Minor Surgery Flashcards
Most common transmitted infection in workplace
Hepatitis B
Different between disinfecting and sterilizing and how to do each.
Disinfecting: done for PEOPLE. Use 2% glutaraldehyde for 10 minutes.
Sterilization: done for TOOLS and SURFACES. Use 2% glutaraldehyde for 10 hours.
Other options for skin:
Intact skin: 10% betadine, 3x, circular motion, wait 7m
Open wound: irrigate w normal saline (0.9%) DONT USE hydrogen peroxide (slows healing)
Other options for tools:
Boil tools for > 30 minutes
Dry heat: 160 C / 320 F for 1 hour
Autoclave: 15psi @ 121 C for 15 minutes ** most efficient and reliable
Types of wounds and how to deal with each
Puncture: if deep or possibility of nerve, tendon damage- secure item which has punctured them, refer
Abrasions: clean, debride, dress
Lacerations: Suture. BUT don’t suture wounds older than 8-12h (or 24h on the face)
What is the difference between a hypertrophic scar and a keloid?
A keloid scar- the tissue extends beyond the original area of the wound
Healing stages
Coagulation: formation of a fibrin clot
Inflammation: days 1-4; PMNs, Pos, basal cells and keratinocytes
Proliferation/granulation: 3-21 days, angiogenesis
Remodeling: 3 weeks- 6 months
Primary, secondary, tertiary intention
Primary: clean straight cut, sutured immediately
Secondary: strangely shaped cut, not easy to approximate, left open to heal on its own
Third: very strange or dirty wound, can’t suture safely or possibility of infection. left open for 3-5 days to drain and then fixed
Suture types
Simple interrupted: may cause railroad track scars, eversion is difficult
Vertical mattress: easy to evert edges under tension. used for cosmesis
Horizontal mattress: high tension wounds, fragile tissue. palms or soles of the feet.
Deep/buried, subQ: requires absorbable sutures
Continous/running: rapid, non cometic, less secure. HIGH risk of infection. Avoid.
3 point/half buried: triangular flaps
Suture materials- absorbable
Natural: digested by body enzymes
- plain catgut: 7-10 day half-life, tissue reactivity (allergic reaction possible)
- chromic catgut: chromic salt delays absorption, 2-3 week half life, less reactive
Synthetic: hydrolyzed by the body
- Polyglactic/Vicryl: braided and monofilament, 2-3 week half life
- Polyglycolic acid/Dexon: monofilament, 2-3 weeks
- Polydioxane/PDS: monofilament, 4-6 weeks
Allergic reaction potential:
Plain catgut > chromic catgut > synthesis
synthetic sutures ALWAYS better in someone with allergies
Suture materials- non absorbable
Natural
Silk: reactive
Stainless steel: not reactive
Polyester: reactive
Synthetic:
Nylon/Ethilon: low risk of infection, low reactivity, but knots may slip
Polypropylene/Prolene: similar to Nylon
Others:
Steri-strips (don’t encircle digits, can strangulate. Apply with Benzoin)
Staples: fast, low risk of infection but uncomfortable
synthetic sutures ALWAYS better in someone with allergies
Sutures- timing of removal
** Always use one more knot than the gauge of the suture**
Face/neck: 5.0-6.0, remove after 3-5 days
Arms/hands: 4.0-5.0, remove after 7-10 days
Scalp, trunk, feet, legs: 3.0-4.0, remove 7-14 days
Needles-types
Conventional cutting: cosmesis
Reverse cutting: mc, what we use
Tapered: pierces and spreads without cutting, used in connective tissue (muscle, fascia, bowel)
Blunt: dissect friable tissue instead of cutting; organs (liver, kidney, spleen, cervix)
Dressings; best and worse
Best dressings to use when trying to bandage something sterilized
Non-adherent > gauze > elastic > tape > occlusive
Post-op instructions
Keep wound/dressing dry for 24-48 hours. Redress every 2-3 days. Remove sutures with suture scissors (second best: iris scissors) or an #11 scalpel with knots PULLED ACROSS (to limit the pulling of dirty thread through a wound; test question).
MOA of local anesthetics?
Block Na+ reuptake to prevent depolarization and propagation of pain stimuli. Called a non-depol block.
Converting between cc and mg
1cc of 1% lidocaine = 10mg
10cc of 1% lidocaine= 100mg
10cc of 2% lidocaine = 200 mg
etc
Angles of IM, SQ and ID injections
IM: 90 degrees
SQ: 30-45 degrees
ID: 5-10 degrees
Amide anesthetics
LIDOCAINE=LIVER=LESS REACTIVE
Metabolized in the liver by microsomal enzymes. Allergies to them are rare. Lidocaine, EMLA, xylocaine.
Lidocaine/xylocaine: 1-10m onset and 30-60m duration
10cc of 1%=100mg
MAX child: 3.3-4.5mg/kg, not over 75-110mg total
MAX adult: 4.5mg/kg, not over 30ccs of 1% (300mg)
*drowsiness
Bupivacaine/Marcaine: 8-12m onset, 3-4h duration
MAX adult: 4mg/kg of 0.25%, not over 200mg
Mepivacaine/Carbocaine: 8-12m onset, 2h duration
less drowsiness than lidocaine
MAX adult: 5mg/kg of 1% not over 400mg
Ester anesthetics
PROCAINE=PERIPHERAL PLASMA=PROBABLY ALLERGENIC
Metabolized in the peripheral plasma by pseudocholinesterase (has to go into the entire body before its broken down). Allergies COMMON.
Topical
Benzocaine: poor absorption, need >10%
Proparacaine: eye surgery
Cocaine: ENT procedures, 1m onset, 1h duration
TAC: tetracaine, epinephrine, and cocaine. CHEAP+ FAST
Infiltrative:
Procaine/Novocaine: similar to lidocaine, but allergic reactions common. most common ester used
3 types of reactions to anesthetics
Toxic: you inject into a blood vessel instead of IM, SQ or ID. CNS depressant, hypotension, bradycardia. Tx: oxygen
Allergic: Type 1 with first dose, Type IV after several , Tx mild with diphenhydramine, severe with epi and O2. Happens with procaine.
Autonomic: fainting, tachycardia, hypertension. Wait it out.
Epi dosages IM, IV and anesthetic
IM 1:1000
IV 1: 10,000
anesthetic: 1:100,000 or 1:200,000
How do you respond when a pt goes into anaphylaxis
Epi -> call 911 -> 50mg diphenhydramine -> steroids
What procedures can’t NDs do
Location: eyes, nose, axillae, groin, posterior neck Large size and/or blood supply Depth (superficial only) Young children Patient with bleeding ds or on anti-coagulants Pulsating lesions Keloid formers Systemic illness or IC
Tools for minor surgery procedures
Forceps:
Toothed Adson: does not crush skin
Toothless Adson: crushes. Foreign body removal
Scissors:
Iris: fine dissection, don’t cut sutures
Metzenbaum: blunt dissection
Scalpel sizes
#3: disposable, sterile, attached to reusable handle #10: for thick skin #11: puncture abscesses, incisions, stabbing #15: blunt dissection, excision, trimming
Matrixectomy procedure
After removal of the nail, apply 80% phenol for 1-3 minutes followed by neutralization with alcohol. x3.
