Chapter 11 Flashcards
hemostasis
exudate
mass of cells and fluids that has seeped out of blood vessels, especially in inflammation
what is a cicatrix
scar
capillarity definition
tendency of liquid to rise and fall as result of surface tension
what is evisceration
cut and everything seeps out
keloid
abnormally large cicatrix (scar)
Rh factor
found in blood
what is dehiscence
wound falling apart
secondary suture line
sutures placed to support tension on primary suture line
lateral to primary suture
definition of hemostasis
stopping the loss blood
methods of achieving hemostasis
clot formation
vessel spasm
surgically
surgical methods to achieve hemostasis
mechanical pressure
ligation
apply hemostatic agents
thermally
coagulation: phases of clotting process
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)
what two materials form thick matrix over blood clot
thrombin + fibrogen
what is the techs procedure for estimated blood loss
provide info to surgeon + anesthesia about pt status and potential need for transfusion
what is EBL determined by
calibrated suction canisters
bloody sponges
how do you calibrate suction containers
volume minus irrigation
factors affecting hemostasis
congenital hemostatic defects
- hemophilia
acquired hemostatic disorders
examples of acquired hemostatic disorders
liver disease
anticoagulant therapy
aplastic anemia
drug therapy
mechanical hemostasis devices
hemostasis instruments
ligatures
clips
sponges
pledgets
bone wax
pressure device
mechanical hemostasis: hemostatic instruments
compress walls of vessel
mechanical hemostasis: ligatures
ties or stick ties
mechanical hemostasis: clips
dissolvable or permanent
nonreactive metal
mechanical hemostasis: sponges
apply pressure and absorb excess fluid
mechanical hemostasis: bone wax
seal off cut edges of bone
use sparingly
mechanical hemostasis: pressure device
tourniquet
SCD
mechanical hemostasis: pledgets
teflon buttressed over a suture line
biological hemostasis examples
fibrine sealants
pooled donor plasma
what is fibrin glue
biological adhesive that produces fibrin needed to perform clots
what is fibrin glue used for
stabilize ocular implants
approximate wound edges
middle ear reconstruction
what is bioglue made of
albumen and gluteraldehyde
what does bioglue do
creates a flexible mechanical seal independent of the bodies mechanical
- used in cardio and vascular
exampels of thermal hemostasis
electrosurgery
lasers
argon plasma coagulaion
ultrasonic harmonic scalpel
most common thermal hemostasis
electrosurgery (bovie)
benefits of ultrasonic harmonic scalpel
allows precise cutting
no plume
examples of chemical hemostasis
absorbable gelatin (gel foam)
hemostatic matrix
epinephrine
absorbable gelatin (gel foam)
composed of collagen
placed over bleeding area, deposits fibrin to advance clotting
absorbed by body In 30 days
hemostatic matrix
absorbable gelatin with topical thrombin
used in difficult to reach bleeding areas
expands slightly for direct pressure + rapid clot formation
microfibrillar collagen
purified bovine collagen shredded into fibrils
must be kept dry
oxidized cellulose
plant based high density pads or low density woven fabric
held in place until bleeding stops
silver nitrate
cervix, nasal bleeding, burn tissue
not used on face, temporary blackening
epinephrine
vasoconstrictor
mixed with local agents and gelfoam
absorbed rapidly
thrombin
activation of prothrombin
topical hemostatic
power and liquid
discarded If not used within three hours
what is homologus
donated by another person
what is autologous
donated previously by the patient and stored
- cell saver
who determines blood transfusion
surgeon and anesthesia
depending on procedure
what is fresh frozen plasma
fluid component
restores clotting factors
increases circulating blood volume
we love it
what are packed red blood cells
most commonly used
oxygen carrying capacity
what is whole blood
has all the components
not commonly used
universal donor
O-
universal recipient
AB+
RH factor
antigenic substance found in erythrocyte in most people
Rh+ individuals
individuals with the factor (most people)
what is an example of intraoperative auto transfusion
cell saver
benefit of autotransfusion
eliminates compatibility mismatch or transmission of disease
auto transfusion is contraindicated for blood exposed to:
collagen hemostatic agents
antibiotics
infection
gastric contents
amniotic fluid
cancer cells
PMMA (bone cement)
causes of hemolytic anemia
blood not properly matched
fatal if not treated asap
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
S+S of conscious hemolytic anemia patient
fatigue no energy
rapid pulse
jaundiced skin + turn white
S+S of unconscious hemolytic anemia patient
generalized loss of blood
lowered blood oxygen saturation level
- can’t carry oxygen
types of wounds
intentional - surgical
unintentional - trauma
incidental - iatrogenic (HAI)
chronic - long period of time
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
what is the inflammatory process
body’s protective response to injury or destruction of tissue
classic signs of inflammatory process
pain
heat
redness
swelling
loss of function
types of wound healing
1st intention (primary union)
2nd intention (granulation)
3rd intention (delayed primary closure)
determined by type and condition of tissue
what is the best way for primary wound healing
side to side in a sterile
no dead space
accurate approximated
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
what happens in phase 1: lag
blood rushes in
platelets aggregate
no tensile strength, very fragile
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
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
what is second intention: granulation
failure of a wound to heal by primary union
prone to herniation
excess scaring flesh
what is third intention: delayed wound closure
two granulated surfaces are approximated
used to treat contaminated wounds
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
factors influencing wound healing
physical condition of pt
external factors
suture technique
