Exam 1 Lec 7-12 Flashcards

Question

What jobs are there for the assistant surgeon? | How do you pass an instrument?

Answer 1

- Organize table - Count gauze sponges: radiopaque show on x-ray when left inside the patient. - Count instruments - Hand instruments - Retract things - Hold things - Cut suture (the most important job): check length with surgeon before cutting - Run suture **Pass instrument like you mean it **

Answer 2

- Accurately report what occurred during the procedure - Details are important and go in a step by step manner about it - Include lengths, instruments, suture most everything used. - Templates need to be tailored - Use proper medical terminology - Generic names, avoid brand names - Not a lot of filler words, "then this" "that" Parts 1. Start with animal being anesthetized/restrained (bried) and position. "The dog was anesthetized and place in a dorsal recumbency in a V through" (table) "The horse was anesthetized and placed in dorsal recumbency with both limbs suspended from dorsal leg brackets with carpal flexion 45 degrees. 2. Describe area prepared and how it was prepared "The right flank from the second to last rib to tuber coxae was clipped and prepared for surgery using 1% povidone-iodine scrub and alcohol." 3. Describe the approach: location, length (cm), and instruments used "A 3 cm prescrotal incision was created with a #10 scalpel blade. The subcutaneous tissues were bluntly dissected with Metzenbaum scissors" THE BODY REPORT - Describe major findings (think pathology report) in order - What was explored - Describe major procedures in order -Ligation, size of suture -General (skin vessel ligated) -Transection instrument used -Blunt dissection -Sharp dissection -Implants placed: exact number, sizes, etc. 4. End with how the animal recovered from anesthesia -"Animal recovered uneventufully from anesthesia." "The horse remained recumbent for a prolonged period and required assistance to stand during recovery from anesthesia" 5. Incision closure -Layers, patterns, suture, +/- needle type. "The linea alba was closed with USP 3 polyglactin 910 in a simple continuous pattern. The subcutaneous layer was closed with 2-0 polydionanone in a simple continous pattern. The skin was stapled."

Answer 3

- Wound need to be covered immediately clean towel or bandage to prevent further trauma and contamination. - Assess the traumatized animal and stabilize its condition. - Clip and aseptically prepare the area around the wound. - Remove debris from the wound - Culture the wound. * **Life-threatening injuries need to be stabilized first*** - Lavage the wound thoroughly - Provide drainage - Close if appropriate

Answer 4

- First 6-8 hours between wound contamination at injury and bacterial multiplication to greater than 10^5 CFU per gram of tissue. - Infected >10^5 CFU per gram of tissue. They are usually grossly dirty and covered with a thick, viscous exudate.

Answer 5

- Contamination: presence of microbes on surface - Colonization: surface microorganisms are replicating - Infection: invasion and replication of microbes within the tissue. Classification - Class 1: 0-6 hours, no infection. - Class 2: 6-12 hours, no infection. - Class 3: older than 12 hours, infection likely. Types of wounds -Abrasion: superficail. Sensitive to pressure. Heal rapidly -Puncture Wound: small skin opening with deep tissue contamination and damage. Damage proportional to missle velocity. -Laceration: may be superficial or deep and have irregular edges. Created by tearing that damages skin underlying tissue and muscles, etc. -Avulsion or Degloving injury: tearing tissues form their attachments and creating of skin flaps. a. Anatomic degloving: skin and various levels of underlying tissue are torn off the limb. b. Physiological degloving: skin surface is intact but separated or avulsed from underlying subcutaneous tissue and blood supply. -Thermal burn: caused by heat or chemicals. Risk of infection and sepsis is high. Possible: a. Severe fluid loss b. Electrolyte loss c. Protein loss -Crush injuries: combination of other types of wound with extensive damage and contusions to skin and deeper tissue. -Decubital Ulcers: result of compression of the skin and soft tissues between a bony prominence and a hard surface. Results in skin loss over the bony prominence. May extend into deeper soft tissue and bone. **Often seen in recumbent animals**

Answer 6

1. Primary wound closure: First intention healing - minimal trauma, heal by first intention, wedges are apposed. - within hours of injury 2. Delayed primary closure - Appositional closure Within 3-5 days - Before granulation - Mildly contaminated - Require some cleansing, debridement and open wound management 3. Healing by Contraction and Epithelialization (Second Intention Healing) - Wound left open to heal - May be inefficient and fail to produce a functional outcome - Dirty wounds, contaminated wounds, traumatized wounds. - Some cleaning and debridement, but no primary closure. - May be secondary closure an option 4. Secondary Closure (Third intention healing) - Appositional closure >5days after wounding over the granulation tissue, some debridement may be necessary - Granulation tissue formed in bed: microbial resistance and vascular substrate. - Severely contaminated - Severely traumatized - Infected

Answer 7

-Copious irrigation (even with tap water) -Cover wound with antimicrobial agent -Bandage to protect -Clipping and prepping the are around the wound -Water soluble lubricant -Close temporarily with staples or Michael clips. -Alcohol is very damaging to exposed tissue and should be used only on intact skin !!!NO Detergents or antiseptic scrubs!! -Sterile isotonic saline or balanced electrolyte solution (lactated Ringer's solution) is the preferred lavage solution. -No distilled or sterile water Wound irrigation: removes bacteria mechanically and loosens necrotic debris. - May use nontoxic wound cleansers: soften necrotic tissue and act as surfactant allowing easy rinse off. - Antiseptics have little to no effect on established bacteria. - To generate 7-8 psi, 1 liter bag of fluid within a cuff pressurized to 300 mmHg needle 18 gauge. Saline 0.9% - Not better to use higher pressures. Damage to underlying tissue. Reduce resistance to infection.

Answer 8

- Removal of necrotic or damaged tissue, foreign bodies, microorganisms, etc. - The goal is to obtain fresh clean wound margins and bed for primary or delayed closure to be possible Devitalized tissue removal: - Wet-dry bandages: adhere to surface and pull the debris off wound. Maintain moist wound environment and absorb exudates. Effective in early stages, but debridement is painful and non-selective - Biosurgical methods: maggots (Lucilia sericata). Best suited for necrotic, infected, or chronin nonhealing wounds. They promote granulation tissue formation. - Enzymes: used in adjunct to lavage and surgical debridement. Beneficial in poor anesthetic risks. Do not damage living tissue. Break down necrotic tissue and liquefy coagulum and bacterial biofilm. Must remain in contact with wound. - Surgical excision: sharp dissection, electrosurgery, laser. Begin at surface. Muscle until it bleeds and contracts. Subcutaneous should be avoided. Fat can be deliverately excised. Cutaneous vessels should be spared. Danger or removal of excessive amount viable tissue. * *With penetrating wounds it may be necessary to enlarged the wound for proper assessment** - Autolytic mechanisms: enzymes dissolve nonviable tissue. Highly effective and preferred over surgical method. Less painful. Accomplished with hydrophilic, occlusive, semiocclusive bandages. After surgical debridement - Hydrophilic dressing - Wound drainage - Wound closure

Answer 9

- Severely contaminated, crushed, or infected wounds, or older than 6-8 hours, typically bnefit from antibiotic therapy. - Based on culture and susceptibility testing Topical - Bacitracin, Neomycin, Polymyxin. - Efficacy against pseudomonas is poor - More effective in preventing that treating - preferred in open wounds - Apply 1-3 hours of contamination - Powders act as foreign bodies DO NOT USE Burn wounds - Silver Sulfadiazine - Effective against most gram positive/negative and most fungi. - Serves as antimicrobial layer - Penetrates necrotic tissue Nitrofurazone - Hydrophilic properties: draw body fluid from wound tissue - Little effect against pseudonomas - Delays wound epitheliaziation - Loses some antibacterial effect organic debris presence Gentamicin Sulfate -Used before and after grafting wounds Cefazolin - Gram positive and some Gram negative - Topical antibiotic in wound fluid. - Wound irrigation produces higher concentrations for longer periods. Mafenide - Topical Sulfa - Pseudomonas and Clostridium spp. Honey Sugar - Early in wound healing - Discontinue once granulation starts - Attracts macrophages - Provide cellular energy

Answer 10

- Increased rate of granulation - Accelerated healing times - Wound cleaning - Improved blood flow - Reduced edema

Exam 1 Lec 7-12 Flashcards

(34 cards)