Lecture 14 10/29/24

Question 1

What are the steps to ligating during the skin incision?

Answer 1

-prepare for bleeding
-identify the vessels
-use hemostatic forceps, encircling ligature, or electrocautery to stop bleeding

Question 2

When is hemorrhage/uncontrolled bleeding likely to occur?

Answer 2

-ovarian pedicle during OVH
-vaginal artery during dystocia
-after removal of emasculators
-any large superficial artery or vein wounds

Question 3

What are the first steps to managing hemorrhage?

Answer 3

-identify the origin of the bleeding
-clamp and ligate the bleeding vessel(s)
-reassess continuation of procedure and any changes needed to prevent further hemorrhage

Question 4

What are the characteristics of pressure/tamponade?

Answer 4

-gentle pressure on the bleeding structures
-use a 4x4 gauze
-hold for 2 to 3 minutes
-pay careful attention when removing gauze and look for continued bleeding

Question 5

What are the characteristics of packing?

Answer 5

-done for profuse bleeding
-re-intervention necessary to remove gauzes used for packing

Question 6

How is the amount of blood loss assessed?

Answer 6

measure volume collected in suction apparatus
-count soaked 4x4 gauzes; each holds approx. 10 mL
-count soaked lap. sponges; each holds approx. 100 mL

Question 7

What are the characteristics of topical vasoconstrictors?

Answer 7

-used for management of diffuse inaccessible bleeding
-often used in sinus surgeries
-used soaked on gauzes
-may induce severe CV effects if absorbed systemically

Question 8

What are the characteristics of tourniquet use?

Answer 8

-broad, tight bandage
-applied proximal to bleeding on the limbs
-prevents arterial and venous blood flow
-increases visibility but makes vessel ID more difficult

Question 9

What are the three groups of hemostatic agents?

Answer 9

-mechanical hemostatic agents
-active hemostatic agents
-hemostatic sealants

Question 10

What are the characteristics of cellulose-based products?

Answer 10

-mechanical agent
-mesh applied on top of oozing structure
-becomes saturated with blood
-forms a gelatinous mass
-acts as a scaffold for the formation of blood clot

Question 11

What are the characteristics of gelatin sponges?

Answer 11

-mechanical agent
-porcine gelatin
-absorbs up to 40x its own weight
-adheres to tissue and induces tamponade effect
-does not actively promote platelet aggregation
-absorbable but can form a nidus of infection if contamination occurs

Question 12

What are the characteristics of collagen?

Answer 12

-mechanical agent
-derived from bovine collagen
-microfillar collagen
-binds with the bleeding surface
-acts as a mechanical obstruction to bleeding
-does not swell; good for use around spine
-absorbed in 14 days

Question 13

What are the characteristics of polysaccharide spheres?

Answer 13

-mechanical agent
-derived starch
-hydrophilic/absorbs water contained in blood
-concentrates the solid components of blood
-stimulates platelet response
-rapidly metabolized
-swells up to 500%

Question 14

What are the characteristics of beeswax?

Answer 14

-mechanical agent
-used for bleeding in bone
-physical barrier applied in the foramen from where bleeding originates

Question 15

What are the characteristics of zeolite-based agents?

Answer 15

-mechanical agent
-microporous aluminosilicate minerals
-absorbant
-absorbs water and forms an exothermic reaction
-external use only

Question 16

What are the characteristics of thrombin?

Answer 16

-active agent
-factor II of the coagulation cascade
-actively converts fibrinogen to fibrin to create a clot
-exogenous origin can lead to antibody development and coagulopathy; do not use in consecutive surgeries

Question 17

What are the characteristics of fibrin?

Answer 17

-hemostatic sealant
-direct apposition of fibrin in surgical site
-completely independent from coagulation cascade
-rare in vet med

Question 18

Which actions should be taken once hemorrhage is identified?

Answer 18

-communicate with anesthesiologist
-animal will become hypotensive and need fluids immediately to restore blood volume

Question 19

What are the characteristics of an animal’s ability to handle blood loss?

Answer 19

-awake animals can tolerate acute blood loss up to 25% of blood volume
-anesthetized animals are less tolerant; blood replacement should be considered for any loss greater than 10% of blood volume

Question 20

How can surgeons be prepared for hemorrhage?

Answer 20

-collect blood from donors prior to risky procedures
-acquire blood from blood banks

Question 21

Which aspects of the patient should be monitored to reassess how the patient is doing following hemorrhage?

Answer 21

-heart rate
-mucous membranes
-PCV and TP

Question 22

What are the potential causes of hemoperitoneum?

Answer 22

-mesenteric bleeding from ligature failure
-non-recognition of active bleeder while under anesthesia

Question 23

What can help to prevent a patient from developing post-operative hemorrhage?

Answer 23

-baseline hematology +/- coagulation profile prior to operation
-effective hemostasis
-monitoring of surgical blood loss
-post-op monitoring of vital signs
-post-op monitoring of PCV and TP

Question 24

What should be done when a patient is suspected to have post-op hemorrhage?

Answer 24

-administration of volume of resuscitation +/- blood transfusion
-medical imaging (ultrasound or CT) to identify origin of bleeding
-second surgical procedure for unstable patients
-continued close monitoring and support for stable patients

Question 25

What is dehiscence?

Answer 25

opening of the surgical incision, including the skin, fascia/muscle layer, and or enterotomy/anastomosis sites

Question 26

What are the risk factors for dehiscence?

Answer 26

-inadequate suture technique
-surgical site infection
-presence of dead space, seroma/hematoma

Question 27

Which components of inadequate suture technique can result in dehiscence?

Answer 27

-poor knot tying technique
-improper suture material selection
-sutures too loose
-sutures too close to wound margins
-sutures not including the holding layer of tissue
-excessive tension on the wound edges

Question 28

What are the common causes for dehiscence in the immediate post-op period?

Answer 28

-improper knot tying technique
-improper suture technique
-improper size of suture material

Question 29

What are the common causes for dehiscence 3 to 5 days post-op?

Answer 29

-minimal healing in the wound bed
-weakening of the sutures

Question 30

What are the systemic risk factors for dehiscence?

Answer 30

-age
-nutritional deficiencies
-hypoproteinemia
-endocrine diseases
-immunocompromised patients

Question 31

What are the characteristics of evisceration?

Answer 31

-complete opening of the body wall
-GI tract becomes exposed
-life threatening
-can lead to secondary blood loss, sepsis, and mutilation

Question 32

What is a hernia?

Answer 32

passage of internal organs through a wound left to heal by second intention

Question 33

What is an incisional hernia?

Answer 33

complete rupture of the body wall with the skin remaining intact

Question 34

How can forgotten instruments and gauze pads be prevented during surgery?

Answer 34

performing gauze and instrument counts before making an incision, before closing the body wall, and after surgery is over

Question 35

What is the most likely cause of orthopedic infection?

Answer 35

Staphylococcus spp.

Question 36

What are the treatment steps for orthopedic infection with Staph.?

Answer 36

-start antibiotics
-removal of implant dependent on stability and possibility
-flush/lavage synovial cavity

Question 37

What can result in implant failure?

Answer 37

-instability of repair
-slow healing process
-fatigue of the implant

Question 38

What are the characteristics of implant migration?

Answer 38

-smooth pins can result in infection and motion of previously repaired injury
-may require revision of the construct and removal of the implants