Flashcards in Minor Sx cards from a quizlet Deck (219):
Branch of medical care which treats injuries, deformities by manual or operative methods.
The act of tearing OR a torn, ragged wound
Pertaining to tissue situated near the surface.
Wearing away of a substance/structure through some unusual or abnormal mechanical process.
Not malignant, not recurrent; favorable for recovery
Any pathological or traumatic discontinuity of tissue or loss of function of a part.
define foreign body
Any material lodged in human tissue that is foreign (wood, metal, glass, etc.)
to probe deeply with a blunt instrument
to clean away damaged or necrotic tissue
- tome (suffix)
to cut" as in episiotome
to remove" cut out completely as in appendectomy.
A substance that inhibits growth and development of microorganisms without necessarily destroying them
Agent whose primary affect is to bring about a temporary loss of localized sensory nerve function.
Number 1 Cause of Minor Surgery Complications
3 Most common complications from DC Minor Surgery
1) Pt. anxiety
2) Adverse reaction to anesthetic.
3) Pre- or Post-operative bleeding.
best age range for minor sx
Body type that is slowest to heal (hint: one of 3 types)
Three basic labs required before minor surgery
CBC, UA, prothrombin
After minor surgery rest for ___ hours (range)
Follow-up with patient within ___ hours
Most effective means of instrument sterilization killing both bacteria and spores. Boiling water under pressure (13 mins at 120*C and 750 mmHg pressure). blunts instruments.
Ethylene oxide used to kill both bacteria and spores but dangerous and expensive.
sterilization in oven at 170*C for 1 hour. Kills most bacteria BUT not spores. Emergency sterilization technique.
Least effective method sterilization but emergency method. Iodine bath (providyne, beta dyne).
True/false: Shaving hair off patient considered Std Of Care in minor surgery
Minimum # of times surgical area cleansed with antiseptic (e.g. beta dyne).
Material that actually kills bacteria
- Strength/effectiveness of an antiseptic is measured by this scale
- Powerful antiseptic. Caustic to skin; used to cleanse counters and floors. AKA carbolic acid. Used in concn's of 2-20% for bacteriostasis.
Ingredient in lotion of calamine (used for dermatitis).
A cream consisting of 30% phenol, 60% camphor, and 10% liquid petroleum.
- Coal tar antiseptic. Has phenol coefficient 3X, brown liquid with tarry odor. Impregnates telephone poles and railroad ties to prevent decay
-Coal tar antiseptic in 50% concn linseed oil soap making it more soluble. Used to disinfect rooms and equipment. Very dilute concn (.25-0.5%) used as vaginal douche or bladder irrigation.
AKA Creolin, Cresolin, Lysol
Coal tar antiseptic that is colorless, odorless crystal. Turns pink in light. Phenol coefficient of -1X.
Coal tar antiseptic. Very soluble in water, alcohol, and glycerine. Primarily used as ointment 5-10% concn treating psoriasis, eczema, erysipelas.
Coal tar antiseptic. Colorless, aromatic crystalline solid. Very soluble in alcohol. Primary use as mouth wash/astringent gargle. Useful as fungal antiseptic and hook worm treatment.
Coal tar antiseptic. AKA picric acid
- Coal tar antiseptic
Yellow crystalline powder with bitter taste and odorless. Stains skin. Phenol coefficient 7X!
. Primary use in burn treatment and superficial wounds. Soaked dressing applied directly to burn. Caustic substance generally. Max allowable surface area ~one extremity of entire body.
Groups of antiseptics which often contain mercury and most effective as antiseptic or chemotherapeutic agents.
Dye antiseptic no longer commonly used. Used in isotonic saline soln with concn 1:1000. Used prior to antibiotics.
Dye antiseptic used frequently prior to antibiotics to saturate gauze, for conjunctival gonorrhea, otitis media, and pack wound cavities. Used for furunculosis and carbunculosis.
Dye antiseptic AKA gentian violet, deep purple soln in 3% water/alcohol concn. Used to treat RING WORM; very effective against gram + bacteria (Staph.). Used as jelly for cystitis, fungus, and burns
Dye antiseptic AKA methylene blue. Dark green powder that forms blue solns. Urinary antiseptic, also used diagnostically to locate ano-vaginal fistulas.
Dye antiseptic AKA thymerol and thmersol. Contains up to 50% mercury. Very effective general antiseptic - even spores. Useful for lacerations/abrasions. Antiseptic of choice for final scrub in preoperative skin preparation in 1:2000 concon
Antiseptic group containing chlorine, iodine, or bromine
Halogen antiseptic. Yellowish irritant gas. Widely used as disinfectant in drinking water.
- Sodium hypochlorite. Dilute chlorine solution contain .45-.5% sodium. Freshly mixed and kept in light-resistant bottle for up to 48 hours. Effective antiseptic for open wounds of all sizes. Dissolves bacteria, pus, necrotic tissue without disturbing clots. Coat unprotected normal skin with petroleum jelly
Halogen antiseptic. Blue-black crystal with metallic odor. Soluble with potassium in water. Popular surgical scrub/skin prep. Used in wound lavage.
Halogen antiseptic. AKA beta dyne or providyne in 10% concn. Used for skin prep and cold sterilization methods. 7% used open wounds, 5% external mucosa lining (vaginal packs).
% iodine vaginal pack is called...
Antiseptic. Solid form on wooden stick applicator. Used for warts, excess tissue, ulcers, canker sores, and cauterization. Fast acting and may cause burns.
Antiseptic. Historically used in .25-1.0% concn for mucus membranes, sinuses, throats, conjunctiva gonorrhea.
An old school treatment. Silver nitrate placed in eyes of newborns to kill off conjunctival gonorrhea.
Silver antiseptic. Protein precipitate used for chronic/acute sinusitis. Cotton-tipped applicator placed into nasal passages for one hour. Repeated for three consecutive days. Used in many DC offices.
- Poor Antiseptic. Mostly used in 20-70% concns. >80% concn hardens protein coats of bacteria but <80% tends to dehydrate bacteria. NOT recommended as sterilization technique.
Antiseptic. Oxidizes bacterial proteins. A gas soluble in water at 40% concn. Extremely powerful; never used on living patients. Commonly used 10% soln for biopsy transfer.
- Brand name is formalin. Used to transfer biopsy samples.
Weak antiseptic. MOA liberates oxygen. On open wounds bubbles and forces debris to surface. Found in 3% solns at most stores. Wash/lavage wound/ulcer. Debrides tissue and removes dirt. Damages tissue while killing bacteria. Used in 1:5 dilution for gingivitis.
Astringent antiseptic. Mild, soothing antiseptic reduces mucous membrane swelling. 2% soln for conjunctivitis and open wounds and vaginitis. 10% concn for skin irritation.
Astringent AKA alum. Skin lotion for irritation treatment. 0.5-1% concn used in solid stick form as hemostatic. Septic pencil for shaving nicks in men.
Potassium aluminum sulfate
Astringent soluble salt. Sulfate form strong astringent and topical antiseptic. Oxide form ointment effective burns/skin diseases. Used in sunscreen.
Wound lavaging agent. 1/4 grain tablets (1 tab per oz water). Good antiseptic and fungicide. Used in cuts, abrasions, animal scratches, insect bites, athlete's foot. DC's use this for irrigating ears.
General purpose antiseptic and fungicide. From Australian tree. Must be diluted in mineral oil. useful in Staph infections. DO NOT take internally.
Tea tree oil
Topical antibiotic/antibacterial ointment of neomycin polymycin. Over-counter topical used post-operative dressing.
Antibiotic ointment. Over-counter purchase w/ neomycin polymycin. Most frequently used topically post-operatively.
A Complex of halogen antiseptic w/ carrier molecule. Effective wound lavaging agent for gram +/- bacteria, fungi, and viruses. Stains clothing. AKA Betadine, Operand, Acu-Dyne, Clonidine.
Wound lavage agent. Effective gram + bactericidal. Used for hand scrubbing primarily; direct wound contact discouraged. AKA Hibiclens, STERIS tat.
Wound lavage agent with hyphenated chemical name. Non-ionic detergent. May be used directly on wounds but has no antibacterial activity. Best for facial wound cleansing. AKA Shur-Clens.
Wound lavage agent. Bacteriostatic agent effective for gram + bacteria. Potential toxicity & teratogenicity. AKA PHisoHex.
Interruption of sensory nerve conduction without subjecting the patient to unconsciousness.
T/F: All anesthetics are toxic.
This type of medication interferes with neural depolarization and transmission of impulses along axons.
T/F: Anesthesia inhibits nociception before pressure/touch sensation.
Properties of ___ to consider before application in minor surgery.
1) onset of action
- Maximum allowable dose of anesthetic used by DC's is ___ cc's. (there is one exception
Maximum allowable dose of 1% lidocaine with epinephrine in adult is ___ cc's
T/F: Pregnant females should be given local anesthetics
T/F: Higher concn anesthetic MORE toxic than increased volume anesthetic
T/F: Anything greater than 2% anesthetic concn is WRONG for injectable local anesthetic.
Average dose of Epi-enhanced lidocaine, (___ cc's).
- Lidocaine enhanced with ___
Advantage of epi with lidocaine
Advantage: vasoconstrictive and decreases bleeding.
Cons of epi with lidocaine
Con's: Increased % infection, cannot use on distal or end organs d/t decrease bloodflow
Always use (larger/smaller) syringe than required for amount anesthetic needed
A ___ gauge needle used for venipuncture
An ___ gauge needle is used for joint aspiration.
Needle gauges used for introducing local anesthetic range from ____-____.
Superficial topical anesthetic used as refrigerant pre-injectable for squeamish patients. Comes in pressurized bottle and applied by inverting and spraying in area of injection for 5 seconds. Anesthetic effect lasts 15-30 seconds.
T/F: Never inject patient in an upright position.
T/F: Acceptable injection positions include supine or prone.
T/F: It is acceptable to perform minor surgery on patients who do not speak your language, have great fear of needles, their own blood, or the elderly
T/F: After placing syringe needle in chosen tissue site, pull back on plunger to test for bloodflow.
T/F: Best to introduce anesthetic 'on the move.'
Method of introducing anesthetic where a portal of entry has already been established (into a laceration to avoid second puncture of skin).
AKA parallel margin infiltration (method of anesthetic application).
Most frequently used method of anesthesia application. Preferred method when wound is dirty or contaminated. Decreases risk of spreading infection.
This type of conduction anesthesia used for sebacous cystectomy, lipomectomy excision, and foreign body removal.
- Method of anesthesia whereby sensory nerves are anesthetized by injecting into nerve plexus.
Nerve block uses ___-___ cc's anesthesia per side.
Most common nerve blocks are ___ (AKA volar blocks).
T/F: Epinephrine is acceptable in digital nerve blocks (fingers).
Facial anesthesia utilizes nerve blocks in the supr/infraorbital and ___ foramen.
Anesthetic soln used for all methods. comes w/ and w/o epinephrine. Ester-based soln packaged in concn's of 0.5, 1.0, 1.5, and 2.0%. In minor surgery highest concn needed is 1.0%. Commonly used in dentist offices.
Potent and toxic anesthetic. 10X more potent than procaine. Limited to few procedures like spinal blocks. Not used in DC offices.
Most popular and frequently used local anesthetic. Comes in 0.5, 1.0, 1.5, 2.0% concn w/ and w/o Epi. Has low toxicity compared to novocaine, rapid diffuses, topical activity and chemical stability. Very good stuff.
Amide-base anesthetic soln widely used in minor surgery that ISN'T Lidocaine. Used for procedures with longer time frames. Possesses slightly vasoconstrictive properties and CAUTION indicated in distal end organs.
- A newer amide-based anesthetic soln. Not widely used in minor surgery but getting there. Con's: Slow onset of action. Pro's: Duration of action surpasses lidocaine and mepivacaine.
Non-injectable topical anesthetic. Useful in pediatric patients for simple lacerations/wound care. Mixture 0.5% tetracaine, Epi 1:2000 concn, 11.8% cocaine. Applied directly via soaked gauze sponge 5-10 mins. No needle stick required!
T/F: Can TAC be used on distal organs?
- AKA proparacaine hydrochloride
0.5% soln anesthetic with glycerine for topical eye application. Suitable for foreign body removal of ocular pressure testing. One drop in eye achieves complete anesthesia in 13 seonds and lasts 15-20 minutes.
T/F: Ophthaine contraindicated in hyperthyroidism.
AKA Rostra Spray
___ spray: Topical anesthetic effective on mucous membranes but not conjunctiva. Anesthesia takes ~1 minute. Useful for overriding gag reflex. Contains tetracaine and benzocaine.
Flammable topical skin refrigerant used as pre-injectable. Useful for lancing furuncles and carbuncles. Anesthesia lasts 15-30 seconds.
- T/F: Redness, itching, swelling at inoculation site usually resolves.
Cardiovascular reactions to inoculation include hypotension and ___
CNS rxn's to anesthesia can include excitatory phenomena and ___.
The most common rxn to anesthetic injection is ___ AKA passing out
Anesthesia S/E most common because injecting into a ___.
Supplement with ___ to increase clotting factor ability
T/F: Acceptable to bring up surgical options with patients, (i.e. I can get that mole removed for you?).
If you expect a procedure to take 15 minutes, tell the patient it will take ___.
T/F: Acceptable to use a bactericide on patient tissue?
Six steps in healing process. Step 1 is
Immediate response to injury
Six steps in healing process. Step 2 is
Six steps in healing process. Step 3 is
Epithelialization , scab forms
Six steps in healing process. Step 4 is
Six steps in healing process. Step 5 is
Six steps in healing process. Step 6 is
T/F: Sew them up if wound is primary union.
T/F: Sew them up if wound is secondary union.
Most common cause of primary union wounds (clean with minimal tissue loss).
Primary union wounds have a 'golden period' in which they can be closed with sutures or skin tapes. This period lasts ___ hours
- T/F: You can sew up a tertiary union wound after observation and lavage greater than 12 hours.
T/F: Antibiotic ointment required in tertiary union wounds.
- A wound into the muscle tissue that does NOT involve nerve rupture is a (superficial/deep) wound...
A wound that involves tendon and vasculature is a (superficial/deep) wound
A 2nd degree burn is a (simple/complex) wound...
A puncture wound is a (simple/complex) wound...
if a wound will probably become infected if closed is considered a ___ wound
wounds older than ___ hours are considered 'dirty' wounds...
Erythema extending beyond ___ cm from the wound margin is suggestive of infection
Wound redness accompanied by palpable induration greater than ___cm suggests infection
- critical mass of ___ organisms per gram tissue to be considered 'infection'
most common organism to be active in infection
Other common infective organisms include E coli, Proteus, Enterobacter, Klebsiella, and ___
___X increase in infection rate with 20% weight loss in chronically ill patient
When required, give tetanus booster shots every ___ hours.
Minimum # dozes tetanus toxoid to be considered 'fully immunized'.
___x___ size gauze sponge helps 'maintain hemostasis in wound closures
amount of tissue taken when placing a suture needle in skin or fascia.
Each knot of a suture consists of a series of ___(s).
___ suture: placed on surface of skin for final closure using nonabsorbable materials.
___ suture: made from absorbable material placed in superficail fascia or deris with knot buried in wound.
- ___ suture: single sutures tied separately.
- ___ suture: wound closure effected by taking several bites the full length of the wound without tying individual knots. AKA 'running' suture
Number __ scalpel used for debriding devitalized (dead/dying) damaged tissue from a wound.
Most common surgical knot technique for clean wounds without complications.
Surgical knot technique that uses a shallow first loop, a deep second loop and then ties off. Used in flexed areas or places under regular stress.
Surgical knot technique. Used for cuts that have 'flaps'. Apex of cut must be pointing toward heart.
Suture material. AKA PGA - synthetic polymer, less reactive and resists infection. Primary for superficial and deep fascia and ligatures.
PG 910 suture material. Workable but not the best for tight knots. Preferred for deep wound support for prolonged periods
Suture material. Make from animal tissues. Treated with chromic acid to delay absorption
Suture material - AKA ethilon - Used for minor wounds/lacerations, resists infections, good tensile strength.
- Intradermal subcuticular 'pull out' sutures are used because they decrease ___.
Sutured wounds are vulnerable to infection up to ___ hours post application.
Used during healing to absorb exudates from wound. Small section surgical rubber inserted into inferior aspect of wound
Occlusive wound dressing type. Transparent polyurethane. Transmits water, O2, and CO2. Can pull up scab once epithelialization begins.
Occlusive wound dressing type. Nonadherent material taped in place over a wound
Occlusive wound dressing type. This is an opaque, gas IMpermeable, absorbant material. Over time fluid leaving wound separates dressing from wound itself.
Occlusive wound dressing type. Semitransparent, nonadhesive, absorbent material
Occlusive wound dressing type. AKA "Doctor Spenko's Second Skin"
Coating for dressings used in burns and skin grafts.
Controlled cell proliferation; ie adapting to stresses (callus).
- Adaptive substitution of cell type (e.g. squamous) for another type. Used in inflammation.
'Pre-cancerous' cell substitution. These cells exhibit pelomorphism (change in nucleus materials).
__% of all head/neck cancers begin in the oral cavity.
Basal cell carcinomas are caused by exposure to ___.
Squamous cell carcinomas are caused by exposure to ___. These are rapid metastasizers.
Jet black, most dangerous type of skin cancer (most rare). If it invades Clark's level 4, prognosis grim.
T/F: Fractures are often overlooked in open wounds or bleeding injuries.
Used instead of iodine if Pt is allergic to it. AKA Zephiran in a 1:750 concn soln.
Patients who have had three Tetanus boosters but none in ___ years still need a booster for preventative care.
Benign skin tumor. Scar hypertrophy d/t collagen deposition. Usually result of improper surgical technique done against natural tension lines in the fascia.
Benign skin tumor. Encapsulated fat tissue often d/t blunt force trauma. If there are multiple lesion it's typicaly from familial predisposition.
- Benign skin tumor. Caused by duct blockage of oil gland adjacent to hair follicle. DDX from lipoma via small central well @ middle of raised lump (hair follicle).
Benign skin tumor. AKA verrucae vulgaris. Benign papillae growth. Often on hands and feet; surgical removal rapid and effective.
Benign skin tumor. AKA skin tag. These have vascular and neurological supply.
- Benign skin tumor. Hornlike projection extending above skin level. About 12% are MALIGNANT
Benign skin tumor. These are hard, movable, non-inflammatory lesion within the skin layers..
Benign skin tumor. Cystic swelling surrounded by fibrous tissue that occur within vicinity of joint capsules.
Skin lesion treatment. Liquid nitrogen typically used. Minimal scarring, often more than 1 treatment needed.
skin lesion treatment. A small cordless instrument with local anesthesia is used.
Skin lesion treatment type. Great for superficial skin lesion but may cause scars. Requires sterilization
Skin lesion treatment type. Minimal thermal damage caused, best for cosmetic treatments, self-sterilizing.
Skin lesion treatment. Electrical energy is converted into light energy (used in many DC offices for purposes other than minor surgery).
Infected sebaceous gland with central necrotic induration most commonly caused by staph infection.
A singular furuncle in a large bulbous presentation.
Takes ___-___ days for a carbuncle to become 'fully ripened.'
Distal phalanx infection that appears along base of nail from Staph. aureus.
- Most common organism to infect bite wound from human bite injury. REFER OUT
Anti-venom used for black widow spider bites.
___% of animal bites presenting at minor surgical offices are from dogs.
Brown spiders with particularly strong venom. Symptoms include anorexia, dehyrdation, apathy. Tissue will begin to necrose within a week of bite.
Frostbite. Heat loss caused by wet clothing in contact with metal.
Frostbite. Heat loss caused by wind chill.
Which degree burn? Redness, epidermis only. No blisters. Recovers in 1-2 days.
Which degree burn? Redness and blister. Capillary wall destruction with edema.