E-Med Flashcards
1
Q
ORIF
A
Open Reduction
Internal fixation
2
Q
CRPPF
A
Closed Reduction
Percutaneous pin fixation
3
Q
DRUJ
A
Distal Radio-ulnar joint
4
Q
TFCC
A
Triangular fibro-cartilage complex
5
Q
AVN
A
Avascular necrosis
6
Q
Incomplete FXs
A
Bowing
Greenstick
Torus
7
Q
Physeal FX (children)
A
Salter Harris classif
8
Q
Type 1 “S”
A
Separation
right along the physeal line
9
Q
Type 2 “A”
A
above the line, into the shaft
10
Q
Type 3 “L’
A
Lower, below the line into the epiphysis
11
Q
Type 4 “T”
A
Through
through the line
12
Q
Type 5 “R”
A
Ruined, rammed
crushed together
high impact, MVA
13
Q
Comminuated FX
A
bunch of pieces
14
Q
Two factors that we can control as providers to prevent Osteomyelitis
A
Surgical debridement
Proph Abx
15
Q
Most common open fracture
A
Tibia (so close to skin)
16
Q
Most common ABX used for open fractures
A
IV Cephazolin
17
Q
What can you add to Cephazolin to treat open fracturess?
A
+ Aminoglycoside (like Gentamicin)
18
Q
What do you still have to worry about with open fractures that you may think was not now a problem?
A
Compartment syndrome
19
Q
Keep in mind with Scapula fx
A
Often another injury involved (make sure to evaluate Spine)
20
Q
Proximal humeral fracture
A
Neer classification
21
Q
Humerus Shaft fracture
A
Radial nerve; “wrist drop”
22
Q
Humerus AND Forearm fracture result in
A
“Floating elbow”
23
Q
X Rays for Humeral Shaft fracture
A
AP and
AP w external rotation
24
Q
Most common shoulder dislocation
A
Anterior
Mechanism: sports, blow to shoulder while abducted
25
Posterior shoulder dislocation mechanism of injury
Seizures
| Electrocution
26
Sulcus sign
| Apprehension and Relocation test
Shoulder dislocation
27
What do you need to order to rule out Posterior shoulder dislocation?
Axillary view
| best to see posterior dislocation
28
3 injuries associated with Anterior Shoulder dislocation
Bankart lesion
Hills Sachs lesion
Axillary nerve
29
Bankart lesion
lower part of Labrum becomes detached
30
Hills Sachs lesion
Fracture, depression of the humeral head
31
Axillary nerve damage
secondary to Anterior dislocation
Decreased Sensation to lateral aspect of shoulder and Decreased deltoid fx
32
Elbow fat pad sign
Be cautious of a fracture!!! signifies blood coming out of the bone
33
Nursemaid's elbow is an example of
Elbow Sublux
34
Sublux vs Dislocaiton
Sublux: harder to detect, may spontaneously reduce
Dislocate: clinically deformed, very painful, needs immediate reduction
35
Main scan for Dislocations
X Ray
36
If you suspect an Avulsion injury associated with Dislocation, THEN
order CT
37
If you have concern for Ligament integrity
order MRI
38
Forearm fracture consideration
Suspect TWO injuries:
two FX
FX + dislocation
39
What two X Ray views to oder with Forearm fracture?
AP
| Lateral
40
Monteggia fracture
Ulnar shaft + Radial head dislocarion
41
Colles fracture
"dinner fork"
42
Dinner fork
| Colles fracture
DORSAL displacement
43
Smiths fracture is
Volar displacement
44
Dinner fork
| Colles fracture mecanism
FOOSh
45
Snuff box pain, order _____ X Ray
Scaphoid view
46
Galeazzi fracture
DRUJ
47
Scaphoid fracture
Snuffbox pain
48
Complication of Scaphoid fracture
Avascular Necrosis
49
What part of Scaphoid is at highest risk for Avascular Necrosis?
Proximal aspect
50
Tx of IP Dislocation
Buddy tape x 2 weeks
51
Jersey finger
Flexor tendon rupture
52
Jersey finger
Flexor tendon
| Usually also see Avulsion fracture
53
Jersey finger
ring finger most common
54
Mallet finger
Rupture of Extensor tendon (DIP)
55
Tx for Mallet finger (extensor tendon)
STAX extension splint
56
Boxer's fracture
Neck of 5th MC
57
Tx for Boxer's fracture
Ulnar gutter splint
58
Bennett's fracture
base of 1st MC
| into joint
59
Game Keepers thumb fracture
injury to MCP joint, ---> ulnar collateral ligament tear
60
Tx for Game keepers thumb "skiers thumb"
Thumb spica splint
61
Stop ASA, NSAIDs, Plavix, Warfarin ___ days before surgery
3-5 days before
62
SCIP
Surgical Care Improvement Project
prevent INFECTION
63
SCIP was in response to
77% deaths related to infection
64
SCIP protocol
Proph abx 1 hr before surgery
Stop abx 24 hr after surgery, or end time 48 for Cardiac
Cardiac pts controlled 6am post op glucose measure
Approp hair removal
Colorectal pts appropriate normothermia
65
ASA classification
Predict operative risk
6 classes:
1: healthy
2: mild systemic dz
3: severe systemic dz
4: dz constant threat to life
5: will not survive w/o surgery
6: organs for donation
66
Mallampati Score
Class 1-4
Ease of intubation- how well will someone do with protecting airway?
4: toughest time
67
Pre op EKG needed for
men younger age
Men >45
Women >55
Known hx of Cardiac dz
Diabetes
HTN
Major surgery
68
Pulm risk assmt
High risk:
- Smoking (stop 2 months before surgery)
- COPD, Asthma
- Thoracic/abd procedure
- Obesity
69
Pre op assessment for those at high risk - PULMONARY
CXR
Pulmonary Function Tests
ABGs
Pulm consult
70
Risk of peri-op MI
```
Prior hx:
HTN
MI
CHF
Dysrhythmia
Valvular heart dz
```
71
Post MI, no surgery until
6 months after MI
72
Highest risk peri-op MI
dont want a score higher than 10
```
>age 70
previous MI
S3 gallop or JVD
Aortic stenosis
EKG : PVC
Abnormal labs
Emergency surgery
```
Total possible: 53 points
73
Pre-op Diabetes assessment
Elevations in glucose and A1C increases risk of post op INFECTIONS
74
Post op care for Diabetics
Follow Blood Sugar every 6 hours
maintain b/w 150-200
75
Adrenal insufficiency, need to cover pre-op with
Give Hydrocortisone
76
-otomy
incision into
"thoracotom"
77
-ectomy
removal of
78
-ostomy
creation of new opening
79
-plasty
plastic surgery
| repair of something
80
-pexy
fixation
81
-rraphy
suturing or oversewing something to make it safe/more durable
82
Most common used surgical position
supine
83
Pelvic organs
| Central lines
Trendelenburg
84
Upper abd viscera
reveres Trendelenburg
85
Sitting position
Cranial surgeries
86
Lithotomy
Urology
Gynecology
Rectal
87
Prone
spinal surgery only
88
Lateral position
Retro-peritoneal approaches
89
LaparoTOMY
open, large incision
90
Arthroscopy
| used in Ortho
small incision, camera in JOINT SPACE
91
LaparoSCOPY
minimally invasive
VERY COMMON
use gas (CO2) to inflate peritoneum, use instruments through small incisions, video camera
Referred R shoulder pain
diaphragm stretch
92
Common procedures done via LaparaSCOPY
Gall bladder removal
Appendectomy
Hernia repair (Inguinal, Ventral)
Nissen fundoplication
93
What days are we most worried about fever/infection post-op
3-5
94
Immediate post-op fever
| within hours
Meds
Blood products
Malignant hyperthermia
95
Acute post-op fever
| first week
Nosocomial infection
UTI
Aspiration PNA
96
Subacute post-op fever
| 1-4 weeks
Central venous catheter
97
Delayed post op fever
| >1 month
Abscess
98
post op fever >102 F, quick to draw
CBC
UA
Cultures
CXR
on BOTH arms
99
Post op fever within 48 hours
Atelectasis
100
Wound infection
Group A strep
101
Leakage of bowel anastomosis
back to OR
102
Aspiration PNA
Pulmonary toilet
| Get respiratory involved
103
Clean surgical wounds
Leave in place 48 hours to allow for epithelialization
104
Contaminated wounds
Packed open
| Wet to moist change every 8-12 hours
105
Infections post op
| 24-48 hours
Clostridium
| Group A Strep
106
Wound dehiscence
5-8 days post op
salmon colored fluid
GET BACK TO OR
potential risk for Evisceration
107
Most commonly used Proph abx
1st and 2nd gen Cephalosporin
108
Most common cause of fever within 48 hours of surgery
Atelectasis
109
Why is atelectasis so common after surgery?
Surgical manipulation --> Diaphragm dysfx and Diminished surfactant activity
110
Peritonitis
Look septic
shaking bed test
CXT
CT
US all helpful
111
Intrabdominal infections
E.coli
Enterobacter
Laparotomy
I and D
Drainage
Broad spectrum Abx
112
Bacteremia
fever, chills, tachy
check IV lines every 3 days to PREVENT bacteremia
113
Debridement options
Sharp- remove w blade, often in OR, large amt tissue, infected wounds, fast, painful
Mechanical- wet to dry dressing
Autolytic- use body's own enzymes
Enzymatic- chemicals, turn necrotic tissue into slough
Biologic- maggot
114
CONTRA to using VAC drain
```
Necrotic tissue
Untx Osteomyelitis
Fistula
CA in wound
Exposed artery/vein
```
otherwise, great choice
115
Mayo Scissors
Multi-purpose "workhorse"
Straight- "suture scissors", superficial tissue, fascia
VS
Curved- cut tendons, ligaments, muscle, heavy tissue
116
Metzenbaum Scissors
aka "Metz"
Blunt dissection, or cut delicate tissue
NOT for suture
117
Mayo Scissors
SUTURE scissors
118
DeBakey forceps
Grasp fine tissue and blood vessels
Soft tissue dissection
119
Adson forceps
with teeth
without teeth
grasp delicate tissue
120
Tissue forceps w/teeth
"Rat tooth Forceps"
grasp HEAVIER tissue for manipulation and retraction
121
Russian forceps
grasp DENSE tissue
hold during wound debride and closure
122
MANY types of Locking forceps
```
Mosquito
Hemostat
Kelly
Tonsil
Right angle
Ring
Babcock
Kocher
Rochester Peon
Allis
Towel clips
```
123
Mosquito forceps
Fine tip
| Use: clamp vessels, grasp bleeding tissue, suture-ligate vessel
124
Hemostat (crile) forceps
Same as mosquito, just different in size
Clamp vessels, Grasp bleeding tissue, Suture-ligate vessel
125
Kelly forceps
LARGER hemostat
Clamp large vessels, manipulate heavy tissue, soft tissue dissection
126
Tonsil forceps
tunneling for Drain placement
127
Right angle
Hard to reach vessels
"Tie on a passer"
128
Ring forceps
Sponge forceps, sponge stick
Use: FOLDED SPONGE IN JAWS to retract tissue and ABSORB fluids in surgical field, or tissue removal
129
Babcock forceps
Tubular organs
130
Kocher forceps
TRAUMATIC
poky, will do damage to whatever it holds so it will be something you plan to retract anyway
i.e. hemostasis, hold tough cartilage, hold ribs during rib resection
131
Rochester Peon clamp
Large KELLY
Traumatic
Use: Mesenteric (stomach organ) hemostasis, Chest tube insertion
132
Allis forceps
Traumatic
Hold tough structures
Grasp tissue that's going to be removed (i.e. breast tissue, thyroid)
133
Towel clips
"penetrating type"
Traumatic
Clamp towels together
Clamp tissue for manipulation and removal
Caution- will pierce drapes, gloves, and fingers!!
134
Towel clips
"Non-penetrating type"
Clamp drapes, towels together
135
"Self retaining" Retractors
you don't have to hold them
Weitlaner
| Gelpi
136
Weitlaner (self-retaining) Retractos
sharp or dull ties
137
Gelpi (self- retaining) Retractors
sharp tips
138
Retractor holders (manual) may be instructed to
"toe-in" bring the tips closer together, little at a time
139
Types of manual retractors (MANY)
```
Army navy
Goulet
Richardson
Malleable/ribbon
Dever
Rakes
```
140
Types of Self-retaining Retractors
| only two
Weitlaner
| Gelpi
141
Army Navy and Goulet retractor
Shallow, superficial retraction
142
Richardson retractor
"Big rich" (large) and "baby rich" (small)
Common in most specialties
retracts various tissues
143
Malleable/Ribbon retractors
Many widths
Bend to shape
Used often in ABDOMEN and CHEST
144
Dever retractors
used in DEEP incisions
145
Consider with Dever retractors
can use blue towel to wrap around edges if you are holding for long time bc sides may be sharp
146
Rake retractors
Elevating subQ tissue, broad surfaces and edges
147
Additional equipment
```
Bovie
Irrigation
Suction
Sponges
Needles
```
148
"Bovie"
```
used in Electrosurgery
Can do many things:
-cut
-coagulate
-desiccate
-destroy tissue
```
149
Irrigation
usually saline (diff temps)
150
Bulb syringe irrigation
irrigate wounds, wet hands for suture tyine
151
Pitcher pour irrigation
"washout"
152
Suction types
Yankauer
Poole
Frazier
153
Yankauer suction
general MULTI PURPOSE suction tip
154
Poole suction
good for LARGE VOLUME
155
Frazier suction
very tine suction tip
156
Suction-Irrigator
just like what it sounds like
can do both things at once
157
When to stop smoking before surgery
8 weeks is optimal
158
Post op stress response
"Fight or Flight"
increased SNS
Metabolism, gut motility, absorption affected
159
Meds to continue throughout surgery
If sig withdrawal sx
Cardiovascular meds
Statins
Tight glycemic control
160
Med to stop
Anticoags
| 7-10 days b4 surgery
161
Assessment of Surgical risk
Age
Urgency of operation
Anesthetic mortality
Risk assessment
162
If the surgery is emergent, how does that affect the risk for operative mortality?
Doubles it
163
Coag disorder risk factor
Previous clot
| Mobility
164
Bleeding risk
Prior hx of bleeding is best predictor
165
Risk for malnutrition
>15% weight loss over prior 3-4 months
Albumin <3
166
"Ebb and flow" of post surgery
hours;shock
days; catabolism (break down)
weeks; anabolism (build stuff back up)
167
"Ebb"
Immediate
Tissue hypoperfusion (LESS blood flow)
Decrease metabolism (slow down)
Ne release
168
"Flow"
| Peaks at 3-5 days
Catabolic and anabolic
Increased CO
Increased metabolism
Hyperglycemia
169
Anabolic (last part) of the "Flow"
Corticoid withdrawal
| Repletion
170
Most sensitive test of illness and perioperative morbidity
Prealbumin
half life 2-3 days
171
Serum Transferrin can test for
Protein deficiency
| <200
172
"SQIP" or "SCIP" stands for
Surgical Quality Improvement Project
decreasing surgical infections with standard protocols
173
Prevent complications in all of these ways:
```
Normothermia
Proph Abx
Glucose control
Hair removal
Skin antiseptic
Oxygen
Clot prevention
```
174
Goal temperature
98.6-100.4
175
Glucose control
average 150
176
Skin antiseptic
Chlorhexidine
| or maybe Iodine
177
Oxygenation preferred to remain at
80%
178
How often to measure I&O after surgery
on day 1: every 4-6 hrs
| after that: every 24 hrs
179
Crystalloids
Most commonly used
Sodium is main osmotically active particle
180
Colloids
High molecular weight
more likely to stay in vascular compartment
181
Isotonic Crystalloids
- Normal saline
- Lactated Ringer
Have same salt concentration as normal cells of the body
can bolus
use when someone hasn't been eating/drinking
182
When to use Colloids?
| high molecular weight, stay in vascular compartment
Burns
Peritonitis
when you NEED to increase volume
183
Trigger number when we need to TRANSFUSE BLOOD
if Hg <7 : stable pts
may be lower in those with cardiac, pulm, CVA, or transplant
184
When to transfuse platelets
Active bleeding in Thrombocytopenic (low platelet) pts
185
when to use FFP
pts with Deficiencies in clotting factors
OR
on Anti-coags
186
How many hours for epitheliazation
48
187
How long does it take for gut to become active again
Small int: 24 hrs
R. colon: 48 hrs
L. colon: 72 hrs
188
POD 1 fever
PNA, atelectasis
189
POD 3-5 fever
UTI
190
POD 4-6 fever
Blood clot
191
POD 5-7 fever
Surgical site infection
| OBGYN
192
POD 7+
drug fever
IV lines or
Rxn to blood products
193
Gray, dusky discoloration
Crepitence
Need aggressive surgical excision
Necrotizing Fasciitis
194
Rupture of ALL layers and extrusion of abdominal viscera
Evisceration
5-8 days post op
195
Meckel's diverticulum
rule of 2s
Antimesenteric border of ileum (meaning opposite side of ileum)
196
Mesenteric Ischemia
DEC blood flow
Occlusive (clot) or non-occlusive process (hypotension...etc)
197
Mesenteric ischemia is most common in
Older pts with dz causing clot formation
198
Intestinal angina
relating to Mesenteric Ischemia
Stomach pain worse AFTER MEALS
also: pain out of proportion, hematochezia
199
Tx for Mesenteric Ischemia
```
Aggressive IVF
NG tube
Foley catheter
Abx
Anti-coags
Surgery
```
200
Enteric fistula
usually happens:
Post-op!!
a connection b/w two epitheliazed surfaces that is not supposed to be there
201
Problem with Enteric Fistula is:
Loss of GI contents
Malnutrition
losing a much too high amount of GI contents
202
Tx for Enteric Fistula
```
Close it
Fluids
Bowel rest
Control drainage/ skin protection
Surgery
```
203
Bariatric surgery candidates
BMI >40 YO
BMI >35 + comorbidities
Nothing else working
Compliant pt
204
Roux-En-Y gastric bypass
Most common!!
Restrictive AND Malabsorptive
Make stomach smaller AND bypass duodenum
205
Gastric banding
Silicone band lines with inflatable balloon
RESTRICTIVE
risk: band can move/slide
206
Vertical Band Gastroplasty; RARELY done
RESTRICTIVE
staple and band
207
Sleeve Gastrectomy
Slice off the outside portion of stomach
Staple close
Make stomach smaller; RESTRICTIVE
208
Perforation is more common if your age is
younger than 10
| older than 50
209
PeritonITIS
follow Perforation
High fever --> SEPSIS risk
can be localized (contained by surrounding viscera or omentum) OR generalized (gross spillage into peritoneal cavity)
210
Where is Diverticulitis most common?
Sigmoid colon
| LLQ
211
When to consider surgery for Diverticulitis?
Repeated attacks (2 or more)
Complication
Nothing else working
212
Harmann's procedure
commonly done for Diverticulitis
213
Loop colostomy
Helps to:
- decompress Distal end
- allow Proximal end to drain
214
Ileostomy: loop of ileum (last part of sm. int) brought up to abdominal wall
HIGH OUTPUT
bc you don't have absorption going on
215
Proctocolectomy
removal of ENTIRE colon and rectum
216
Abdominoperineal resection
low rectal CA
| Removal of: lower sigmoid, entire rectum and anus
217
Low Anterior Resection
CA of middle and upper section of rectum
Remove: distal sigmoid, 1/2 of rectum. then perform Proximal sigmoid-distal rectum anastamosis
218
Common tx for Hemmorhoids
Rubber band ligation
219
Surgical Hemorrhoidectomy
Mixed internal and external hemorrhoids
Very uncomfortable procedure
220
Common organisms of Anorectal ABSCESS
E.Coli
| Proteus
221
Common problem after Anorectal Abscess
Fistula
| 50% chance
222
What is Seton placement used for?
Tx of Anal Fistula
It's a loop drainage tube to encourage body to heal from inside out
223
Borders of Heisselbach's triangle
Epigastric artery/vein
Rectus abd muscles
Inguinal ligament
224
INDIRECT hernias go into
inguinal canal
225
Rate of recurrence with hernias is higher in what type?
DIRECT hernias
