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Principles of SA Lecture 2 > Carotid Endarterectomy > Flashcards

Carotid Endarterectomy Flashcards

Exam 2

1
Q

What is a Carotid Endarterectomy?

A

A surgical procedure to plaque from the Common Carotid and Internal Carotid Arteries

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2
Q

Why is Local Anesthesia sometimes used during a Carotid Endarterectomy?

A

If patient is at risk for a stroke

-Patient is not asleep so team is able to monitor for strokes

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3
Q

True or False: Carotid Endarterectomies are performed on vessels that are less than 100% occluded.

A

True

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4
Q

What is Reperfusion Syndrome?

A

When a Carotid vessel is 100% occluded, the brain gets used to lack of oxygen
-Revascularization could shock the brain

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5
Q

What is Patient Positioning for a Carotid Endarterectomy?

A
  • Supine with Bilateral Arms tucked
  • Neck extended (Head in Jelly Ring)
  • Shoulder roll under Axilla
  • Head turned away from operative side
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6
Q

What are the key instruments used in a Carotid Endarterectomy?

A
  • Potts Scissors
  • Gerald Forceps
  • Vessel Loops
  • Carotid Shunt
  • Fogarty Hydragrip Clamp
  • Profunda Clamp
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7
Q

How much of the patient’s skin is prepped for a Carotid Endarterectomy?

A

From Ear to Clavicle

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8
Q

True or False: The tip of the earlobe is covered when draping for a Carotid Endarterectomy?

A

False

-The tip of the earlobe is left exposed for orientation

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9
Q

Which type of drape is used for a Carotid Endarterectomy?

A

Thyroid drape

  • With four sterile towels
  • With two towels to “build up” the neck
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10
Q

Where is the skin incision made for a Carotid Endarterectomy?

A

Parallel to the anterior border of the Sternocleidomastoid

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11
Q

Which type of retractor is used when dissecting the SCM for a Carotid Endarterectomy?

A

Dull Weitlaners

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12
Q

Why do we ligate the Facial Vein for a Carotid Endarterectomy?

A

It runs right over the Carotid Bifurcation

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13
Q

Why must you avoid DeBakey manipulation of the Carotid Sinus during a Carotid Endarterectomy?

A

Patient can go into Bradycardia due to stimulation of the Aortic Baroreceptors

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14
Q

What structure must be avoided when dissecting the Carotid Sheath during a Carotid Endarterectomy?

A 
Hypoglossal Nerve (CN XII)
-Runs right over the Carotid Bifurcation
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15
Q

What is given to the patient to prevent blood clotting during a a Carotid Endarterectomy?

A

5000 mL of Heparin

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16
Q

What is Clamp Order for a Carotid Endarterectomy?

A
  1. Common Carotid Artery
  2. External Carotid Artery
  3. Internal Carotid Artery
17
Q

Why is the Internal Carotid Artery the last one clamped during a Carotid Endarterectomy?

A

We want as much blood to reach the brain before we start

18
Q

What do we use to make the initial incision for the arteriotomy during a Carotid Endarterectomy?

A 
#11 blade
-Continue incision with Potts Scissors
19
Q

What instrument is used to separate the plaque from the artery during a Carotid Endarterectomy?

A

Freer elevator

20
Q

What is the Shunt Order during a Carotid Endarterectomy?

A
  1. Internal Carotid Artery

2. Common Carotid Artery

21
Q

What is the SA’s role in Carotid Artery Shunting during a Carotid Endarterectomy?

A

Control clamps and suction

22
Q

What suture is used to tack floating plaques to arterial walls during Carotid Endarterectomies?

A

5-0 Prolene

23
Q

What suture is used on the patch that covers the arteriotomy during a Carotid Endarterectomy?

A

5-0 Prolene (C1 Needle)

-Running stitch

24
Q

What is the SA’s role while suture the patch over the arteriotomy during a Carotid Endarterectomy?

A

Follow the suture

25
Q

What is the Shunt Removal Order during a Carotid Endarterectomy?

A
  1. Internal Carotid Artery
  2. External Carotid Artery
  3. Common Carotid Artery
26
Q

What is the Unclamp Order during a Carotid Endarterectomy?

A
  1. External Carotid Artery
  2. Common Carotid Artery
  3. Internal Carotid Artery
27
Q

Why must hemostasis be perfect during a Carotid Endarterectomy?

A

You don’t want a hematoma to form in the neck and depress the trachea causing airway issues

28
Q

What is given to the patient to reverse the effects of Heparin?

A

50 mg of Protamine

29
Q

What suture is used to close the Carotid Sheath during a Carotid Endarterectomy?

A

2-0 Vicryl (CT1 Needle)

-Running stitch

30
Q

What suture is used to close the Dermis during a a Carotid Endarterectomy?

A

3-0 Vicryl (CT1 Needle)

-Running stitch

31
Q

What suture is used to close the Skin during a Carotid Endarterectomy?

A

4-0 Monocryl (PS2 Needle)

-Intracuticular stitch

32
Q

What dressings are used after a Carotid Endarterectomy?

A
  • Steristrips
  • 4x4s
  • Tegaderm
33
Q

Why must you avoid using Dermabond after a Carotid Endarterectomy?

A

To allow release of pressure from the wound

-You don’t want a hematoma forming in the neck

34
Q

What is the SA’s role during Emergence (waking up) after a Carotid Endarterectomy?

A

Hold light pressure on neck

-Prevents patient from ripping suture in case of cough

35
Q

What are the signs of stroke that are checked for after a Carotid Endarterectomy?

A
  • Tongue deviation
  • Hand strength
  • Feet movement
  • Speech

Principles of SA Lecture 2 (26 decks)

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