Unit 1 - principles of surgery and anesthesia and infection, soft tissue injury and inflammatory processes Flashcards
components of surgeon’s exam
history, general exam (posture, alignment, deformities, relationships, gait, body mechanics), specific (uninvolved side first, then joint above and below, looking for deformity, swelling, color, skin defects, ROM active and passive, palpation, joint position, circumferential measurements, neurologic exam, vascular assessment, imaging)
timeframe for most likely cause of post-operative fever
day 1-3: atelectasis (wind)
day 4-6: UTI (water)
day 7-10: wound infection or DVT (wound)
aseptic technique
more elaborate and stringent than general surgery, especially for open joint cases, infection of bones and joints more difficult to treat, and bones have less resistance to infection
location of incision
ideally longitudinal to avoid major neurovascular structures, allow for proximal/distal extension of incision, along Langer lines (normal tension lines of skin)
dissection planes
internervous: between two muscles with different nerve supplies (safest)
intermuscular: between two muscles with same innervation, can denervate if too proximal near muscle origin
muscle splitting: likely to denervate part of the muscle
wound closure types
primary: close wound immediately
delayed primary: allow to drain, clear, then close
healing by secondary intention: wound heals from inside out
interscalene block
shoulder surgery
Bier block
for hand and wrist surgery
wrist block
fracture reduction and minor procedures
femoral nerve block
LE surgery
septic arthritis presentation and management
Staphylococcus aureus most common cause, can cause irreversible damage to articular cartilage
Symptoms: pain and limitation of single joint, fever and visible joint swelling
Lab test: arthrocentesis and culture, elevated sed rate (ESR)
Treatment: antimicrobial therapy, daily aspiration of joint fluid, possible incision and drainage, immobilization and rest
acute osteomyelitis presentation and management
infection of bone
chronic osteomyelitis presentation and management
infection that lasts more than 3-6 months, disease of ischemia more than infection
Clinical picture: chronic persistent drainage
Treatment: thorough surgical debridement, antibiotics for rest of life, amputation may be best treatment
inflammatory phase
first phase of inflammatory process, reachtion to acute injury
damaged blood and lymph vessels vasoconstrict to slow loss, undamaged vessels vasodilate and increase permeability, leukocyte chemotaxis (WBC’s come to the area, specifically PMN’s to kill and sequester infection), monocytes -> macrophages to phagocytose invaders
fibroplastic (proliferative) phase
5-21 days after injury, second phase of inflammatory process
high collagen turnover, quantity increases. fibroblasts and myofibroblasts become predominant cells over WBC’s
consolidation (reparative) phase
21-60 days after injury, third phase of inflammatory process
changes from cellular tissue to fibrous tissue, increase in strength and suppleness of scar
maturation (remodeling) phase
last phase of inflammatory process, 60 days-year
collagen turnover high until about 120 days, develops into an almost totally collagenous connective tissue by end of maturity.
bone healing time
6-8 weeks
muscle healing time
4-8 weeks
ligament healing time
6-12 weeks, with full maturation taking up to 12 months
tendon healing time
6 weeks to several months for laceration
nerve healing time
1 mm/day
cardinal signs of inflammation
rubor (redness)
calor (heat)
tumor (swelling)
dolar (pain)
strain vs sprain
strain to muscle or tendon, sprain to ligament
