Minor Surgery Flashcards
What are universal precautions?
OSHA - things to keep YOU (as provider) protected
MC transmitted infx
Hep B
2% Glutaraldehyde: _____ to disinfect, _____ to sterilize
10 min to disinfect
10 hr to sterilize
How long do you need to boil to sterilize?
> 30 min
Dry heat sterilization
160’C/320’F for 1 hr
Autoclave sterilization
15 PSI at 121’C for 15 min
*most efficient and reliable form of sterilization
You ______ tools, you ______ people
Sterilize tools
Disinfect people
How do you disinfect intact skin?
10% betadine X3
0.4% chlorhexidine gluconate
How do you disinfect an open wound?
irrigate with normal (0.9%) saline
*do NOT use H2O2
Puncture with nerve, tendon, joint involvement or in chest/abdomen
Stabilize (secure large objects) and refer
Something to consider with puncture wounds
Pt last tetanus shot
Do not suture wounds older than
8-12 hr on body or 24 hr on face
Hypertrophic vs. keloid scar
hypertrophic is normal healing
keloid extends beyond the original area of wound
Healing stages
1) Hemostasis (coagulation): fibrin clot
2) Inflammation: immediately (days 1-4), cytokines and complement
3) Proliferation (granulation): 3-21 days, angiogenesis
4) Remodeling: 3wk to 6-18 mp. Contraction (normal) and contracture (abnl)
During inflammation stage of healing: _________ in 5-6 hrs, last 3-4 days to destroy bacterial
Neutrophils
During inflammation stage of healing: _________ transition from inflammation to repair and phagocytize
Macrophages
During inflammation stage of healing: __________ migrate w/in 24-48 hr to repair wound (re-epithelialization)
Basal cells
During inflammation stage of healing: _________ proliferate 1-2 days after injury
New keratinocytes
During remodeling: ____% strength by 3-4 wks, ____% at 1 year
30-40% at 3-4 wk
80-90% at 1 hr
__________ is normal due to myofibroblasts and orientation of collagen
Contraction
________ is abnormal formation of tight scar due to excessive contraction
contracture
Name this healing intention:
cut with kitchen knife - clean, fresh; we can clean and close it up; 8-12 hr
Primary intention
Name this healing intention:
Full thickness (into SubQ), older, leave open and allow to heal by granulation; usu. w/ significant tissue lost or contamination/infection; < 12 hr
Secondary intention
Name this healing intention:
Grossly contaminated wounds without significant tissue loss can be cleaned, packed, covered and left open for 3-5 days - can be sutured after this if not infx; e.g. dog bite
Tertiary (delayed primary) intention
may cause railroad tract scarring, eversion may be difficult
Simple interrupted
easy to evert edges under tension, better for cosmesis
Vertical mattress
suture for high tension wounds and fragile tissue; palms or soles
Horizontal mattress
larger, deeper wounds; requires _____ sutures
absorbable
Deep/buried suture
dermal layer, not visible, eliminates tracts; linear wounds with little tension; can use absorbable or non-absorbable sutures
SubQ/intradermal running
rapid, non-cosmetic, less secure; HIGH risk of infx
Continuous running
triangular flaps without strangulation
3 point/half-buried
Natural sutures are digested by
body enzymes
Plain catgut (suture)
natural, absorbable, some reactivity
T1/2 = 7-10 days
Chromic catgut (suture)
natural, absorbable, less reactivity than plain catgut
chromic salt delays absorption
T1/2 = 2-3 wk
least reactivity of sutures, hydrolyzed, easy to tie
synthetic (vicryl, dexon, PDS)
Polyglactic/vicryl (suture)
synthetic, absorbable, braided and monofilament
T1/2 = 2-3 wk
*braided = stronger BUT incr. chance of infx
Polyglycolic/Dexon (suture)
synthetic, absorbable, monofilament
T1/2 = 2-3 wk
Polydioxanone/PDS (suture)
synthetic, absorbable, monofilament
T1/2 = 4-6 wk
Silk (suture)
natural, non-absorbable, braided, easy to tie
HIGH tissue reactivity
Stainless steel (suture)
natural, non-absorbable, permanent
minimal tissue reactivity
Polyester/Polybutester (suture)
natural, non-absorbable
HIGH tissue reactivity
Nylon/ethilon (suture)
synthetic, non-absorbable, monofilament, slips easily
low tissue reactivity, low risk infx
Polypropylene/prolene (suture)
synthetic, non-absorbable, monofilament, similar to nylon
if using steri-strips, do NOT
encircle digits = tourniquet
______ helos steri-strips stick better
benzoin
wound closure that is fast, low risk of infx, uncomfortable
staples
Face/neck: suture gauge ____, remove after _____
5-0, 6-0
3-5 days
Arm/hands: suture gauge ____, remove after _____
4-0, 5-0
7-10 days
Trunk/legs/feet/scalp: suture gauge ____, remove after _____
3-0, 4-0
7-14 days
needle used for cosmetic procedures
conventional cutting
MC needle use for most minor surgery procedures
reverse cutting**
needle that pierces and spreads without cutting, used in bowel, muscle, and fascia
tapered
needle used to dissect friable tissue instead of cutting; liver, kidney, spleen, cervix
blunt
Post-op: keep wound/dressing dry for ___ hours and limit movement; redress every ___ days.
24-48 hr
2-3 days
Post op: remove sutures with _______ with knots pulled across
iris scissor or #11 scalpel
if dehiscence occurs, re-suture within
48-72 hrs
as long as it’s not infected!
local anesthetics block ____ reuptake to prevent _______ of pain stimuli
Na
depolarization
(called non-depolarization block)
10cc of 1% = ___ mg
100
just add a zero
Amides are metabolized in
liver by microsomal enzymes
True allergies are rare with amides/esters
amides
topical amides
lidocaine and EMLA cream/patch
injectable amides
lidocaine
bupivacaine
mepivacaine
Lidocaine: _____ onset and ____ duration
onset: 1-10 min
duration: 30-60 min
Bupivacaine: _____ onset and ____ duration
onset: 8-12 min
duration: 3-4 hr
Max dose of lidocaine in child
3.3-4.5 mg/kg of 1%, not to exceed 75-110 mg total
Max dose of lidocaine in adult
4.5 mg/kg of 1%, not to exceed 300 mg (30cc) total
Max dose of bupivacaine in adult
4 mg/kg of 0.25%, not to exceed 200 mg
Which anesthetic is used for digit blocks
bupivacaine
bupivacaine SE
heart block
BLOCKS - used for digit block and MAJOR SE of ht block
Mepivacaine: _____ onset and ____ duration
onset: 8-12 min
duration: 2-2.5 hr
*less drowsiness than lidocaine
Max dose of mepivacaine in adult
5 mg/kg of 1%, not to exceed 400 mg
Esters are metabolized in
peripheral plasma by pseudocholinesterase
topical esters
benzocaine
proparacaine
cocaine
TAC (tetracaine + adrenaline/Epi + cocaine)
injectable esters
procaine
topical ester that is poorly absorbed, need at least 10%
benzocaine
topical ester used in ophthalmology, < 1 min onset, 15 min duration
proparacaine
topical ester used in ENT procedures, < 1 min onset, 1 hr duration
cocaine
topical ester that is CHEAP and FAST
TAC (tetracaine + adrenaline/Epi + cocaine)