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Chapter 11 Flashcards

hemostasis

1
Q

exudate

A

mass of cells and fluids that has seeped out of blood vessels, especially in inflammation

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2
Q

what is a cicatrix

A

scar

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3
Q

capillarity definition

A

tendency of liquid to rise and fall as result of surface tension

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4
Q

what is evisceration

A

cut and everything seeps out

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5
Q

keloid

A

abnormally large cicatrix (scar)

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6
Q

Rh factor

A

found in blood

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7
Q

what is dehiscence

A

wound falling apart

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8
Q

secondary suture line

A

sutures placed to support tension on primary suture line

lateral to primary suture

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9
Q

definition of hemostasis

A

stopping the loss blood

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10
Q

methods of achieving hemostasis

A

clot formation
vessel spasm
surgically

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11
Q

surgical methods to achieve hemostasis

A

mechanical pressure
ligation
apply hemostatic agents
thermally

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12
Q

coagulation: phases of clotting process

A

brief vasoconstriction

inflammation (vasodilation)

platelets adhere to vessel walls

platelets release ADP
- collects more platelets

fibrin makes the wall over wound

permanent thrombosis forms (scar)

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13
Q

what two materials form thick matrix over blood clot

A

thrombin + fibrogen

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14
Q

what is the techs procedure for estimated blood loss

A

provide info to surgeon + anesthesia about pt status and potential need for transfusion

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15
Q

what is EBL determined by

A

calibrated suction canisters
bloody sponges

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16
Q

how do you calibrate suction containers

A

volume minus irrigation

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17
Q

factors affecting hemostasis

A

congenital hemostatic defects
- hemophilia
acquired hemostatic disorders

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18
Q

examples of acquired hemostatic disorders

A

liver disease
anticoagulant therapy
aplastic anemia
drug therapy

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19
Q

mechanical hemostasis devices

A

hemostasis instruments
ligatures
clips
sponges
pledgets
bone wax
pressure device

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20
Q

mechanical hemostasis: hemostatic instruments

A

compress walls of vessel

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21
Q

mechanical hemostasis: ligatures

A

ties or stick ties

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22
Q

mechanical hemostasis: clips

A

dissolvable or permanent
nonreactive metal

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23
Q

mechanical hemostasis: sponges

A

apply pressure and absorb excess fluid

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24
Q

mechanical hemostasis: bone wax

A

seal off cut edges of bone
use sparingly

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25
mechanical hemostasis: pressure device
tourniquet SCD
26
mechanical hemostasis: pledgets
teflon buttressed over a suture line
27
biological hemostasis examples
fibrine sealants pooled donor plasma
28
what is fibrin glue
biological adhesive that produces fibrin needed to perform clots
29
what is fibrin glue used for
stabilize ocular implants approximate wound edges middle ear reconstruction
30
what is bioglue made of
albumen and gluteraldehyde
31
what does bioglue do
creates a flexible mechanical seal independent of the bodies mechanical - used in cardio and vascular
32
exampels of thermal hemostasis
electrosurgery lasers argon plasma coagulaion ultrasonic harmonic scalpel
33
most common thermal hemostasis
electrosurgery (bovie)
34
benefits of ultrasonic harmonic scalpel
allows precise cutting no plume
35
examples of chemical hemostasis
absorbable gelatin (gel foam) hemostatic matrix epinephrine
36
absorbable gelatin (gel foam)
composed of collagen placed over bleeding area, deposits fibrin to advance clotting absorbed by body In 30 days
37
hemostatic matrix
absorbable gelatin with topical thrombin used in difficult to reach bleeding areas expands slightly for direct pressure + rapid clot formation
38
microfibrillar collagen
purified bovine collagen shredded into fibrils must be kept dry
39
oxidized cellulose
plant based high density pads or low density woven fabric held in place until bleeding stops
40
silver nitrate
cervix, nasal bleeding, burn tissue not used on face, temporary blackening
41
epinephrine
vasoconstrictor mixed with local agents and gelfoam absorbed rapidly
42
thrombin
activation of prothrombin topical hemostatic power and liquid discarded If not used within three hours
43
*what is homologus*
donated by another person
44
*what is autologous*
donated previously by the patient and stored - cell saver
45
who determines blood transfusion
surgeon and anesthesia depending on procedure
46
what is fresh frozen plasma
fluid component restores clotting factors increases circulating blood volume we love it
47
what are packed red blood cells
most commonly used oxygen carrying capacity
48
what is whole blood
has all the components not commonly used
49
universal donor
O-
50
universal recipient
AB+
51
RH factor
antigenic substance found in erythrocyte in most people
52
Rh+ individuals
individuals with the factor (most people)
53
what is an example of intraoperative auto transfusion
cell saver
54
benefit of autotransfusion
eliminates compatibility mismatch or transmission of disease
55
auto transfusion is contraindicated for blood exposed to:
collagen hemostatic agents antibiotics infection gastric contents amniotic fluid cancer cells PMMA (bone cement)
56
causes of hemolytic anemia
blood not properly matched fatal if not treated asap
57
what do you do if suspect hemolytic anemia
stop transfusion asap send blood sample to bank for verification start drug counteract therapy watch urine output maybe dialysis
58
S+S of conscious hemolytic anemia patient
fatigue no energy rapid pulse jaundiced skin + turn white
59
S+S of unconscious hemolytic anemia patient
generalized loss of blood lowered blood oxygen saturation level - can't carry oxygen
60
types of wounds
intentional - surgical unintentional - trauma incidental - iatrogenic (HAI) chronic - long period of time
61
types of intentional wounds
chemical - coagulate or denude area occlusive banding - ischemia of tissue - cuts off venous flow, tissue dies surgical site incisions - intentional cut surgical site excisions -removing tissue
62
what is the inflammatory process
body's protective response to injury or destruction of tissue
63
classic signs of inflammatory process
pain heat redness swelling loss of function
64
*types of wound healing*
*1st intention (primary union) 2nd intention (granulation) 3rd intention (delayed primary closure)* determined by type and condition of tissue
65
*what is the best way for primary wound healing*
*side to side in a sterile* no dead space accurate approximated
66
*three distinct phases of first intention primary union*
*phase 1: lag/ inflammatory response -getting ingredients phase 2: proliferation -baking cake phase 3: maturation/ differentiation -frosting cake*
67
what happens in phase 1: lag
blood rushes in platelets aggregate no tensile strength, very fragile
68
what happens in phase 2: proliferation
day 3- 20 bridge wound edges day 5-8: capillary networks reform day 10: lymphatic network forms 25-30% tensile strength
69
what happens in phase 3: maturation
day 14- 12 months collage fiber weaves + increases wound contraction collagen density increases formation of new blood supply cicatrix forms
70
what is second intention: granulation
failure of a wound to heal by primary union prone to herniation excess scaring flesh
71
what is third intention: delayed wound closure
two granulated surfaces are approximated used to treat contaminated wounds
72
process of third intention wound healing
wound debrided and left open pt gets antibiotics and care infection is free wound is closed by first intention
73
factors influencing wound healing
physical condition of pt external factors suture technique

SURG TESTS (24 decks)

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