minor surger brainscape Flashcards
universal precautions (3)
- blood and body fluids of all patients should be consider infections
- barriers and sharps
- Hep B is most commonly transimitted infection
what is the most commonly transmitted infection?
Hep B
autoclave sterilization method
15 PSI @ 121 degrees C for 15 min
Dry heat
320 degrees F for 60 min
boiling
> 30 min
2% glutaraldehyde
- 10 min to disinfect
* 10 hr to sterilize
how is intact skin disinfected?
- 10% betadine three times OR
* 0.4% chlorhexidine gluconate
how are open wounds disinfected?
irrigation with normal saline
name the types of wounds
- puncture
- abrasion
- laceration
when to refer a puncture wound?
when any nerve, tendon, joint, or chest/abdomen involved
what do you do if a large item is involved with a puncture wound?
- leave item
- stabilize
- secure and refer
normal procedures with a managable puncture wound
- clean
- debride
- leave open with sterile dressings
- consider tetanus shot
normal procedures with abrasions
- clean
- debride
- dress
time frames when not to suture a laceration
- 8-12 hours on body
* 24 hours on face
what is a keloid scar?
scarring that occurs beyond area of wound
name the stages of healing?
- hemostasis
- inflammation
- proliferation
- remodeling
characteristics of hemostasis
coagulation and formation of fibrin clot
characteristics of healing, time frame
- hemostasis, begins immediately
- inflammation, proceeds from days 1-4
- proliferation days 3-21
- remodeling 3 weeks to 18 months
characteristics of healing, name cellular involvement
- platelets (secrete cytokines)
- neutrophils within 5-6 hours, last 3-4 days to destroy bacteria
- macrophages (inflammation to repair and phagocytize)
- basal cells migrate to wound within 24-48 hours
- keratinocytes proliferate 1-2 days after injury
characteristics of healing, proliferation
- post hemostasis, inflammation
- days 3-21
- granulation tissue = new capillaries + fibroblasts
characteristics of healing, remodeling
- 30-40% strength at 3 weeks
* 80% at 1 year
what is contracture in regards to healing?
abnormal formation of tight scar due to excessive contraction.
suture type: difficult to evert skin, “railroad track”
simple interrupted
suture type: better to evert skin and cosmesis
vertical mattress
suture type used for larger deeper wounds
deep / buried
suture type with high risk of infection
continuous running
absorbable sutures reactivity
plain catgut > chromic catgut > synthetic sutures
half life of plain catgut
7-10 day
suture types with 2-3 week half life
- chromic catgut
- polyglactic/vicryl
- polyglycolic/dexon
suture with longest half life
- 4-6 weeks
* polydioxanone/PDS
remove sutures on face / neck after
3-5 days
remove sutures on arm / hands after
7-10 days
remove sutures on trunk / legs after
7-14 days
remove sutures on feet / scalp after
7-14 days
10 cc of 1% = ___ mg
100 mg
1 cc of 1% = ___ mg
10 mg
metabolizes amide anesthetics
liver
amide anesthetics
- lidocaine
- bupivacaine
- mepivacaine
onset and duration of lidocaine
- 1-10 min onset
* 30-60 min duration
max dose for lidocaine
- child 3.3-4.5 mg/kg max 75-110 mg
* adult 4.5 mg/kg max 300 mg
onset and duration bupivacaine
- 8-12 min onset
* 3-4 hour duration
onset and duration of mepivacaine
- 8-12 min onset
* 2-2.5 hour duration
metabolizes ester anesthetics
peripheral plasma
topical esters
- benzocaine
- proparacaine
- cocaine
- tetracaine
infiltrative esters
procaine / novocaine
toxic adverse reactions of anesthetics
CNS depressant > hypotension > bradycardia > cardiac arrest
TX for toxic amounts of anesthetic
O2
adverse reactions are more common in type of anesthetics
esters
- benzocaine
- proparacaine
- cocaine
- tetracaine
- procaine/novocaine
why use epinephrine?
- decrease oozing/bleeding
- prolongs duration / decreases absorption
- risk toxic reaction
dose of epinephrine
1 : 200,000, max of 0.2 mg
antidote to epinephrine
Magnesium and B6 to push COMT metabolism
never use epinephrine with
- end-arteries
- MAOi
- TCAs
- thyrotoxicosis
- severe CVD
minor surgery procedures NDS cannot perform
- locations: eyes, nose, axilla, groin, neck
- large size / blood supply
- depth
- young children
- patient taking anti-coagulant or bleeding d/o
- pulsating lesion
- keloid formers
- immunocompromised
blade used in excisional biopsy
15
length ratio in excisional biopsy
3 to 1
degree angle of ends of excisional biopsy`
30 degrees
space necessary for punch biopsy
1-2mm beyond border
blunt dissection, excision, trimming
- # 15
- # 10 for thick skin
- metzenbaum for blunt dissection
puncture abcess and stabbing
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