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Wilson Flashcards

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1
Q

Why might we use a bandage?

A

Support suture lines! But also:

owner convenience and early wound management

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2
Q

Why would we use a pressure bandage?

A
  • reduce limb edema
  • reduce dead space
  • control hemorrhage
  • control granulation tissue
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3
Q

What ideal properties should a bandage have? 7

A

cheap, conformable to the wound, capable of desired function, free or particulate matter, inert, gas permeable, easily cleaned, looks nice

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4
Q

What are the three layers of a bandage?

A

Primary: dressing
Secondary - padding and absorption
Tertiary - resistant to environmental contamination

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5
Q

Which bandage layer is most important? What properties must this layer have?

A

the primary layer. Must be sterile and maintain wound contact. Can be adherent or not

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6
Q

Which type of primary bandage is aggressively adherent? Non aggressive?

A

Most aggressive is Dry - Dry, least aggressive is wet - wet.

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7
Q

Which primary bandage would you use to debride a wound for a graft?

A

dry -dry

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8
Q

Which primary bandage would you use to moderately debride with topical antibacterials and enhanced capillary action?

A

wet -dry

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9
Q

Which primary bandage would you use to minimally debride for a very high fluid producing wound?

A

wet - wet

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10
Q

Which primary bandage would you use for very sensitive tissue? What is a type of this?

A

a non-adherent dressing such as tefl a or petrolatum impregnanted or polyethylene glycol

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11
Q

Which primary bandage would you use for very sensitive tissue? What is a type of this?

A

a non-adherent dressing such as tefl a or petrolatum impregnanted or polyethylene glycol

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12
Q

What are the primary functions of a secondary bandage?

A

absorption (+ capillary), pressure distribution, and support `

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13
Q

How much pressure can you get without elastics. With a 50% stretch?

A

less than 30 minutes without elastics, but can get 6-8 hrs with a 50% stretch.

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14
Q

When is it good to use a vacuum bandage?

A

helping a skin graft to take

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15
Q

Someone phones you with a wounded animal. What do you recommend in general?

A
  • restrict movement of patient and provide support (Splint)
  • flush the wound
  • control bleeding with pressure bandage
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16
Q

within what time frame can you close a wound? what other factors influence this?

A

can usually do it if less than 8 hrs. The closer the wounds are to the head the more time you have, and the less contamination the more likely you can close it

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17
Q

What should you keep in mind while examining a new wound?

A

Use sterile gloves and possible anesthesia. Can use sterile lube and clip and prep area as well.

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18
Q

Why do we debride?

A

remove contaminated tissue and devitalized tissue. Elimates infection

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19
Q

What technology do you use to debride a wound?

A

pulsavac

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20
Q

What is an ideal solution to lavage a wound with?

A

something non-irritating and bactericidal (lactated ringers > saline, can also use povidone iodine which is not useful and chlorohexidine which is effective.)

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21
Q

Why does povidone iodine suck?

A

need to half the effective dose for it not to be irritating, and it also inhibits neutrophil migration

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22
Q

When should you use antibiotics in lavage solution?

A

at the end of treatment so it doesn’t wash out.

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23
Q

When is it important to use antimicrobila in lavage solution?

A
  • open synovial structures
  • severe muscle injury
  • cellulitis
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24
Q

When is it important to use antimicrobila in lavage solution?

A
  • open synovial structures
  • severe muscle injury
  • cellulitis
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25
What are the systemic responses to major trauma? 4
increased metabolic rate increased CO increased RR Fever
26
What are major factors in the increased metabolic rate during major trauma?
pain! use analgesia! | Nutritional intake - can limit catabolism
27
How does your body change in major trauma?
loses fat and muscle | ECF expands
28
How does your body change in major trauma?
loses fat and muscle | ECF expands
29
How does the body respond to losing blood?
increases ADH and aldosterone
30
How does the body respond to losing perfusion?
organ failure from schema and reperfusion injury
31
How does the body respond to starvation?
makes keytones
32
What does pain stimulate in the nervous system?
cortisol, catecholamines - increases blood glucose via insulin, mobilizing fat, gluco and glycogenesis. Increasing metabolic rate while decreasing nutritional status makes for a skinny animal.
33
How can we minimize the effects of major trauma on increased metabolism?
analgesia | don't fast horses
34
How can we minimize the effects of major trauma on increased metabolism?
analgesia | don't fast horses
35
What are the three types of wound closure?
primary (surgical or laceration) delayed primary (resolved inection + debridement but before granulation tissue) secondary (after granulation)
36
What is the number one reason not to close a wound?
tension on suture lines (caused by motion) | also tissue considerations (if it is lost etc)
37
Should you use braided suture for non surgical wounds?
no! infection!
38
Why does a primary wound fail to close?
tension! also devitalized tissue and infection
39
List 5 ways to reduce tension
Undermining tissue tension relieving sutures (near far far near/mattresses) tension reliving incisions plasty pre-suturing (stretching skin over a mass)
40
When a wound closure fails what is the cost?
lose tissue costs money infection
41
When a wound closure fails what is the cost?
lose tissue costs money infection
42
What must you do to perform a delayed primary closure?
resolve any infection and debride wound. Must be before granulation tissue occurs.
43
What are the advantages and disadvantage of closing a wound secondary?
allows infection to resolve and the host self debrides. The tissues are harder to manipulate though.
44
What are the three components of second intention healing?
granulation, contraction and epithelialization
45
What may harm secondary healing via stopping contraction?
contact inhibition and tension, also lost of miofibroblasts
46
Why don't limb wounds contract as well as body wounds?
less vasculariation, less skin elasticity | fewer myofibrils and cytokines
47
Why don't limb wounds contract as well as body wounds?
less vasculariation, less skin elasticity | fewer myofibrils and cytokines
48
Why do limb wounds epithelialize slower than body wounds?
we don't know
49
What meds can inhibit granulation tissue?
corticosteroids, white wound lotion (lead/zinc), copper sulcate, amnion, skin grafts,
50
How do corticosteroids change wound healing?
inhibit granulation tissue and slows epithelialization
51
How do lead acetate/zinc sulfate change wound healing?
inhibits granulation tissue by slows epithelialization by killing fibroblasts
52
How does copper sulfate change wound healing?
inhibits gran. tissue by killing fibroblasts
53
How does furacin change wound healing?
stimulates granulation tissue and inhibits epithelialization
54
How does prep H change wound healing?
stimulates granulation tissue production while slowing contraction and epithelialization
55
How does amnion change wound healing?
inhibits granulation tissue and promotes epithelaization - actually speeds healing!
56
How des split thickness skin grafting change wound healing?
inhibits gran tissue and promotes contraction
57
How des split thickness skin grafting change wound healing?
inhibits gran tissue and promotes contraction
58
Ideal properties of suture? 12
maintain strength, non electrolytic, noncapillary, non allergenic, non cacinogenic, good handling, secure knots, no reactivity, absorb dependably or inert, cheap, available, easily cleaned, doesn't fair bacteria
59
What are the two ways to classify suture?
absorbable/not | synthetic/natural
60
Ideal properties of suture? 12 (7 important)
maintain strength, noncapillary, good handling, secure knots, no reactivity, absorb dependably or inert, doesn't fair bacteria non electrolytic, non allergenic, non carcinogenic, cheap, available, easily cleaned,
61
What are the two ways to classify suture?
absorbable/not | synthetic/natural
62
Which sutures are absorbable?
- collagen - surgical gut - anything poly/glycomer
63
Which sutras are not absorbable?
silk, cotton, nylon, polyproplyene polymerized caprolactam, polyester, steel
64
Why is surgical gut a bad suture choice?
poor strength (down to 50% in 14 days), non capillary, knots don't tie well, phagocytosis causes unpredictable absorption, favours bacteria
65
Why is Dexon (polyglycolic acid) a poor suture choice
it is capillary and doesn't have much strength. It is braided and favours bacteria. Breaks down reliably in 100 days - good point.
66
Why is coated vicryl a good/poor suture choice?
non capillary and graded but otherwise good. smiler strength to dexon and surgical gut.
67
why is PDS II a good/poor suture choice?
generally good on all fields! a bit hard to handle. breaks down in 180 days. it is non capillary and doesn't attract bacteria! yay!
68
why is PDS II a good/poor suture choice?
generally good on all fields! a bit hard to handle. breaks down in 180 days. it is non capillary and doesn't attract bacteria! yay!
69
why is maxon a good/poor suture choice?
good in all ways, good to use when there may be bacteria present.
70
why is monocryl a good/poor suture choice?
good in all ways, breaks down in 90 days though so good for SQ layer and good when bacteria may be present
71
why is Biosyn a good/poor suture choice?
best absorbable for strength. lasts 110 days. good in all other ways.
72
why is Biosyn a good/poor suture choice?
best absorbable for strength. lasts 110 days. good in all other ways.
73
why is silk a good/poor suture choice?
multifiliment - favors bacteria and is capillary, but is very strong.
74
why is cotton a good/poor suture choice?
really favours bacteria. capillary. reactive.
75
why is nylon a good/poor suture choice?
its good!
76
why is prolene a good/poor suture choice?
great for closing skin, bad for tendons because they have a bit of stretch to them
77
why is vetafil a good/poor suture choice?
multifilament! capillary, reactive, favors bacteria. comes in a cassette so no waste. DO NOT BURY or it gets infected!
78
why is polyester a good/poor suture choice?
capillary, bacteria, and reactive. poor choice but strong.
79
why is stainless steel a good/poor suture choice?
hard to handle.
80
why is stainless steel a good/poor suture choice?
hard to handle.
81
how do you choose a suture material?
mainly based on strength and how long it takes to decay
82
What do you use to close skin?
monofilament that isn't absorbable
83
what do you use for subcutaneous tissue
snythetic absorbable
84
what do you use to close fascia?
monofilament - either absorbable or not
85
what do you use to suture tendon?
monofilament absorbable or nylon
86
how do you choose a type of needle circle?
wound depth
87
needle head for skin?
cutting
88
needle head for bowel, fascia, tendon or subQ?
taper
89
needle head for bowel, fascia, tendon or subQ?
taper
90
When you see a wound, what do you consider before attempting to deal with it?
location, how it was injured, how long it was injured, if it is contaminated
91
When you see a puncture wound, what do you need to do?
imaging before you take out the puncture object so you can see how deep it is
92
what are picture wounds predisposed to?
innoculation and foreign body.
93
what secondary problems do burns cause?
smoke inhalation, protein loss, sepsis
94
what kind of injury are serum scald and chronic diarrhea?
chemical burns
95
what two kinds of gun injurys
low velocity - tumbling phenomenon - different tissue density changes projection high velocity -destroys everything in path
96
What's a major problem with all gun wounds?
high contamination
97
What causes a vascular injury?
a poorly applied cast
98
What is a clean wound?
surgery, elective. no drains
99
how often are clean wounds infected?
2.5%
100
what is a clean-contaminated wound?
a hallow viscous surgery (Bladder or sinus), or a clean surgery with a drain
101
how often are clean-contaminated wounds infected?
4.5% - more able to justify prophylactic antibiotics
102
What is a contaminated surgery?
gastro, a contaminated wound, or an open fresh wound less than 4 hours old.
103
Infection rate of contaminated surgery?
5.8%
104
What is a dirty surgery?
old wounds over 4 hrs old, GI rupture
105
dirty surgery infection rate?
18.1% - use antibiotics!
106
What are the 5 events of wound healing?
``` wounding acute vascular phase inflammatory phase cellular phase maturation phase ```
107
What are the 5 events of wound healing?
``` wounding acute vascular phase (bleeding, vasoconstriction, clot) inflammatory phase (serum and granulation) cellular phase (fiberous tissue + capillary growth) maturation phase (crosslinking, collagen remodelling, gains strength) ```
108
what is involved in the inflammatory stage of wound healing?
vasodilation, inflammatory cells, cellular adhesion. also many vasoactive factors such as histamine, serotonin, cytokines, kinins, prostoglanins
109
what occurs when a wound epithelialises?
fibrin seal, epithelials migrate to area and proliferate under direction of macrophages
110
what occurs when a wound epithelialises?
fibrin seal, epithelials migrate to area and proliferate under direction of macrophages
111
What three major factors influence wound healing?
surgeon (our skill, suture choice, etc), the wound environment (infection, contamination degree) and the patients systemic condition (age, nutrition, immune)
112
when there is low oxygen how does this effect granulation?
increases granulation

Surgical Skills (4 decks)

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