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Surg Block 2 (No Foot Notes) Flashcards

1
Q

By definition, sutures are a ?

How are these categorized?

A

Foreign body

Material
Configuration
Strength
Absorbability Degradation

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2
Q

What type of suture fibers cause a more intense inflammatory reaction?

How are suture strengths annotated?

A

Natural>synthetic

#-0
Larger number, smaller diameter
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3
Q

What does suture configuration mean?

What type of configuration has a higher risk of infection?

A

Single or multiple filaments

Braided

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4
Q

What type of filament requires 5 knots to hold skin together but is not as efficient as ? which requires 3 knots?

What type of knot must be used?

A

Mono- 5
Multi- 3

Knot

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5
Q

What type of needle is preferred for suturing skin?

What type of needle is used for delicate tissues inside the body such as bowel or vessels?

A

Cutting

Tapered/round

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6
Q

What type of suture material already has the needle and suture pre-attached?

What type of material has needles at both ends of the suture material?

What are the 4 categories of suture types

A

Swaged

Double armed
Anastomose vessel/bowel

Absorbable
Non-absorbable
Braided
Monofilament

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7
Q

What are the 3 types of absorbable suture?

What are the 3 types of non-absorbable sutures?

A

Gut- monofilament
Monocryl- monofilament
Vicryl- multifilament

Ethilon- monofilament
Prolene- monofilament
Silk- multifilament

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8
Q

What is a pro and con of braided suture material

What is a pro and con of monofilament suture material?

A

Hold knot better d/t pliability
May harbor bacteria in braids

Harder to tie/hold knots
Less wound infections

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9
Q

What is the name of the instrument used for suturing and what part of the finger is used for control?

How much of the suture is loaded?

A

Needle driver, first joint

50-75% past the tip, perpendicular to driver

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10
Q

What is the name of suture forceps used outside of the body?

What is the name of the forceps used inside of the body?

Both are held similarly to a ?

A

Adsons

Debakeys

Pencil

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11
Q

Define Extrinisic tension

Tension is inversely proportional to ?

A

Force that pulls wounds apart

Suture spacing, more bites= less tension

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12
Q

Where are basic laceration sutures started?

Upon completion of the bite, tissue should have ? effect on the edges?

A

1cm from edge x 2 drives

Evert

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13
Q

4 ‘Do’s’ of suturing technique

What are 6 ‘don’ts’ of suturing

A

Load needle 50-75% from tip
Insert 90* 1cm from edge
Avoid dulling needle tip, leave tail
Ensure edge eversion

Load needle too far forward
Push needle through skin
Crush suture materials w/ driver
Grab needle tip to pull suture through
Pull needle all the way through
Let wound edges invert
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14
Q

When are simple interrupted sutures used

How long are these sutures left in place?

A

External closures
Start in middle, divide wound in half for each placement

7-10days
5 days if on face

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15
Q

When are horizontal mattress sutures used and for how long?

When are vertical mattress sutures used?

A

Larger lacerations
Leave x 7-10 days

Laceration that poorly evert

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16
Q

When is the Running Suture used

Why is this method preferred?

What is the name of the last knot in this technique and why is it used?

A

Completed end to end
Tied off at distal end
Used for subcuticular/buried closure

More cosmetic
Holds skin closed

Aberdeen (fishermen) knot- buries entire closure

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17
Q

When are subcuticular sutures used

How are these closed?

A

Deeper tissues to prevent hematoma/seroma formation

Absorbable suture

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18
Q

Why is caution used when excising limited lipomas?

Define Epidermal Inclusion Cysts and why these ca be so resistant

A

Usually larger than appear w/ possible vasculature

Sebaceous cyst, hard lump w/ pore
Recur if wall is not removed

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19
Q

Define Pilar Cyst

When are 10, 15 or 11 blades used

A

EIC on scalp

10- large incisions by cutting w/ hump of blade
15- smaller incisions
11- punctures or cutting sutures for removal, not for long incisions

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20
Q

Wounds should be closed in ? direction across extensor surfaces except for ?

How are dog ears avoided?

A

Longitudinally
Flexor surface of joint- close transversely

Excise as ellipse four times longer than width

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21
Q

What is the usual medication ratio used for site anesthetization?

Why are these ones selected?

A

1 : 1 Lidocaine/Marcaine

Lidocaine- faster onset
Marcine- lasts longer

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22
Q

What are the three benefits of using staples for closure?

What is the down side to this closure method?

A

Very high tensile strength
Quickly placed
Infection resistant

More permanent scar is left

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23
Q

What tool is used to lift sutures off the skin prior to removal?

Why are cover sponges not used for wet/dry dressing changes?

A

Adsons or hemostat

Microfilaments can act as foreign body

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24
Q

When is silver nitrate used in would closing?

What effect does this cause?

A

Minor bleeds or to knock down granulation tissue

Grey/necrosis tissue should not be closed but will slough off, leaves flat space epithelization

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25
Q

Local anesthetics are normally weak acids between ?

How do most work?

A

5.5-6

Block Na
Impair propagation of action potential

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26
Q

What types of nerves are more easily blocked by local anesthetics?

Do not place local anesthetics into ? tissue?

A

Thinner/myelinated

Infected tissue, inc acidity

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27
Q

Local amides are classified into ? and ?

Which one is the MC used local anesthetic in GenSurg and how can this category be identified?

A

Amides- metabolized by liver
Esters- metabolized by plasma cholinesterase into PABA, allergen

Amides- have ‘i’ before ‘-caine’

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28
Q

What are the advantages and disadvantages of adding Epi to local anesthetics?

These combos need to be avoided in ? PT populations?

They also need to be avoided in ? areas of the body

A

Adv: Inc duration of action, Dec bleeding/volume needed for anesthesia
Dis: Inc myocardial activity (Tachy, Hypo, Dysrhythmia)

Cardiac dz HTN DM Hyperthyroid

Tissues supplied by end arteries

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29
Q

What are the MC adverse effects of local anesthetic use?

How are these adverse effects Tx

A

Dermatitis Urticaria Edema Erythema

Steroid Antihistamine Fluid Epi O2

30
Q

What are the prodromal Sxs of local anesthetic toxicity

What are the Sxs of CV toxicity?

A

Metallic taste
Circumorla numbness
Light headed
Tinnitus

HTN to HOTN
Tachy/brady arrhythmias
V-fib leading to collapse

31
Q

What are the Sxs of severe local anesthetic toxicity?

How is toxicity due to anesthetic injections avoided?

A

Tonic clonic activity
AMS

Avoid intravascular injections
Aspirate prior to injecting

32
Q

Max doses for Lidocaine w/ or w/out Epi

How much Epi is in 1% or 2% Lidocaine?

What is Lidocaines onset and duration?

A

W/out Epi: 4mg/kg, max 300mg
W/ Epi: 7mg/kg, max 500mg

1% Lidocaine= 10mg/ml
2% Lidocaine= 20mg/ml

On: 2-5min
Duration: 30-120min

33
Q

Bupivacaine is not for PTs under ? age?

What is its max dose?

What is the onset?

What is the duration?

A

<12y/o

2mg/kg, 100mg

5-10min

2-4hrs

34
Q

How is anesthetic toxicity managed?

A

D/c anesthetic
Hyperventilate to dec pCO2, Benzos for seizures

CV Sxs:
IV fluids for HOTN
Shock wide arrhythmias, Drugs for narrow arrhythmias

35
Q

What type of drugs are more likely to induce malignant hyperthermia?

How does this present?

How is it Tx?

A

Volatile, Succinylcholine

Hypermetabolism causing fever, tetany, HyperK

Cooling blankets, BiCarb, Dantrolene

36
Q

What is the sequence of loss after administering clinical anesthesia?

When is the use of peripheral nerve blocks preferred?

A

Sympathetic tone- dilation
Pain/temp
Pressure
Motor

Rib blocks
Digital blocks (plantar/palmar aspects)
37
Q

Central nerve blocks administer ? drugs and are injected into ?

This form of nerve block is used for ? procedures

A

Anesthetic Narcotic +/-Epie
Subarachnoid space, CSF

Abdominal LE GU Gyn

38
Q

Central nerve blocks inhibit ? sensations

What is the MC complication?

A

Sympathetic Sensory Motor

Post-spinal HA- Tx w/ fluids, caffeine, blood patch

39
Q

Epidural anesthesia is done by injecting drugs into ?

This type of nerve block requires ?

What type of sensation does this inhibit?

A

Epidural spaces

Continuous infusions
Larger volume of anesthetic

Sensory, not motor

40
Q

Epidural anesthesia is good for ? type of injuries?

What are the acute complications from central nerve blocks?

A

Rib Fxs

Neurogenic shock (HOTN)
Tx w/ pressors/fluid
41
Q

What are the complications that can arise from high spinal central nerve blocks?

How does Cauda Equina Syndrome present?

A

Bradycardia HOTN Arm tingling
Respiratory distress- ventilate, IV Naloxone

Bowel/bladder dysfunction
Motor/sensory change in legs

42
Q

What part of the spine innervates the diaphragm?

What is the MC later complication to arise from central nerve blocks?

A

C3-5

Urinary retention

43
Q

Epidural hematomas arising as a later complication from central nerve blocks are suspected in ? PTs

How does it present?

These PTs will be recommended for ? type of anesthesia

A

Anti-coagulated

Loss of neuro function below infusion site

Endotracheal

44
Q

What is conscious sedation used for?

What is usually the combination used for this type of sedation?

A

Analgesia
Anxiolysis

Benzo or Propofol + Narcotic

45
Q

Why is conscious sedation preferred?

What are the 3 goals of general anesthesia

A

PT maintains own airway, responds to stimuli
Antegrade amnesia

Pain control
Amnesia
Muscle relaxation

46
Q

Since most PTs are NPO prior to general anesthesia, what meds may they take PO?

What is the name of the maneuver when applying cricoid pressure when intubating?

A

Antacids

Sellick maneuver

47
Q

What are the PACU goals that need to be met for d/c?

How are retained foreign bodies screened for prior to the PT leaving the OR?

A 
Out of bed x 30min/ambulatory
Stable VS
ANO
Controlled pain/nausea
PO intake and voiding

X-ray and wand

48
Q

What post-op complications can occur within 0-48hrs?

What can occur 48hrs-30 days later?

A 
Resp/Cardio:
Failure to maintain ventilation
Aspiration
Sudden cardiac event
HOTN

UTI/Pneumonia
SIRS
MODS

49
Q

What post-op complication is one of the MC of general anesthesia?

How can this be reduced/prevented in the pre-op setting?

A

Atelectasis

Cessation 2wks piror

50
Q

How does pneumonia present in post-op setting

How does it appear on CXR if it’s early/late

How is it Tx

A

Fever Tachy +cough

Early= infiltrate
Late= consolidation

ABX/Pulm toilet
Intubate/ventilate w/ goal of PCO2 35-45 and O2>95%

51
Q

How is VAP prevented?

How is aspiration pneumonia avoided?

A

HOB at 30-45*
Daily liberation trials
PUD/DVT prophylaxis
PO hygiene

NPO x 6hrs prior
NG decompression
Cricoid pressure to avoid insufflating stomach

52
Q

How is aspiration pneumonia managed?

How is pulmonary edema managed?

A

Bronchoscopy w/ suction
Bronchial hygiene
ABX
Mechanical ventilation

Sit up
Diuretics PRN

53
Q

ARDS can be AKA ? and resembles ?

How is ARDS different?

How is it Tx?

A

Non-cardiogenic pulmonary edema
Pulmonary edema

No response to diuretics

Inc PEEP (10-15cm) to inc functional residual capacity
Lower tidal volumes 5-7ml/kg
FiO2 <60%
Prone position

54
Q

Why are central lines placed?

What are the complications that can occur?

A

Administer caustic agents (TPN, ABX, Blood)
Monitor hemodynamics
Longer term placement

Ptx
Arterial injury
Tamponade
Infection

55
Q

Well’s Criteria

A

Sxs of DVT
No other Dx explains Sxs

Tachy
Immobile

DVT/PE Hx
Hemoptysis
Ca

> 6- high probability
2-6: mod
<2: low

56
Q

What will be seen on PE of PE

What images are ordered

A

O2 <95
Hypoxemia/Hypocarbia

CXR Spiral CT
VQ if pregnant/renal failure
Pulm arteriogram- Dx and Thx bu invasive, reqs central line

57
Q

How are PEs Tx w/ anticoags?

What is used it PTs are c/i to receiving PO anticoagulation?

A

IV Heparin/SQ LMWH
PO Warfarin x 6mon; goal INR 2-3
PO Xa/Direct inhibitors: Digatraban, Fondaparinux

IVC filter

58
Q

How can surgically induced ileus be avoided?

How are GI bleeds mitigated?

A

Pre-op Entereg (Alvimopan)

PPI/H2 blockers

59
Q

What ABX are most likely to cause C Diff

When is this Dx considered?

How is it Tx?

A

Clina Cephalosporins Floroquinolones

> 3 loose stools/24hrs

PO Vanc/Metronidazole

60
Q

What is the first consideration of an oliguric post-op PT

Intra-renal oliguira is considered in PTs that were given ?

How is post-renal oliguria due to BPH Tx

A

Pre renal dehydration/hypovolemia

IV contrast ABX and diuretics

Alpha blockers

61
Q

What is the MC complication of bladder catheterization

? procedures can damage peripheral nerves and cause neurological issues

A

UTI

Hernia repair: ilio-inguinal, skin numbness
Mastectomy: long thoracic nerve, winged scapula
Para/thyroid: recurrent laryngeal, hoarsness
Carotid endarterectomy: hypoglossal nerve, deviated tongue

62
Q

DIC is initially a ? problem that progresses into ?

How is it Tx

A

Prothrombotic
Consuption of all coagulation proteins

FFP

63
Q

Why does HypoCa occur after blood transfusions

How is Transfusion Related Acute Lung Injury Tx

A

Ca binds to citrate

D/c transfusion, support respiratory care
No diuretics

64
Q

What is the lethal triad?

How are large hematoma/seromas Tx

A

Metabolic acidosis
Coagulopathy
Hypothermia

Aspirate/open decompression

65
Q

How does early/late fascial dehiscence present?

How are surgical site infections Tx

A

Early: Salmon colored fluid
Late: incisional hernia

Open Irrigate Pack
Do not reclose

66
Q

Late sign of Compartment Syndrome

How are decubitus ulcers Tx

A

Loss of function/pulse

Incise/darin
Debride necrotic tissue

67
Q

How is a fever worked up?

What cultures are ordered?

A

Wind: atelectasis, pneumonia
Water: UTI
Wound: SSI

BUS: blood urine sputum

68
Q

What causes parotiditis

What causes epistaxis

What causes ototoxicity

A

Inadequate PO hygiene
Dehydration

Unhumidified O2

Aminoglycosides
Vanc

69
Q

What is used for anaphylaxis Tx

What are the top 3 causes of nosocomial infections

A

Epi Diphenhydramine Steroids

SSI
C Dif
Catheter UTi

70
Q

Define ICU death spiral

A

SIRS: two or more of- Temp >101.5, Tachy/Tachy, Leukocytosis

Sepsis w/ SIRS source

Septic shock- end organ failure/MODS

Death

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