Final Flashcards
Kelly Forcep aka Kelly Hemostatic Forceps
Control hemostasis
Serrations on entire Jaw
Crile Hemostatic Forcep
Clamp large vessels or large tissue masses
approx. 8” long
Jaw is 31/2” long
Long vertical serrations with checkered serrations at the tip
Rochester-Carmalt
Allis Tissue Forceps
Ferguson Angiotribe
Used in general surgery
In most surgical packs
Has 9 little teeths on tip
Adson Brown Thumb Tissue Forcep
10 - Most Common
Larger blades are for large animals
Surgical Blades
units of measurement are used for photographic documentation
Bard Parker Handle
Aids in making incisions in the linea alba
Provides a channel for the scalpel to follow to avoid accidental incision of the abdominal viscera
Groove Director
Used to secure drape on the patient
Has balls on tips to prevent excessive penetration into tissue
Backhaus Roeder Towelclamp
Used to secure drape on the patient
Ideal for small or exotic patients
Smaller and lightweight than Backhaus style towel clamps
Jones Towel Clamp
Locate and exteriorize uterine horns in an ovariohysterectomy
Spay Hook
aka
Snook Hook
Common needle holder
Comes in different lengths
Mayo Hegar
Needle holder with built in scissor at the jaw for cutting suture
Comes in different sizes
Olsen Hegar
Retract or deflect tissues away from surgical field
Handheld, double ended
One end is narrow with blunt blade
Other end is toothed, traumatic end
(Teeth may be sharp or blunt)
Senn Retractor
Retract or deflect tissues away from surgical field
Self retraining
Fairly traumatic for soft tissue surgeries
More often in orthopedic and neurological procedures
Gelpi Rectractor
Retract or deflect tissues away from surgical field
Self retaining with teeth (blunt or sharp)
Used generally in orthopedic procedures and also soft tissue surgery
Weitlander Rectractor
For delicate dissection
Thin, delicate blades
Straight or curved
Metzenbaum Dissecting Scissor
Used when cutting through large muscles masses, cartilages and other non-delicate tissues
Thick blades
Can be straight or curved
Mayo Dressing Scissors
Knoles bandage scissor
rochester ochsner
O2 Flowmeter
Flow rate
100ml/kg/min
find (L)
note: 0.5L is minimum
resevoir bag
60ml/kg
find in (L)
Induction vs maintanence
induction: 50-100ml/kg/min
3-5%
Maintanence: 25ml-50ml/kg/min
1.5-2.5%
O2 tank
psi x 0.3 = L
L x min/L/60
Wrap Packing
Sterilizing instrument packs are: Cotton, Linen, paper or plastic
Be able to withstand heat, moisture and steam
Instruments
Soak in warm water and detergent
Place in ultrasonic cleaner: 12-15 mins
Rinse thoroughly
Blot dry
SURGICAL PACKS
2 HALSTED-MOSQUITO HEMOSTATS, CURVED 5-INCH
2 KELLY or CRILE HEMOSTATS, CURVED 5½-INCH
2 ROCHESTER-CARMALT or 2 KELLY or CRILE HEMOSTATS, STRAIGHT 5½-INCH
1 MAYO-HEGAR NEEDLE HOLDERS, 7-INCH
1 ADSON-BROWN TISSUE FORCEPS
1 THUMB DRESSING/TISSUE FORCEPS
2 ALLIS TISSUE FORCEPS, 6-INCH
4 BACKHAUS or JONES TOWEL CLAMPS, 5½-INCH
1 OPERATING SCISSORS, SHARP-BLUNT CURVED 5-INCH
1 MAYO SURGICAL SCISSORS
1 NO. 3 BLADE HANDLE
1 OVARIOHYSTERECTOMY “SPAY” HOOK
INSTRUMENT TRAY
SALINE BOWL
10 GAUZE SPONGES
Gown Pack
Make 2
1 Gown
Towel
Indicator strip
Drape pack
4 drapes (accordian folder, dog ear)
indicator stripe
Instrument pack
Instrument tray
Saline bowl
10 gauze sq
4 towel clamp place on 2 pc of gauze in saline bowl
indicator stripe
Autoclave
121C
15psi
for 10-12 mins, 20 mins recommended
Check distilled water level. Must be halfway b/t min and max
Circulating nurse vs surgical nurse
circulating: dirty
surgical: must be scrubbed
Clipping
Female
Xiphoid process down to pubic bone
1-1.5” off the sides
Midway to the stifles
Male
Do not shave pupice or scrotum
shave midway of abdomen down to the stifles
Scrubbing patient
up down circle flip
Scrub (degreaser)
Alcohol
Scrub
Alcohol
Scrub
Alcohol
Take to surgical room
Scrub
Alcohol
Paint with betadine
Anesthetic machine color
Green - O2
Blue - Desoflurane
Purple - Isoflurane
Yellow - Sevoflurane
Rebreathing system
A) Oxygen source with pressure gauge - Oxygen is supplied to the animal. It also is the carrier gas that brings the inhaled anesthetic to the pet.
B) Pressure reducing valve - This valve decreases the high pressure from the oxygen tank to a usable level.
C) Flowmeter - This allows the anesthetist to determine the rate the oxygen will flow to the animal.
D) Oxygen flush valve - This valve allows oxygen to flow directly to the animal bypassing the anesthesia. It is used to quickly increase the amount of oxygen and decrease the anesthesia in the system. This is done at the end of the anesthesia or if the animal is at too deep of a plane of anesthesia during the surgery.
E) Vaporizer - The vaporizer converts the liquid anesthetic to a gas state and adds controlled amounts of the gas anesthetic to the oxygen that is flowing through the machine.
F) Inhalation valve - This allows the gases to flow only to the animal and not back to the vaporizer, by way of a one-way valve.
G) Inhalation hose - This hose carries the gases to the animal.
H) Connecting port - The rebreathing system has a Y piece which connects the inhalation hose, endotracheal tube, and exhalation hose.
I) Endotracheal tube - This tube is placed into the animal’s trachea (windpipe) to allow the oxygen and gases to be breathed into the lungs.
J) Exhalation hose - This hose carries the gases the animal breathed out back to the anesthetic machine.
K) Exhalation valve - This allows the exhaled gases to flow only into the anesthetic machine, not back to the animal, by way of a one-way valve.
L) Rebreathing (reservoir) bag - This is an inflatable rubber bag which allows the accumulation of fresh and expired gas during exhalation so that a reservoir of gas is available for the next breath. The bag also acts as a safety device to prevent rapid pressure increases in the system. It can be manually squeezed to ‘bag’ an animal as needed during surgery to assist breathing.
M) Pop-off valve - This is a pressure relief valve that allows the release of waste gases and extra pressure from the system into the scavenger hose.
N) Scavenger hose - This hose carries waste gases (e.g., oxygen, nitrous oxide, inhalation anesthetic, and carbon dioxide) out of the system and out of the building.
O) CO2 absorber canister - Any gases that do exit through the pop-off valve pass through the carbon dioxide absorber before returning to the animal. The chemicals in the container remove carbon dioxide from the gases that pass through it.
Non Rebreathing system
The first three parts are the same as with the rebreathing system.
A) Oxygen source with pressure gauge
B) Pressure reducing valve
C) Flowmeter
It is at this point that the system changes. The nonrebreathing system does not have each of the parts of a rebreathing system. It does have:
E) Vaporizer - The vaporizer converts the liquid anesthetic to a gas state and adds controlled amounts of the gas anesthetic to the oxygen that is flowing through the machine.
G) Inhalation hose - The gases exit the vaporizer and go directly into a hose for delivery to the animal.
H) Connecting port - This connects the inhalation and exhalation hoses to the endotracheal tube.
I) Endotracheal tube - This tube is placed into the animal’s trachea to allow the oxygen and gases to be breathed into the lungs.
J) Exhalation hose - Exhaled gases pass through this tube directly to the reservoir bag.
L) Rebreathing (reservoir) bag - Exhaled gases pass into the reservoir bag.
M) Pop-off valve - This is a pressure relief valve that allows the release of waste gases and extra pressure from the system into the scavenger hose.
N) Scavenger hose - Exhaled gases pass from the reservoir bag and out of the system (and building) through the scavenger hose.
pH
Normal Blood: 7.40 = 40 namoMols/liter (H+)
measures: moles / L
Henderson Hasselbalch Equation
pH = pK + log ([HCO3] / [CO2])
Interaction b/t CO2 and bicarbonate
pCO2
PaO2
SaO2
Partial Pressure of CO2
Arterial blood: 35-45mmHg
Mixed venous PCO2: 42-52mmHG
Partial Pressure Oxygen
Arterial Blood: 70-100mmHg
Mixed Venous: 35-40mmHg
Normal Value: 5x% inspired air
Room air: 100mmHg
100% oxygen - 500mmHg
Hypoxemia <60mmHg
Oxygen Saturation
Arterial: >95%
Mixed Venous: 65-75%
Hypoxemia: <90% saturation
Acidosis vs Alkalosis
Acidosis
Respiratory Acidosis - Build up of CO2 & High PCO2
Metabolic Acidosis - increase in metabolic acid & loss of bicarbonate
Alkalosis
Respiratory Alkalosis - Elimination in CO2 & low PCO2
Metabolic Alkalosis - Loss of acid
Anion Gap
Major anions - major cations
i.e. (Na+ + K+) - (CL- - HCO3-)
High anion gap = loss in bicarbonate and replaced by unmeasured anions (lactic acidosis, ketoacidosis, uremia, toxins)
Dogs: 10-18
Cats: 12-19
ECF (extracellular fluid): 20% of body
Treatable Vol.: 30%
Awkward Inverse
Hydrogen
pH
Metabolic Acidosis
Hydrogen: When H ion loses an electron to become H+
pH: Decrease in pH = increase in acidity
Metabolic Acidosis: Negative base excess. Decrease in BE = increase acidemia
Acid regulation/elimination
Metabolic acids
- lactic
- pyruvic
- keto-acids of diabetic acidosis
main regulators of acid: lungs & kidneys
Compensation
Lungs compensate faster
Kidneys compensate slower
Temperature
Blood/Gas analyzed at 37C
CO2 soluble at lower temp
Reduces pCO2 about 4.5% per C
Respiration vs Ventilation
Respiration: Process where O2 is supplied to the tissues and CO2 is eliminated from the tissues
Ventilation: Movement of gas in and out of the aveoli
Suture Needles
Swaged Needles
- Less traumatic
- expensive
- sterile
Needle point
Taper:
- Atraumatic
- Internal organs
Cutting edge:
- Traumatic
- Skin
Reverse Cutting:
- Less traumatic
- Skin
Suture Materials
Monofilament vs Multifilament
Natural vs Synthetic
Monofilament
- No wicking
- Poor knot security
- No tissue reaction
- has memory
- Less tissue drag
Multifilament
- wicks/bacteria
- good knot securty
- Has tissue reaction
- more tissue drag
- easy handling
Natural - breaks down by phagocytosis
- Absorbable
- Gut - 3-5 days
- Chromic gut - last longer (10-15 days)
- silk - for opthalmic only
- collagen- for opthalmic only
Synthetic
- Vicryl - absorbable, inhibit bacteria, enzyme breaks down
- Dexon - good knot security
- PGA - good knot security
- PDA - monofilament, worse know security, good memory, absorbable 182 days
- Maxon - monofilament, abosrbable, strong, poor knot security
- Nylon - poor knot security, mono or multi, good memory
Small Animals: 0 - 3-0
Large Animals: 0 - 3
Colloid vs Crystaloid
Crystaloid
Saline (0.9% NaCl)
Lactated ringer
Colloid
Gelatins Hetastarch Albumin Plasma protein fraction Dextran
Respiration vs Ventilation
Respiration: Transport of O2 and CO2
Ventiliation: movement of gas
