-3 week 1/2 life - ( synthetic are less likely to react)
32
what are the three types of synthetic absorbable sutures
``` Vicryl: (polygalactic) 2-3 week 1/2 life - braided - monofilament Dexon: (polyglycolic) 2-3 week 1/2 life - monofilament PDS: (polydioxanone 4-6 week 1/2 life - monofilament ```
33
what absorbably synthetic last longest, or is braided
Lontest duration: PDS: 4-6 weeks | Braided: Vicryl: 2-3 weeks
34
what type of sutures would you do with absorbable sutures?
Sub Q: | burried
35
what are the major types of non absorbable surures
Natural - Silk: braided; easy to tie, very very reactive - Stainless steel: Permanent , little reactivity - Polyester/polybutester: more reactive synthetic - Nylon/ethilon: Monofilament, little reactive, low infx risk - polypropylene/Prolene: monofilament
36
what non absorbable and absorbable are most reactive:
absorbable: normal cat gut | non absorbable: silk
37
what makes steri strips stick better?
Benzoin
38
what about staples
fast, uncomfortable, low reactivity | Good for scalp wounds
39
How many knots when tying off suture?
One more knot than size of suture, smaller 0 means larger sutures and less knots 4-0: 5 knots 5-0: 6 knots 3-0: 4 knots
40
suture for face neck
face/neck: 5-0, 6-0: 3-5 days
41
suture for arm and hands
arm and hands: 4-0 - 5-0: 7-10 days
42
suture for trunk/legs/feet/scalp
trunk/legs/ scalp/trung: 3-0 - 4-0: 7-10 days
43
what is the most common needle for procedures
Reversed cutting:
44
what is the needle for cosmetic procedures
conventional cutting: cosmetic
45
what needle for bowel, fascia, stuff we would never do?
tapered
46
when to use blunt needle?
dissect friable tissue: liver, kidney, spleen, cervis
47
what is a dressing
Covering that: - absorption of drainiage - support - provides moisture for epithelixaiton - limits movement
48
order of dressings?
``` From wound out: - non adherent dressing - gause - elastic - tape - occlusive dressing AIR ```
49
how often should wound be redressed
Every 2-3 days
50
how long should would be kept dry
24-48 hours
51
how to remove sutures
Iris sutures suture scissors 11 scaple
52
what is the most common infection of procetures and when does it happen?
S. aureus shows up around 4-10 days after procedure.
53
what do you do when wound gets infected
Ipen it up, clean it and allow it to heal with 2nd intention. cover it with bandage
54
what is the problem with hematoma
if blood collects following surgery, it can lead to infection and dehiscence in 24-72 hours
55
what is dehiscence
wound rupture along inscision after suture has closed | - Resuture withing 48-72 hours, 3 days
56
how do local anesthetics work
Non-depolarizing block | Block Na recepturs, preventing depolarization and propigation of pain stimuli.
57
10CC of 1% local anesthetic equals how many mg?
Add a zero to the CC if its 1%: so 100mg | them multiply by % so if 1% stays the same, 2% would be 200mg.
58
what is the angle for IM injection
90 degrees to reach muscle
59
angle for Sub Q injection
30-45 degrees.
60
angle for indradermal injection
5-10 degress, just below skin, shallow to make bleb
61
what are the 2 main type of anesthetics
Amides: liver metabolized Esters: peripheral plasma by pseudocholinesterase
62
what are the 3 main amides used
Amide: Liver - Lidoxaine/xylocaine: 1-10 min/30-60min duration - bupivacaine/marcaine: 8-12 min/3-4 hour duration - mepivacaine/carbocaine: 8-10 min/2-2.5hour duration
63
what anesthetic is used for digit block
Bupivacaine/marcaine: lasts for 3-4 hours and is metabolized in the liver
64
what is max dose of mepivacaine/carbocaine
mepivacaine/carbocaine: 5mg/kg of 1% | Do not exceed 400 mg.
65
Max dose of bupivicaine/marcaine
Bupivacaine/marcaine: 4mg/kg of 25% | DO NOT exceed 200mg
66
Max dose of lidocaine/xylocaine
Lidocance/xylocaine: 10cc of 1% -100g - child: 3.3-4.5mg/kg DO NOE exceed 75-100mg (about 10CC) - adult: 4.5mg/kg: DO NOT exceed 30CC of 1%: 300mg.
67
what are the esters anesthetic main groups
Ester: periphery: - topicals - infiltrative
68
What are the topical esters
Ester: periphery: pseudocholinesterase - Benzocaine: 10% needed, poorly absorbed - Proparacaine(novacaine): opthalomogest fast <1 min last 15 min - Cocaine: ENT procedures, <1min, lasts 1 hours - TAC: tetracaine, epinephrine and cocaine: cheap and fast option.
69
what is the cheep and fast topical ester:
TAC: tetracaine (ester), epinephrine and cocaine
70
what are the infiltrative esters
Ester: periphery - Procaine/novagaine allergic reactions are commin, slow onset
71
Anesthetic reactions: toxic
Toxic: inject into vein or excessive: acts like CNS depressant causing hypotension, bradycardia or cardiac arrest. Treated with )2
72
Anesthetic reactions allergic/hypersentitive
Allergic hypersensitive: ture anaphylaxis is rare: Type 1 after 1st dose
73
anesthetic reaction IV:
may occur after frequent exposures: | - treat with benydryl if mild, EPI and O2 if severe
74
what type of anesthetic is most likly to cause reaction
esters: peripheral plasma
75
autonomic reaction to anesthetic
Looks like allergic: - tachycardia, sweating, dizziness, and syncope, - Resolves in minutes
76
hot to tell between autonomic and allergic reaction
Allergic: Pulse goes up and presssure goes down automin: pulse goes up and blood pressure goes up
77
why use epinephrine
Vasoconstriction - reduce bleeding - increase duration of anesthetic - reduce risk of toxin reaction
78
side effects of epi
anxiety, restlessness, tremors, palplitaiton and tachycardia.
79
dose of epi
1:200,000 concentration at a max of .2mg
80
what is epi anadote
IV puse of Mg + B6 to increase comT metabolism
81
what can you not use epi with?
those on MAOI, TCA, Thyroid storm, severe cardiovascular disease

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