2: Surgical hemostatisis and electrosurgery

Question 1

Hemostasis definition

Answer 1

Process by which hemorrhage is arrested

Question 2

Drugs that affect bleeding times

Answer 2

Acetylsalicylic acid
Warfarin
adequan
heparin
NSAIDs

Question 3

PTT tests

Answer 3

intrinsic coagulation

Question 4

PT tests

Answer 4

extrinsic coagulation

Question 5

Platelet count test

Answer 5

platelet contribution to hemostasis

Question 6

Buccal mucosal bleeding time test

Answer 6

Platelet contribution to hemostasis

Question 7

FDP test

Answer 7

intravascular coagulation

Question 8

3 factors that help achieve hemostasis

Answer 8

vascular factors
intravascular factors
Extravascular factors

Question 9

Examples of vascular factors

Answer 9

reflex vasospasm
vascular retraction
inversion of the intima of the blood vessel

Question 10

Result of the interaction of intravascular factors

Answer 10

thrombus formation

Question 11

Primary hemostasis

Answer 11

Platelet plug temporarily closes the opening in a vessel

Question 12

Secondary hemostasis

Answer 12

conversion of soluble fibrinogen into the insoluble fibrin clot

Question 13

Examples of extravascular factors

Answer 13

Tissue elasticity

Release of tissue thromboplastin

Question 14

What does a pressure pad control

Answer 14

low pressure hemorrhage from small vessels

Question 15

When do you use hemostatic forceps

Answer 15

when bleeding vessels are to be sacrificed rather than repaired
Small low pressure vessels

Question 16

Goal of hemostatic forceps

Answer 16

Hemorrhage is temporarily arrested

vascular wall is sufficiently injured to activate the physiologic clotting mechanisim

Question 17

Pros of vascular ligation

Answer 17

most secure method of hemostasis from severed vessels

Question 18

Cons of vascular ligation

Answer 18

introduction of foreign material in the wound

increased application time

Question 19

Square knot

Answer 19

Used for ligatures

Security without excessive bulk

Question 20

Surgeon’s knot

Answer 20

Increased friction

More bulk than square

Question 21

Granny knot

Answer 21

Accidental

Tie a square knot over it

Question 22

Modified Miller’s knot

Answer 22

Ligate vascular pedicles

Question 23

Trans fixation type ligation

Answer 23

increased security

suture and needle penetrate vessel and then encircle

Question 24

Ligating clips advantages

Answer 24

Fast

Good for hard to access areas

Question 25

Ligating clips disadvantages

Answer 25

Foreign bodies

potential for being dislodged

Question 26

Vascular forceps

Answer 26

atraumatically occlude blood vessels during surgery

Question 27

Absorbable gelatin sponges (gelfoam)

Answer 27

provide physical matrix for clotting
physical barrier to hemorrhage
Slowly absorbable

Question 28

Oxidized cellulose-treated surgical gauze (gurgicel)

Answer 28

Interacts with protein and platelets

mechanical barrier

Question 29

Bone wax

Answer 29

arrest bleeding from edges of cancellous bone

non-absorbable

Question 30

Epinephrine and norepinephrine

Answer 30

Vasoconstrictive

may cause arrhythmias

Question 31

Primary vascular repair

Answer 31

maintains vessels

Question 32

When is primary vascular repair used

Answer 32

critical vascular structures

during transplantation of organs

Question 33

Electrocautery

Answer 33

thermal cautery

Question 34

Electrocautery advantages

Answer 34

Functions in a bloody field

inexpensive

Question 35

Electrocautery disadvantages

Answer 35

extensive tissue destruction

effective only on very small vesseles

Question 36

High frequency electrocoagulation

Answer 36

Electrode is not hot

Tissue resistance causes heat

Question 37

Electrocoagulation disadvantages

Answer 37

No function in bloody field

Don’t use near heart or spinal chord

Question 38

Bipolar coagulation units advantages

Answer 38

Functions in bloody field

Safer near spinal chord or heart