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minor surgery midterm Flashcards

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1
Q

what is a laceration?

A

a torn ragged wound often with irregular edges

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2
Q

what is a lesion?

A

discontinuity of tissue or loss of function

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3
Q

what is a foreign body?

A

a piece of material lodged in tissue

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4
Q

what is dead space?

A

any area left in tissues after lesion removal or trauma that has the potential to fill with fluid or blood

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5
Q

what is to excise?

A

to cut off or remove

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6
Q

what is to incise?

A

to cut into

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7
Q

what is to bite? suture term

A

the portion of tissue taken by the suture needle in a single pass

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8
Q

what is to throw?

A

one part of a knot, multiple throws form the final surgical knot

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9
Q

what is to ligate?

A

to tie off a vessel or structure

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10
Q

what is sound?

A

using a blunt instrument to probe or assess tissue depth and character

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11
Q

what is to debride?

A

remove damaged or necrotic tissue to promote healing and prevent infection

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12
Q

what health conditions will make for complications during minor surgery?

A

diabetes, anemia, hemophilia or any immunocompromised person that can affect healing

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13
Q

what medications should you ask your patient about before having minor surgery?

A

blood thinners- (warfarin, aspirin, fish oil), gingko, st. john’s wort

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14
Q

what is Langer’s lines?

A

natural skin tension lines which are best for incision or excisions for cosmetic purposes

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15
Q

what is something to PARQ your patient on before doing minor surgery and after?

A

first PARQ about potential for scarring especially if patient is doing surgery for cosmetic purposes. Talk about healing times, meds to avoid and potential side effects and when to go to PCP/ED if needed.

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16
Q

what are red flag signs post op?

A

increased bleeding, signs of infection: redness, warmth, increased pain, fever, or malaise

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17
Q

what are the sterile techniques used in minor surgery?

A

hand hygiene, PPE, sterile field management, instrument sterilization

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18
Q

where are skin flora found ?

A

on the surface of the skin and under stratum corneum

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19
Q

what are the methods for sterilization?

A

moist heat (autoclave). dry heat, chemical, radiation, filtration (fluids)

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20
Q

how long should you leave Betadine on?

A

2 mins

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21
Q

how should you prep skin for sterile field?

A

clean soiled skin with soap and water or alcohol and dry skin before applying antiseptic and apply in 3 + concentric circles. prep area beyond size of area and opening of draped area

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22
Q

how long should you scrub hands?

A

3 times up to 5 mins from hand to elbow. hands should be held above elbows to allow for excess water to drip off at elbows to prevent debris contamination on hands

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23
Q

how long should instruments be autoclaved?

A

15-30 mins at 121 degrees Celsius 15 psi

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24
Q

are chemical germicides and filtration good enough for sterilization?

A

no

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25
what kind of tape does autoclaving use?
heat sensitive tape and a chemical indicator strip or vial is placed inside to show when it's ready
26
what type of autoclaving is done for instruments ?
steam at 250 degrees F, 15 psi for 30 mins.. only need to be done once to prevent instruments from dulling
27
what is the best form of cleaning instruments?
chemical sterilization. doesn't dull instruments, effective at killing harmful microbes but dangerous to humans if inhaled. Uses ethylene oxide or ozone gas
28
what is dry sterilization?
uses dry heat up to 450 F for 30 mins. kills most bacteria but not all and doesn't kill off spores. only good for emergent cases when autoclaves aren't available
29
what is cold sterilization?
can use betadine to sterilize. not the most effective (least effective)
30
what are the types of antiseptics?
alcohol, iodine (3%), 7.5-10% iodophors (betadine), 2-4% chlorhexidine gluconate, hydrogen peroxide, nonionic surfactants (Shur-Clens, PharmaClens)
31
what makes alcohols not the best antiseptic?
inactivated by dirt, blood, foreign bodies, flammable, cautery devices/electric devices can cause ignition, and damage latex
32
what organisms does alcohol kill?
bacteria, fungi, viruses (HBV, HCV, HIV) however doesn't have any residual killing effects. ethyl alcohol is less drying to skin compared to isopropyl alcohol
33
what are the benefits of using iodine and iodophor solutions?
effective at killing bacteria, viruses and fungi. can use 3% iodine solution on mucous membranes like the vagina.
34
what are the disadvantages of using iodine and iodophor solutions?
requires at least 2 mins before effective. needs to release enough free iodine to produce adequate antimicrobial activity. has little residual antimicrobial activity, inactive by organic materials, absorption of free iodine through skin and mucous membranes can cause hypothyroidism in newborns, allergic reactions
35
what is the form of iodine solution for betadine?
povidone-iodine which is the most common iodophor for pre-surgery antiseptic
36
what are the different forms of betadine?
7.5% povidone-iodine- good for hand scrubbing, pre-op skin prep, 10% povidone-iodine- good for broad spectrum antibiotic prep op and wound prep and betadine 10% povidone iodine swab sticks used for minor surgery (3 swabs, 3 spiral layers)
37
what are the advantages of using chlorhexidine gluconate 1?
good alternative to using iodophors, can use on newborns, effective antimicrobial, residual skin action for 6+ hours, not too affected by organic material. available in 2-4% concentration
38
what are the disadvantages of CHG antiseptic?
expensive, action is reduced by neutralized natural soaps, not effective against tubercle bacillus, and semi active against fungi. will decompose at ph of 8 + and can cause conjunctivitis
39
how does hydrogen peroxide work as an antiseptic?
the bubbles that are formed help to dislodge bacteria, debris and other contaminants from small crevices in tissue. can be used to clean out dirty wounds with blood crusts. and good to remove blood and iodine from clothing
40
disadvantages of using hydrogen peroxide?
not good for wound healing, should not be used on freshly sutured wounds. can cause ulcers. should not use to pack sinus tracts or for forceful irrigation
41
what are nonionic surfactants?
act like soap doesn't cause toxicity to tissues, can be used on eyes, however NO ANTIBACTERIAL ACTIVITY
42
suture sizing?
larger numbers of thread equals finer/thiner thread
43
what area of the body is best for 5-0/6-0 suture?
face
44
what is the best suture placement?
start in the middle of the wound and follow the rule of halves to make sure it's evenly closed
45
what are steri strips?
suture closing technique that is used for small superficial wounds to reinforce sutures in high tension areas
46
what is dermabond?
skin glue. will set in 50 seconds and helps to heal wound in 5-10 days. However isn't for high motion or moisture rich areas
47
what are the advantages of staples?
best for scalp or large wounds and is quick and limited risk of infection
48
what are the superficial biopsy techniques?
lift and snip, shave, scoop, punch biopsy, elliptical excisional
49
what are the lift and snip steps?
clean the area, draw up 0.5-1.0 cc anesthesia with 18-22 g needle, switch to a new 0.5-1 inch 27-30 g needle. inject anesthesia to create a cutaneous bleb, grasp lesion with forceps and elevate, snip off lesion with sterile iris scissors or electrocauterize, apply direct pressure (electro, silver nitrate), apply minor surgery tincture and add bandage
50
what are the shave biopsy steps?
clean, draw up anesthesia use 27-30 g needle to inject under lesion, use forceps to lift and shave off lesion with 15 or 10 scalpel or dermablade, apply direct pressure and or cautery then dress with minor surgery tincture on band aid
51
what are the punch biopsy steps?
prep with alcohol, apply local anesthesia in skin, prep with betadine, firmly press the punch tip perpendicular to the skin and rotate back and forth, grab lesion with forceps and snip through sub-q layer with scissors, deposit specimen in container, control bleeding with cautery or silver nitrate, for larger wounds apply sutures, dress with minor surgery tincture
52
what is elliptical (fusiform) excision?
first draw an elipse around the lesion parallel to the skin lines with a marker. ellipse should have 3:1 lenght to width ratio with 30 degree angles at ends. use scalpel to make excision at 90 degree angle, use atruamatic forceps to pick up tissue, close would with sutures using rule of halves (use mattress and simple sutures)
53
when is I&D done?
to drain abscesses. can only be done when perfectly ripe or else will cause excess bleeding instead of pus drainage and possibly spread infection
54
how to do I&D?
confirm abscess is ready to be drained, prepare MS field, anesthetize the skin using more lidocaine than usual since increased circulation at inflamed site will carry drug away, use scapel 11 to open lesion and let pus drain (use cruciate X incision to help prevent premature wound closer, and use linear incision along skin lines to reduce scarring, express pus from abscess and break up any pockets, irrigate (optional) and pack the with an iodine gauze, dress wound with non-adherent bandage
55
how to parq patient after I&D?
instruct patient to change the dressing daily , return to clinic in 2-3 days to remove drain and pus if needed, repack wound with less packing than before, daily dressing changes at home, patient returns every 3 days to remove drain and repack for 1-2 weeks
56
what is hemostasis?
control or cessation of bleeding
57
what techniques are used for hemostasis?
tourniquet for larger wounds/excess bleeding, epinephrine, cold/ice packs, direct pressure
58
what are two forms of emergent hemostasis techniques?
clamping- arteries/vessels, ligating- suturing vessels
59
what are hemostypics?
powdered cayenne pepper, hydrastis, myrrh
60
what are the forms of cautery?
chemical- silver nitrate electrical/thermal- electrocautery
61
what is a benefit of using electrocautery pens?
cheap, disposable, can use around eyes, can use with pacemakers and can be used to drain subungual hematomas
62
what are electrocautery machines?
hyfrector- used for electrofulguration (hemostasis) and electrodessication (destroy/cut) radio frequency electrosurgery machine- uses high frequency radio waves
63
what are disadvantages of using electrosurgery machines?
can't use with patients who have pacemakers
64
what are the RF electrosurgery waveforms?
fully filtered and rectified current- cutting fully rectified current- cutting and coagulation partially rectified current- coagulation fulgurating current- destruction of large lesions
65
what is the stages of healing for a wound?
bleeding/hemostasis, inflammation, proliferation, remodeling
66
what happens during hemostasis phase?
formation of a fibrin clot
67
what happens in the inflammation phase?
platelets secrete cytokines, clot formation triggers complement cascade, neutrophils destroy bacteria and macrophages repair and phagocytose, new epithelial is formed via basophils doing wound repair and keratinocytes form
68
what happens in the proliferation phase?
fibroblasts make collagen and angiogenesis brings oxygen and nutrients
69
what happens in remodeling phase?
where more collagen is formed to remodel new tissue however a scar can form during this phase
70
what nutrients are needed for wound healing?
vitamin c- promote collagen formation zinc- collagen synthesis and cross linking, immune support copper- collagen cross linking vitamin E- reduces scar formation flavanoids- reduce scar formation
71
how to remove sutures?
11 scalpel or iris scissors
72
what are the stitch types?
simple interrupted, continuous sutures, horizontal and vertical mattress, deep or buried, subcuticular running stitch, three point or half buried mattress- good for V shaped wounds
73
what are the needle types?
conventional cutting- for cosmetics, reverse cutting- most common, tapered- good for fascia muscle bowel
74
which form of anesthia can cause anaphylaxis?
ester forms like procaine/novocaine
75
what is the role of epinephrine in anesthesia?
decrease bleeding, help prolong anesthesia, decrease toxic reaction by vasoconstricting. can't be used on nose, fingers, P or V, toes. need to be avoided for pts with MAOIs, TCAs, thyrotoxicosis, severe CVD
76

Dermatology (5 decks)

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