Day associated with Surgical Site infections: - Superficial SSI _____________________ - Deep SSI ______________________ - Organ/space _____________________

- Superficial SSI - within 30 days - Deep SSI - within 30 days till 90 days in some cases - Organ/space - 30 till 90 days in some cases

Clean: No break in aseptic technique Clean-contaminated: Minor break in aseptic technique Contaminated: Major break in aseptic technique Dirty

Anticipated bacteria associated with: - Skin - Orthopedic - Hepatobiliary - Urinary

Skin - Staphylococcus spp. Orthopedic - Staph spp., Streptococcus, Anaerobes Hepatobiliary - Clostridium spp., Gram negative bacilli, Anaerobes Urinary - Strep spp., Stap spp., E.coli, Anaerobes

General Surgery Flashcards by Youry D

What are 6 Risk Factors for Surgical Site Infection

Duration of surgery
Duration of anesthesia
Surgical site preparation
Method of wound closure
Antimicrobial prophylaxis
Comorbidities

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Fill in the blank: Risk of infection ____ with each hour of surgery

Infection Risk - Duration of Surgery/Anesthesia

Doubles

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Fill in the blank: ____ body temperature secondary to anesthesia can impact/alter immune system

Infection Risk - Duration of Surgery/Anesthesia

Decreased

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Infection Risk Factors - Surgical Site Preparation

Traumatic clipping, use of poorly maintained clippers, excessive scrubbing, use of harsh biocides, recontamination of prepared sites, and inadequate contact time for biocides
Clipping or shaving well in advance of surgery allows for bacterial proliferation -> patients should be clipped as close to surgery as possible

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What is associated with surgical site infection risk?

Further studies are required to evaluate this association.

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Is there data supporting one wound closure method being more likely to result in infection?

Method of Wound Closure

There is no data supporting that staples, intradermal, or skin sutures differ in infection rates. There is no consensus on the effectiveness of skin staples.

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Fill in the blank: Prophylactic post-op antimicrobials are not typically recommended for more than ____ following surrgery.

24 hours

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What is the suggested temporary ligation time for the descending thoracic aorta?

5 to 10 min

This time frame is critical to minimize ischemic damage.

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What is the suggested temporary ligation time for the portal triad (Pringle maneuver), hepatic artery, portal vein, and common bile duct?

10 to 15 min

This technique helps control bleeding during liver surgeries.

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What is the suggested temporary ligation time for the hepatic artery?

30 min

Extended ligation time can lead to liver ischemia.

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What is the suggested temporary ligation time for the splenic artery and vein?

15 to 20 min

This duration helps to preserve splenic function.

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What is the suggested temporary ligation time for the renal artery and vein?

30 min

Prolonged ligation risks renal injury.

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What is the suggested temporary ligation time for the abdominal aorta?

30 min

Careful monitoring is required to prevent organ damage.

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What are the three types of surveillance?

Active, passive, and syndromic

These types of surveillance are used to monitor health-related events.

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Which type of surveillance is the most common in veterinary medicine?

Passive

Passive surveillance involves the reporting of health events by individuals or institutions.

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What is the recommended oxygen flow for nasal insufflation?

50 to 100 mL/kg/minute

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Day associated with Surgical Site infections:

Superficial SSI _____________________
Deep SSI ______________________
Organ/space _____________________

Superficial SSI - within 30 days
Deep SSI - within 30 days till 90 days in some cases
Organ/space - 30 till 90 days in some cases

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Class of SSI

Clean: No break in aseptic technique
Clean-contaminated: Minor break in aseptic technique
Contaminated: Major break in aseptic technique
Dirty

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Overall rate of SSI?

Rate of SSI of All Clean procedures

Rate of SSI with clean Orthopedic?

Rate of SSI of Clean contained procedures?

Over rate of SSI is 3% (2.5%)

All Clean SSI rate is 4.8%

Orthopedic Clean SSI rate is 7.1%

Clean-contained SSI rate 5.9%

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Anticipated bacteria associated with:

Skin
Orthopedic
Hepatobiliary
Urinary

Skin - Staphylococcus spp.
Orthopedic - Staph spp., Streptococcus, Anaerobes
Hepatobiliary - Clostridium spp., Gram negative bacilli, Anaerobes
Urinary - Strep spp., Stap spp., E.coli, Anaerobes

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What is Nosocomial Infection?

Development of infection 48 hours after hospital admission.

naa · suh · kow · mee · uhl

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Causes that increase SSI?

Duration of Surgery
Duration of anesthesia time
Method of wound closure (there is no clear difference between skin suture vs staples vs intradermal)
Antimicrobial prophylaxis - over dose can predispose to averse effects and resistance
Comorbidities

Prevalence vs Incidence

Prevalence = proportion of cases in the population at a given time (aka how wide spread it is)

Incidence = rate of new diagnosed cases/ period of time

What are HALSTED principles?

H - Hemostasis
A - Aseptic technique
L - Light touch surgery
S - Supply of blood preserved
T - Tension free closure / anastomosis
E - Even tissue apposition
D - Dead space obliteration

What are the four main categories of surgical hemostasis?

1. Reduction of blood flow 2. Hemostatic agents 3. Antifibrinolytics 4. Miscellaneous Agents (see table) ## Footnote Includes Epi/Adrenaline/Ephedrine, Hypotension/Hypothermia/Reduced Perfusion, Tourniquet, Hemostatic agents, Antifibrinolytics, and Miscellaneous.

Four ways to reduce surgical blood flow

* Pressure/Tamponade * Topical Vasoconstrictors * Hypotension/Hypothermia/Reduced Perfusion * Distal control of Blood Flow ## Footnote This technique is often used in combination with other methods.

Name three topical vasoconstrictors used in surgical hemostasis.

Epinephrine, Adrenaline, Ephedrine ## Footnote These agents help constrict blood vessels at the site of bleeding.

Fill in the blank: _______ is a method used to control blood flow by applying pressure to a limb.

Tourniquet

What are hemostatic agents?

Substances used to promote hemostasis ## Footnote They can include various materials and medications that help stop bleeding.

True or False: Antifibrinolytics are used to promote bleeding.

False

List some what can be occluded on a Temparory basis to assist in surgery?

Vessels that can't be permanently ligated in cat?

* Both common carotid arteries * Both jugular veins * Left renal vein

Which vessels can be permanently ligated if the vertebral artery is preserved and the circle of Willis is functional?

Both common carotid arteries ## Footnote This is not applicable in cats.

Which veins can be permanently ligated in dogs, but not in cats?

* Both common carotid arteries * Both jugular veins * Left renal vein ## Footnote This is not applicable in cats.

Which arteries can be permanently ligated?

* Brachial arteries * Femoral arteries * Both external iliac arteries ## Footnote * Both femoral veins * Both common iliac veins * Hepatic vein * Brachiocephalic veins

What can be permanently ligated in the abdominal region under certain conditions?

Abdominal vena cava caudal to liver ## Footnote This is applicable in the case of chronic compression and established collateral circulation or concurrent right nephrectomy.

What is held off in a Pringle Maneuver?

Temporary ligation of hepatic artery and portal vein, common bile duct for 10-15min max

Suggested Temporary Ligation Times in Normothermic Animals for: * Descending thoracic aorta: ____ * Portal triad (Pringle maneuver), hepatic artery, portal vein, common bile duct: ____ * Hepatic artery: ____ * Splenic artery and vein: ____ * Renal artery and vein: ____ * Abdominal aorta: ____

* Descending thoracic aorta: 5 to 10 min * Portal triad (Pringle maneuver), hepatic artery, portal vein, common bile duct: 10 to 15 min * Hepatic artery: 30 min * Splenic artery and vein: 15 to 20 min * Renal artery and vein: 30 min * Abdominal aorta: 30 min

What is the suggested temporary ligation time for the descending thoracic aorta?

5 to 10 min

What is the suggested temporary ligation time for the portal triad (Pringle maneuver), hepatic artery, portal vein, and common bile duct?

10 to 15 min

What is the suggested temporary ligation time for the hepatic artery?

30 min

What is the suggested temporary ligation time for the splenic artery and vein?

15 to 20 min

What is the suggested temporary ligation time for the renal artery and vein?

30 min

What is the suggested temporary ligation time for the abdominal aorta?

30 min

What is the maximum recommended application time for an Esmarch tourniquet?

1.5 – 2 hours ## Footnote Exceeding this time increases the risk of systemic and limb complications.

What is the effect of reapplication of a tourniquet?

Increases risk of systemic and limb complications ## Footnote Reapplication should be approached with caution.

True or False: Exsanguination is recommended before the application of a tourniquet in all cases?

**False** Not recommended with infection or neoplasia. ## Footnote Exsanguination is NOT recommended in these cases.

When do energy stores (ATP) deplete after applying a tourniquet?

2-3 hours ## Footnote Mitochondrial changes are visible after 1 hour.

What is visible after 1 hour of applying a tourniquet?

Mitochondrial changes ## Footnote Microvascular damage becomes evident after 2 hours.

What is the recommended setting for a pneumatic tourniquet relative to the patient's systolic pressure?

100 mmHg above patient systolic pressure ## Footnote Alternatively, try to find the lowest effective tourniquet pressure.

What does La Place’s Law state regarding pressure and tourniquet width?

P = T(N)/RW ## Footnote There is an inverse relationship between pressure applied and the width of the tourniquet.

True or False: The application of a tourniquet can last longer than 2 hours for effective results.

False ## Footnote It is recommended to apply for a maximum of 1.5 to 2 hours.

Fill in the blank: Energy stores (ATP) are depleted within _______ hours of tourniquet application.

2-3 ## Footnote This depletion can lead to complications if the tourniquet is left on too long.

True or False: All collagens share a tertiary structure.

True