Midterm Flashcards
How long should sutures stay in: the face, the thigh
Face: 3-5 days
High tension areas, eg Thigh: 10-14
Low tension areas: 6-10 days
Trunk: 6-12 days
What suture materials are used internally?
Vicryl or Gut
What sutures are absorbable? Non absorbable?
Absorbable: vicryl, gut
Nonabsorbably: silk, nylon, cotton, etc
What are the different types of nerve blocks? What might they be used for?
Field block, digital block, IV anesthesia, Spinal/ Epidural anesthesia…
When might we use a digital block? What kind of anesthetic would we use?
Toenail removal; Lidocaine with Marcaine (longer lasting anesthetic effect)
What type of anesthetic are marcaine and lidocaine?
amides
When would we use a vertical mattress suture?
closing deep dead spaces (eg. after lipoma/cyst removal)
When would we use other stitches?
Subcutaneous: close deep dead spaces
Vertical mattress: as a stay, and to close dead spaces
Horizontal mattress: as a stay for wounds under tension
What is the most common cause of anaphylaxis during minor surgery procedures?
Accidental injection of anesthetic into central circulation (vein/artery)
What are signs/Sxs of an adverse reaction to anesthetic?
coma, convulsions, syncope, LOC, bradycardia, hypotension etc
Nerve block vs. Field block vs. Infiltration
Field block: uses less anesthesia to get effect, surrounds the area of use
Nerve Block: inject into peripheral nerve roots directly
Infiltration: Inject underneath the area of interest (causes distortion of area and may require more anesthesia to gain desired effect)
What is infiltration? What might it be used for?
Injection at or underneath a lesion to be removed.
What are the major solutions we use for sterile prep?
Betadine, Provoiodine, Hebiclense
NOTE: alcohol not effective, as sterility doesn’t last very long
What is the most important step in creating a sterile field/environment?
GLOVES!
What medications are contraindicated in minor surgery?
MAOI
use caution with antidepressants
What are the best tools for undermining?
dull (iris) scissors, hemostat, use care/caution with pointed scissors
How far do we undermine around a wound?
1/2 the distance of the wound
At what temperature and how long at that temperature is required to sterilize tools?
Autoclaving: 250degF at 15lb/sq.in. for 30 minutes
Dry Sterilization: 450degF for 30 minutes
What kills spores on tools?
quick release/snap (sudden decompression)
What is the progression of pain/numbness with anesthetic?
- pain sensation lost
- cold/warmth sensation
- sense of touch lost
- deep pressure sense lost
- motor fxn lost
What are the pros/cons of using betadine?
Betadine: requires 2 minutes contact to be effective. Some patients may be allergic to components of the product
Is it better to have wound closure with inversion or eversion?
EVERSION
What channel does lidocaine block?
sodium channels
What instruments are in a suture pack?
curved iris or dull scissors needle holder/hemostat forceps (toothed and flat) gauze may have a scalpel handle
Which forcep is best to grab tissue?
toothed
1:100,000 epinephrine is used in:
when mixed with lidocaine for topical anesthesia
1:1000 epinephrine is used in:
Epipens
Adults dose: 0.3ml
Ped. dose: 0.15ml
1:10,000 epinephrine is used in:
in an IM injection for MI
What size needles do we use for drawing up lidocaine?
18g
What size needles do we use for injection of lidocaine?
25g
In what order would you want to draw up anesthetic materials?
Bicarb 1cc, Lidocaine, then Epinephrine 9-10cc
Bicarb, then Lido+Epi, if they’re already mixed
What size scalpel would we want to use most often? (eg: for cutting elliptical areas around a biopsy)
15 blade
What size scalpel would we want to use for lancing boils?
11 scalpel
What size scalpel would we want to use for a shave biopsy?
10
What are the pros/cons of using topical anesthetics?
CONS: can’t apply to deep wounds- may be absorbed systemically
Who (what type of pt) is more prone to infection and why?
Immunocompromised
Does injection do long term damage to the nervous system?
No- there is no evidence to support this
How long does it take Lidocaine and Marcaine to take effect? How long do the effects last?
Lidocaine: onset 1 minute, lasts 45-60 minutes
with Epi: lasts 2-6 hours
Marcaine: onset 5 minutes, lasts 2-4 hours
