Minor surgery Flashcards
what is the most commonly transmitted infection
hep b
disinfect versus sterile
Disinfect people: they still have some bugs
sterilize equipment: they don’t have bugs
Autoclave pressure, time and temp
15 psi x 15 minutes @ 121 deg Celcius
How to steralize in solution/disinfect in what solution?
2% glutarladehyde
Disinfect x 10 minutes
sterilize x 10 hours
how long to boil something to dininfect
30 minutes
how long to dry heat to steralize
160c/320F x 1 hour
Disinfect a wound/open skin?
Normal saline 0.9%
disinfect intact skin
10% betatine x 3
0.4% chlorhexidine gluconate
when should you refer a puncture?
If any nerve, tendon, joint or penetrates chest or abdommen. Secure and refer if large item.
how should you treat a puncture you don’t refer
Clean, debride and leave open with sterile dressing. 3rd intention.
after how many hours should you not suture a wound
after 8-12 hours on body
after 24 hours on face
simple vs complex wounds
rated on about of tissue loss andd contamination.
Complex: road rash
Simple: cut with kitchen knife
Keyloid healing
healing that extends beyond the original area of wound
Hypertrophic healing
Normal healing that remains in the original area of wound
What are the stages of healing?
- Hemostasis: coagulation
- Inflammation
- proliferation (granulation)
- remodeling
what happens stage 1 hemostasis
Coagulation and formation of fibrin clot
what happens stage 2: inflammation
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
what happens stage 3: proliferation
also called granulation, it lasts from 3-21 days
- granulation tissue around new capilaries and fibroblasts.
- angiogenesis neurovascularizations
what action brings oxygen and nutrients to the new tissue in stage 3 of healing
- angiogenesis
- neurovascularizations.
what happens stage 4, remodeling of healing
3 week - 18 months:
- 3-4 week = 20-30% strength
- 1 year = 80%
difference between contraction and contracture of a scar
contraction: normal with orientaiton of collagen and myofibroblasts
contracture: abnormal: tight stcar from excessiv contraction.
what are the healing intestions
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
what suture can cause a rail road tract scarring?
Simple interupted: it may be hard to get good eversion
what suture is easy to evert under tension?
Verticle matress : better cosmetically
what sutue for high tension or fragile skin?
Horizontal mattress: IE palms or soles
what sutre requires absorbable suture
Deep or burried suturs. this is for large deep wounds
what suture would you use to make invisable sutures
subcuticular/transdermal running
Absorbable or not
what suture increases risk of infection
COntinuous running: Rapid and non cosmetic
how do you sew a 3 corner flap without strangulatino
3 point/half burried
major categories of absorbable suture
Natural:
SYnthetic:
what are the natural absorbable sutures
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)
what are the three types of synthetic absorbable sutures
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
what absorbably synthetic last longest, or is braided
Lontest duration: PDS: 4-6 weeks
Braided: Vicryl: 2-3 weeks
what type of sutures would you do with absorbable sutures?
Sub Q:
burried
what are the major types of non absorbable surures
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
what non absorbable and absorbable are most reactive:
absorbable: normal cat gut
non absorbable: silk
what makes steri strips stick better?
Benzoin
what about staples
fast, uncomfortable, low reactivity
Good for scalp wounds
How many knots when tying off suture?
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
suture for face neck
face/neck: 5-0, 6-0: 3-5 days
suture for arm and hands
arm and hands: 4-0 - 5-0: 7-10 days
suture for trunk/legs/feet/scalp
trunk/legs/ scalp/trung: 3-0 - 4-0: 7-10 days
what is the most common needle for procedures
Reversed cutting:
what is the needle for cosmetic procedures
conventional cutting: cosmetic
what needle for bowel, fascia, stuff we would never do?
tapered
when to use blunt needle?
dissect friable tissue: liver, kidney, spleen, cervis
what is a dressing
Covering that:
- absorption of drainiage
- support
- provides moisture for epithelixaiton
- limits movement
order of dressings?
From wound out: - non adherent dressing - gause - elastic - tape - occlusive dressing AIR
how often should wound be redressed
Every 2-3 days
how long should would be kept dry
24-48 hours
how to remove sutures
Iris sutures
suture scissors
11 scaple
what is the most common infection of procetures and when does it happen?
S. aureus shows up around 4-10 days after procedure.
what do you do when wound gets infected
Ipen it up, clean it and allow it to heal with 2nd intention. cover it with bandage
what is the problem with hematoma
if blood collects following surgery, it can lead to infection and dehiscence in 24-72 hours
what is dehiscence
wound rupture along inscision after suture has closed
- Resuture withing 48-72 hours, 3 days
how do local anesthetics work
Non-depolarizing block
Block Na recepturs, preventing depolarization and propigation of pain stimuli.
10CC of 1% local anesthetic equals how many mg?
Add a zero to the CC if its 1%: so 100mg
them multiply by % so if 1% stays the same, 2% would be 200mg.
what is the angle for IM injection
90 degrees to reach muscle
angle for Sub Q injection
30-45 degrees.
angle for indradermal injection
5-10 degress, just below skin, shallow to make bleb
what are the 2 main type of anesthetics
Amides: liver metabolized
Esters: peripheral plasma by pseudocholinesterase
what are the 3 main amides used
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
what anesthetic is used for digit block
Bupivacaine/marcaine: lasts for 3-4 hours and is metabolized in the liver
what is max dose of mepivacaine/carbocaine
mepivacaine/carbocaine: 5mg/kg of 1%
Do not exceed 400 mg.
Max dose of bupivicaine/marcaine
Bupivacaine/marcaine: 4mg/kg of 25%
DO NOT exceed 200mg
Max dose of lidocaine/xylocaine
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.
what are the esters anesthetic main groups
Ester: periphery:
- topicals
- infiltrative
What are the topical esters
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.
what is the cheep and fast topical ester:
TAC: tetracaine (ester), epinephrine and cocaine
what are the infiltrative esters
Ester: periphery
- Procaine/novagaine
allergic reactions are commin, slow onset
Anesthetic reactions: toxic
Toxic: inject into vein or excessive: acts like CNS depressant causing hypotension, bradycardia or cardiac arrest. Treated with )2
Anesthetic reactions allergic/hypersentitive
Allergic hypersensitive: ture anaphylaxis is rare: Type 1 after 1st dose
anesthetic reaction IV:
may occur after frequent exposures:
- treat with benydryl if mild, EPI and O2 if severe
what type of anesthetic is most likly to cause reaction
esters: peripheral plasma
autonomic reaction to anesthetic
Looks like allergic:
- tachycardia, sweating, dizziness, and syncope,
- Resolves in minutes
hot to tell between autonomic and allergic reaction
Allergic: Pulse goes up and presssure goes down
automin: pulse goes up and blood pressure goes up
why use epinephrine
Vasoconstriction
- reduce bleeding
- increase duration of anesthetic
- reduce risk of toxin reaction
side effects of epi
anxiety, restlessness, tremors, palplitaiton and tachycardia.
dose of epi
1:200,000 concentration at a max of .2mg
what is epi anadote
IV puse of Mg + B6 to increase comT metabolism
what can you not use epi with?
those on MAOI, TCA, Thyroid storm, severe cardiovascular disease
