EXAM 1: Lecture 8 - principles of hemostasis Flashcards

1
Q

All hemorrhage ______________

A

stops eventually!

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2
Q

T/F: Hemostasis is a simple process that only involved clotting factors

A

false! it is a COMPLEX process that involves platelet activation and circulating clotting factors

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3
Q

what are the benefits of surgical hemostasis

A

allows appropriate visualization of tissue and prevents life-threatening hemorrhage

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4
Q

how do you use hemostatic forceps

A

you grab the vessel and clamp it for several minutes until it coagulates

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5
Q

when should you ligate a vessel

A

when it is a larger vessel

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6
Q

when do you use double ligatures

A

larger vessels particularly arteries

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7
Q

when should you use transfixation ligatures

A

may be used for larger arteries to prevent the ligature from slipping off the vessel

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8
Q

what are the benefits and disadvantages of circumferential ligature

A

benefits - less likely to bleed than transfixation

disadvantages - more likely to slip than a transfixation

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9
Q

what are the benefits and disadvantages of transfixation ligature

A

benefits - penetrates the lumen of the vessel and less likely to slip than a circumferential

advantages - more likely to bleed than circumferential

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10
Q

what type of throw should NOT be used for vessel ligation

A

surgeons throw

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11
Q

what are the types of topical hemostatic agents

A

bone wax, gelatin-based hemostatic products (gel-foam, vetspon), and cellulose-based hemostatic products (surgicel)

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12
Q

when should you not use gelatin-based hemostatic product

A

in the closure of skin incisions as they may interfere with healing

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13
Q

how does gel foam work

A

when it has contact activation, it sells and exerts pressure on the wound

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14
Q

should you put gel foam in infected sites

A

no! it may exert unnecessary pressure on neighboring vital structures

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15
Q

how does surgicel work

A

it is cut to the size needed and placed on an area of hemorrhage

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16
Q

what is electrocautery

A

coagulates small vessels/cuts tissue by using heat generated by direct electrical current into a metal wire or probe

17
Q

T/F: with electrocautery, the electrical current enters the patients body

A

false! It does not

18
Q

what is electrosurgery

A

generating heat inside the tissue using an alternating electric current that passes through the tissue creating a circuit

19
Q

what is this

A

electrocautery

20
Q

what is this

A

electrosurgery

21
Q

what size vessels is electrosurgery commonly used for

A

less than 1.5-2mm in diameter

22
Q

what happens on the “cut” setting of electrosurgery

A

there is a constant waveform that produces heat quickly to vaporize or cut tissue

23
Q

what happens on the “coagulation” setting of electrosurgery

A

there is intermittent waveform that produces less heat and creates a coagulum rather than vaporizing tissue

24
Q

what is the most common form of electrosurgery

A

monopolar electrosurgery

25
Q

what does monopolar electrosurgery involve

A

the flow of current from an active electrode (handpiece) through the patient to a ground plate

26
Q

what can happen with no ground pad in monopolar electrosurgery

A

the circuit with inadvertently use alternative paths to ground and burn the patient

27
Q

how do you prevent burns with monopolar electrosurgery

A

use a large pad placed in good contact with a vascularized area

28
Q

other than a large ground pad, how can you prevent burns with monopolar electrosurgery

A

towels dampened with water/conduction gel can improve contact

29
Q

what does direct contact of the electrode cause in monopolar electrosurgery

A

produces a lower heat sufficient to coagulate

30
Q

what does indirect contact of the electrode cause in monopolar electrosurgery

A

involves touching the electrode to an instruments to allow for more precise application of energy and effective coagulation

31
Q

what is bipolar electrosurgery

A

uses forceps-like hand piece. Current passes from one tip of the forceps to the opposite tip through the tissue being held between the tips

32
Q

T/F: you do not need a ground plate or pad for bipolar electrosurgery

A

true!

33
Q

what is radiosurgery

A

similar to electrosurgery BUT the energy is generated by a low temp high frequency current

34
Q

what is the most widely used laser in SA surgery

A

CO2 laser

35
Q

how does carbon dioxide laser work

A

tissue vaporization occurs as this light energy is absorbed by water into the soft tissue

36
Q

what are the advantages of CO2 laser

A

less bleeding, less pain, less tissue swelling, and decreased risk of infection

37
Q

when is vessel sealing used

A

for hemostasis in laparoscopic and thoracoscopic surgery as well as open abdominal procedures and soft palate resection

38
Q

what is vessel sealing

A

an electrothermal, feedback controlled, bipolar system that can permanently seal vessels up to 7mm in diameter