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Minor Surgery > Midterm > Flashcards

Midterm Flashcards

1
Q

What’s inside a NCNM suture pack?

A

Forceps, hemostats, scissors, guaze

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2
Q

What are the two types of forceps typically in a NCNM suture pack?

A

Adson dressing forceps

Brown-Adson tissue forceps - teeth!

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3
Q

What is the difference between the structure and use of needle holders vs. hemostats?

A

Needle holders have serrated or smooth jaws. Hemostats have a crosshatched surface that will cause the needle to “roll”

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4
Q

What are the typical scalpel sizes, and when are each used?

A 
#15 - small lesions
#11 - draining abscesses
#10 - large lesions
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5
Q

What are the different types of suture materials?

A

Nylon (Ethilon), Silk - non-absorbable
Vicryl - absorbable
The more 0000, the thinner the suture (3-0 > 6-0)
3-0 Ethilon is most common at NCNM

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6
Q

What are the basic types of needles used?

A

Strait suture needles - not used typically, only for very large wounds
Curved needles - #19 is the MC used at NCNM; conventional or reverse cutting

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7
Q

What suture sizes are used in various body areas?

A

Face/head - 5-0, 6-0, 7-0

General body - 3-0, 4-0, 5-0, 6-0

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8
Q

What are the common needle sizes used for anesthetic injection in minor surgery and applicable locations on the body?

A

27 gauge - 1” - typical

30 gauge - 1” - for minimal pain/facial lesions

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9
Q

What is considered the most important aspect of sterile technique?

A

Dawning on sterile gloves

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10
Q

What are the basic antiseptics commonly used?

A 
60-90% alcohols
3% iodine
7.5-10% iodophors (betadine)
2-4% Chlorhexidine gluconate (Hibiclens, Hibiscrub, Hibitane)
0.2-2% Triclosan
Hydrogen peroxide
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11
Q

Which is considered the best pre-surgical antiseptic?

A

Betadine

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12
Q

What are the pros/cons of nonionic surfactants?

A

Pro - surface active agents with the cleaning properties of soap but virtually no tissue toxicity, including the eye and cornea
Con - No antibacterial activity

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13
Q

Post-operative infection is determined by what risk factors?

A

Number of microorganisms entering the wound
Type and virulence of the bacteria
Patient vitality
External factors - surgery duration, length of hospital stay, etc.

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14
Q

What are the pros and cons of shaving skin before prepping for surgery?

A

Pros - visibility and sterility
Cons - shaving causes multiple areas of nicking of the skin which provides a portal of entry for secondary infections
Best to use scissors or clippers

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15
Q

What are the pros and cons of using alcohol for skin prep injections?

A

Pros - good sterile ability

Cons - no residual antiseptic effect

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16
Q

What are the standard numbers for effective autoclaving?

A

250 degrees F, at 15lbs/sq. in. for 30min

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17
Q

Informed consent implies that the patient completely understand what issues?

A
  1. The nature of the treatment
  2. All material risks for the treatment
  3. The possibility of risk
  4. Alternative treatments available and associated risks
  5. Consequences of going untreated
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18
Q

What is the meaning of PARQ?

A

P - procedure
A - alternatives
R - risk
Q - questions

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19
Q

What is the concept of “free margin”?

A

Free margins indicates that the edges of the biopsy are normal, indicating complete removal of the abnormal tissue

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20
Q

What is the “dead space”?

A

Deep wounds that, if closed superficially, leaves a space below

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21
Q

Why do you undermine?

A

It allows the skin to slide over the subcutaneous tissue more easily and stretch enough to close the opening with less tension, resulting in less scarring.

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22
Q

What are the four reasons for/advantages of using the subcutaneous suture? What type of suture would you typically use?

A
  1. Provide wound stability
  2. Close dead space
  3. Help evert the edges
  4. Relieve tension on the wound edge
    A buried stitch
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23
Q

What are the four most widely used local anesthetic agents used? Which are esters and which are amides? Which is most likely to cause allergies?

A

Esters: Procaine and Tetracaine (allergies more common)
Amides: Lidocaine and Marcaine

24
Q

What are the mechanisms of action of local anesthetics?

A

Prevent or relieve pain by preventing the generation and conduction of nerve impulses - block ion channels

25
Q

Which nerve fibers are most sensitive to actions of local anesthetics?

A

Small nerve fibers - pain fibers

26
Q

What can be added to tetracaine and lidocaine when used for topical anesthesia to produce vasoconstriction?

A

Epi or cocaine

27
Q

What are the benefits of adding epinephrine to local anesthetics?

A

Decreases bleeding, prolongs anesthetic effect, minimizes the amount needed

28
Q

What are the potential side-effects of local epinephrine injection?

A

Hypoxic damage in areas with limited circulation - digits, genitals, toes, ears, nose

29
Q

How quickly will epinephrine in a local anesthetic produce it’s full effect?

A

5-10min

30
Q

When applying local anesthetics, which sensations/functions disappear first? What order do they return?

A
  1. Sensation of pain
  2. Temp
  3. Touch
  4. Deep pressure
  5. Motor function
    Recover in reverse order
31
Q

What are some major drug interactions with local anesthetics?

A

MAO inhibitors –> Hypertensive crisis
Carbamezapine and cyclobenzaprine –> increase effects
Tricyclics and tetracyclics –> hypertensive crisis
Phenothiazines –> profound HTN

32
Q

What is the most frequent CNS action of local anesthetics?

A

Sedation

33
Q

Into which tissues is it not safe to inject local anesthetics containing epinephrine?

A

Fingers, toes, genitals, ears, and nose

34
Q

What is the purpose of adding sodium bicarbonate to local anesthetics?

A

Buffer the acidic solution to a more physiologic pH to reduce pain

35
Q

Can sodium bicarb be safely added to local anesthetic products containing epinephrine? What are the effects?

A

Yes, as long as it is immediately before use.

It decreases the overall activity of Epi

36
Q

Define “infiltration anesthesia”

A

Injection of a local anesthetic directly into tissue without considering the course of cutaneous nerves

37
Q

What are the “two” definitions of a field block?

A
  1. Injection of a combination of intradermal and subQ local anesthetic solution in an inverted V just proximal to and to each side of the lesion
  2. Injection of a combination of intradermal and subQ local anesthetic solution completely around the boundaries of the lesion
38
Q

What are the two advantages of a field block over infiltration anesthesia?

A

Less drug can be used to provide a greater area of anesthesia and you avoid distorting the anatomy of the lesion for bx

39
Q

What are the various routes of administration of local anesthetics?

A

Topical, infiltration, field block, digit or nerve block, IV regional, spinal, epidural

40
Q

What are the considerations when choosing an infiltration anesthetic?

A

Side effect profile, hx of pt use, how long the procedure is going to last, pain post-procedure

41
Q

What are the maximum allowable safe single doses of plain 1% lidocaine and 0.25% bupivacaine alone and with epinephrine?

A

1% Lidocaine - 4.5mg/kg (30mL average adult)

0.25% Marcaine - 3mg/kg (70mL per average adult)

42
Q

What alternatives to local anesthesia are available when a patient is apparently allergic to the ones commonly used?

A

Skin testing - if possible
Use methyl paraben preservative-free if possible. Use the opposite class (ester or amide) or inject with some local benadryl

43
Q

Vertical mattress sutures: advantages and disadvantages?

A

Pros - everts edges better than other stitches, helps close large area of dead space in a wound
Cons - time consuming, can scar

44
Q

What is the difference in onset and duration of cocaine and tetracaine? Maximum dose?

A

Cocaine - O: 3-5min; D: 30-120min; MD: 200mg

Tetracaine - O: 3-8min; D: 30-60min; MD: 50mg

45
Q

In what instances do topical anesthesia most likely carry the risk of systemic absorption?

A

When applied to denuded skin and in infants

46
Q

What are the present day medical uses of tetracaine drops?

A

For glaucoma testing and removal of corneal foreign bodies

47
Q

What are the OTC uses for lidocaine gel/ointment?

A

Sunburns, insect stings and bites

48
Q

What is EMLA? Common uses?

A

Eutectic mix of lidocaine and prilocaine.
Relieve pain of venipuncture/injections, superficial minor surgery, pretx for infiltration anesthesia, skin graft harvesting

49
Q

How deep does EMLA penetrate? How quickly does it work? Can it be used on mucosal membranes? Precautions?

A

5mm
1hr
Yes! And genitalia!
Don’t apply near the eyes, on broken or inflamed skin, open wounds, more than 2,000 c. cm.

50
Q

What are the cutaneous sxs that may occur in anaphylaxis?

A

Urticaria, pruritus, warmth and redness

51
Q

What are the early s/sxs of anaphylaxis?

A

Sensations of warmth or flushing, itching, lightheadedness, sudden fatigue, and a sense of unease

52
Q

Protocol for treating anaphylaxis?

A
  1. Call 911
  2. Administer Epi 1:1000, 0.3-0.6cc subQ or IM
  3. Begin with lower dosage and repeat 15-30min
  4. Administer oxygen at 15L/min
  5. Administer benadryl 50mg IM
  6. Monitor for EPI toxicity
  7. If attack continues, maintain airway, administer second dose of epi and benadryl
  8. Check vitals - if BP drops, start IV and maintain systolic BP at 90mmHg
  9. Cardiac arrest - give epi at 1:10,000 10cc IV, followed by 50mg IV benadryl
53
Q

Concentrations of Epi in an epi pen and epi pen jr?

A

Epi pen - 0.3ml 1:1000

Epi pen Jr - 0.15ml 1:2000

54
Q

What flow rate of oxygen is generally considered to be safe in a COPD patient?

A

at or below 2L/min

55
Q

What happens if you administer too high of oxygen?

A

Pain with breathing or coughing and oxygen toxicity.

56
Q

What are the three functions of a horizontal mattress suture? What are the risks? When should you remove them?

A

Retention or stay stitch
Helps approximate edges
Helps hemostasis
Removal: at time of surgery as stay suture or a few days after healing has begun
Don’t pull too tightly, can cause hypoxia

Minor Surgery (2 decks)

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