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NPLEX botanical > Minor surgery > Flashcards

Minor surgery Flashcards

1
Q

what is the most commonly transmitted infection

A

hep b

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2
Q

disinfect versus sterile

A

Disinfect people: they still have some bugs

sterilize equipment: they don’t have bugs

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3
Q

Autoclave pressure, time and temp

A

15 psi x 15 minutes @ 121 deg Celcius

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4
Q

How to steralize in solution/disinfect in what solution?

A

2% glutarladehyde
Disinfect x 10 minutes
sterilize x 10 hours

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5
Q

how long to boil something to dininfect

A

30 minutes

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6
Q

how long to dry heat to steralize

A

160c/320F x 1 hour

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7
Q

Disinfect a wound/open skin?

A

Normal saline 0.9%

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8
Q

disinfect intact skin

A

10% betatine x 3

0.4% chlorhexidine gluconate

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9
Q

when should you refer a puncture?

A

If any nerve, tendon, joint or penetrates chest or abdommen. Secure and refer if large item.

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10
Q

how should you treat a puncture you don’t refer

A

Clean, debride and leave open with sterile dressing. 3rd intention.

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11
Q

after how many hours should you not suture a wound

A

after 8-12 hours on body

after 24 hours on face

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12
Q

simple vs complex wounds

A

rated on about of tissue loss andd contamination.
Complex: road rash
Simple: cut with kitchen knife

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13
Q

Keyloid healing

A

healing that extends beyond the original area of wound

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14
Q

Hypertrophic healing

A

Normal healing that remains in the original area of wound

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15
Q

What are the stages of healing?

A
  1. Hemostasis: coagulation
  2. Inflammation
  3. proliferation (granulation)
  4. remodeling
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16
Q

what happens stage 1 hemostasis

A

Coagulation and formation of fibrin clot

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17
Q

what happens stage 2: inflammation

A

Begins immediatiely from 1-4 days

  • clot formation triggers complement, with cytokines
  • Neutraphils show up and kill bacteria within 5 hours and last 3-4 days
  • macrophages repair and phagocytize
  • Basal cells show up in 1-2 days to repair wound
  • kerationcytes 1-2 days proliferate
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18
Q

what happens stage 3: proliferation

A

also called granulation, it lasts from 3-21 days

  • granulation tissue around new capilaries and fibroblasts.
  • angiogenesis neurovascularizations
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19
Q

what action brings oxygen and nutrients to the new tissue in stage 3 of healing

A
  • angiogenesis

- neurovascularizations.

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20
Q

what happens stage 4, remodeling of healing

A

3 week - 18 months:

  • 3-4 week = 20-30% strength
  • 1 year = 80%
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21
Q

difference between contraction and contracture of a scar

A

contraction: normal with orientaiton of collagen and myofibroblasts
contracture: abnormal: tight stcar from excessiv contraction.

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22
Q

what are the healing intestions

A

1st: clean wound and suture: <12 hours
2nd: This is when it cant really be closed or cleaned adequately like in road rash and the full thickness is scraped. So its cleaned and covered
3rd: Super contaminated; can be cleaned, and packed with something to make sure its not getting infected. Finally close it 3-4 days later. can only be done it there hasn’t been tissue lost: ie for a cut rather than a scrape

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23
Q

what suture can cause a rail road tract scarring?

A

Simple interupted: it may be hard to get good eversion

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24
Q

what suture is easy to evert under tension?

A

Verticle matress : better cosmetically

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25
Q

what sutue for high tension or fragile skin?

A

Horizontal mattress: IE palms or soles

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26
Q

what sutre requires absorbable suture

A

Deep or burried suturs. this is for large deep wounds

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27
Q

what suture would you use to make invisable sutures

A

subcuticular/transdermal running

Absorbable or not

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28
Q

what suture increases risk of infection

A

COntinuous running: Rapid and non cosmetic

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29
Q

how do you sew a 3 corner flap without strangulatino

A

3 point/half burried

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30
Q

major categories of absorbable suture

A

Natural:
SYnthetic:

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31
Q

what are the natural absorbable sutures

A

Natural

  • Plain cat gut: most likly to cause reaction: 7-10 day 1/2 life
  • chromic cat gut: middle reaction: 2-3 week 1/2 life
  • ( synthetic are less likely to react)
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32
Q

what are the three types of synthetic absorbable sutures

A 
Vicryl: (polygalactic) 2-3 week 1/2 life
- braided
- monofilament
Dexon: (polyglycolic) 2-3 week 1/2 life
- monofilament
PDS: (polydioxanone 4-6 week 1/2 life
- monofilament
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33
Q

what absorbably synthetic last longest, or is braided

A

Lontest duration: PDS: 4-6 weeks

Braided: Vicryl: 2-3 weeks

34
Q

what type of sutures would you do with absorbable sutures?

A

Sub Q:

burried

35
Q

what are the major types of non absorbable surures

A

Natural
- Silk: braided; easy to tie, very very reactive
- Stainless steel: Permanent , little reactivity
- Polyester/polybutester: more reactive
synthetic
- Nylon/ethilon: Monofilament, little reactive, low infx risk
- polypropylene/Prolene: monofilament

36
Q

what non absorbable and absorbable are most reactive:

A

absorbable: normal cat gut

non absorbable: silk

37
Q

what makes steri strips stick better?

A

Benzoin

38
Q

what about staples

A

fast, uncomfortable, low reactivity

Good for scalp wounds

39
Q

How many knots when tying off suture?

A

One more knot than size of suture, smaller 0 means larger sutures and less knots
4-0: 5 knots
5-0: 6 knots
3-0: 4 knots

40
Q

suture for face neck

A

face/neck: 5-0, 6-0: 3-5 days

41
Q

suture for arm and hands

A

arm and hands: 4-0 - 5-0: 7-10 days

42
Q

suture for trunk/legs/feet/scalp

A

trunk/legs/ scalp/trung: 3-0 - 4-0: 7-10 days

43
Q

what is the most common needle for procedures

A

Reversed cutting:

44
Q

what is the needle for cosmetic procedures

A

conventional cutting: cosmetic

45
Q

what needle for bowel, fascia, stuff we would never do?

A

tapered

46
Q

when to use blunt needle?

A

dissect friable tissue: liver, kidney, spleen, cervis

47
Q

what is a dressing

A

Covering that:

  • absorption of drainiage
  • support
  • provides moisture for epithelixaiton
  • limits movement
48
Q

order of dressings?

A 
From wound out:
- non adherent dressing
- gause
- elastic
- tape
- occlusive dressing
AIR
49
Q

how often should wound be redressed

A

Every 2-3 days

50
Q

how long should would be kept dry

A

24-48 hours

51
Q

how to remove sutures

A

Iris sutures
suture scissors
11 scaple

52
Q

what is the most common infection of procetures and when does it happen?

A

S. aureus shows up around 4-10 days after procedure.

53
Q

what do you do when wound gets infected

A

Ipen it up, clean it and allow it to heal with 2nd intention. cover it with bandage

54
Q

what is the problem with hematoma

A

if blood collects following surgery, it can lead to infection and dehiscence in 24-72 hours

55
Q

what is dehiscence

A

wound rupture along inscision after suture has closed

- Resuture withing 48-72 hours, 3 days

56
Q

how do local anesthetics work

A

Non-depolarizing block

Block Na recepturs, preventing depolarization and propigation of pain stimuli.

57
Q

10CC of 1% local anesthetic equals how many mg?

A

Add a zero to the CC if its 1%: so 100mg

them multiply by % so if 1% stays the same, 2% would be 200mg.

58
Q

what is the angle for IM injection

A

90 degrees to reach muscle

59
Q

angle for Sub Q injection

A

30-45 degrees.

60
Q

angle for indradermal injection

A

5-10 degress, just below skin, shallow to make bleb

61
Q

what are the 2 main type of anesthetics

A

Amides: liver metabolized
Esters: peripheral plasma by pseudocholinesterase

62
Q

what are the 3 main amides used

A

Amide: Liver

  • Lidoxaine/xylocaine: 1-10 min/30-60min duration
  • bupivacaine/marcaine: 8-12 min/3-4 hour duration
  • mepivacaine/carbocaine: 8-10 min/2-2.5hour duration
63
Q

what anesthetic is used for digit block

A

Bupivacaine/marcaine: lasts for 3-4 hours and is metabolized in the liver

64
Q

what is max dose of mepivacaine/carbocaine

A

mepivacaine/carbocaine: 5mg/kg of 1%

Do not exceed 400 mg.

65
Q

Max dose of bupivicaine/marcaine

A

Bupivacaine/marcaine: 4mg/kg of 25%

DO NOT exceed 200mg

66
Q

Max dose of lidocaine/xylocaine

A

Lidocance/xylocaine: 10cc of 1% -100g

  • child: 3.3-4.5mg/kg DO NOE exceed 75-100mg (about 10CC)
  • adult: 4.5mg/kg: DO NOT exceed 30CC of 1%: 300mg.
67
Q

what are the esters anesthetic main groups

A

Ester: periphery:

  • topicals
  • infiltrative
68
Q

What are the topical esters

A

Ester: periphery: pseudocholinesterase

  • Benzocaine: 10% needed, poorly absorbed
  • Proparacaine(novacaine): opthalomogest fast <1 min last 15 min
  • Cocaine: ENT procedures, <1min, lasts 1 hours
  • TAC: tetracaine, epinephrine and cocaine: cheap and fast option.
69
Q

what is the cheep and fast topical ester:

A

TAC: tetracaine (ester), epinephrine and cocaine

70
Q

what are the infiltrative esters

A

Ester: periphery
- Procaine/novagaine
allergic reactions are commin, slow onset

71
Q

Anesthetic reactions: toxic

A

Toxic: inject into vein or excessive: acts like CNS depressant causing hypotension, bradycardia or cardiac arrest. Treated with )2

72
Q

Anesthetic reactions allergic/hypersentitive

A

Allergic hypersensitive: ture anaphylaxis is rare: Type 1 after 1st dose

73
Q

anesthetic reaction IV:

A

may occur after frequent exposures:

- treat with benydryl if mild, EPI and O2 if severe

74
Q

what type of anesthetic is most likly to cause reaction

A

esters: peripheral plasma

75
Q

autonomic reaction to anesthetic

A

Looks like allergic:

  • tachycardia, sweating, dizziness, and syncope,
  • Resolves in minutes
76
Q

hot to tell between autonomic and allergic reaction

A

Allergic: Pulse goes up and presssure goes down
automin: pulse goes up and blood pressure goes up

77
Q

why use epinephrine

A

Vasoconstriction

  • reduce bleeding
  • increase duration of anesthetic
  • reduce risk of toxin reaction
78
Q

side effects of epi

A

anxiety, restlessness, tremors, palplitaiton and tachycardia.

79
Q

dose of epi

A

1:200,000 concentration at a max of .2mg

80
Q

what is epi anadote

A

IV puse of Mg + B6 to increase comT metabolism

81
Q

what can you not use epi with?

A

those on MAOI, TCA, Thyroid storm, severe cardiovascular disease

NPLEX botanical (14 decks)

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