Surg Block 2 (No Foot Notes) Flashcards by brandon lovin

By definition, sutures are a ?

How are these categorized?

Foreign body

Material
Configuration
Strength
Absorbability Degradation

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

How are suture strengths annotated?

Natural>synthetic

#-0
Larger number, smaller diameter

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What does suture configuration mean?

What type of configuration has a higher risk of infection?

Single or multiple filaments

Braided

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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?

Mono- 5
Multi- 3

Knot

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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?

Cutting

Tapered/round

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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

Swaged

Double armed
Anastomose vessel/bowel

Absorbable
Non-absorbable
Braided
Monofilament

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What are the 3 types of absorbable suture?

What are the 3 types of non-absorbable sutures?

Gut- monofilament
Monocryl- monofilament
Vicryl- multifilament

Ethilon- monofilament
Prolene- monofilament
Silk- multifilament

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What is a pro and con of braided suture material

What is a pro and con of monofilament suture material?

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

Harder to tie/hold knots
Less wound infections

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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?

Needle driver, first joint

50-75% past the tip, perpendicular to driver

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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 ?

Adsons

Debakeys

Pencil

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Define Extrinisic tension

Tension is inversely proportional to ?

Force that pulls wounds apart

Suture spacing, more bites= less tension

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Where are basic laceration sutures started?

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

1cm from edge x 2 drives

Evert

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4 ‘Do’s’ of suturing technique

What are 6 ‘don’ts’ of suturing

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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When are simple interrupted sutures used

How long are these sutures left in place?

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

7-10days
5 days if on face

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When are horizontal mattress sutures used and for how long?

When are vertical mattress sutures used?

Larger lacerations
Leave x 7-10 days

Laceration that poorly evert

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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?

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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When are subcuticular sutures used

How are these closed?

Deeper tissues to prevent hematoma/seroma formation

Absorbable suture

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Why is caution used when excising limited lipomas?

Define Epidermal Inclusion Cysts and why these ca be so resistant

Usually larger than appear w/ possible vasculature

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

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Define Pilar Cyst

When are 10, 15 or 11 blades used

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

How are dog ears avoided?

Longitudinally
Flexor surface of joint- close transversely

Excise as ellipse four times longer than width

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What is the usual medication ratio used for site anesthetization?

Why are these ones selected?

1 : 1 Lidocaine/Marcaine

Lidocaine- faster onset
Marcine- lasts longer

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What are the three benefits of using staples for closure?

What is the down side to this closure method?

Very high tensile strength
Quickly placed
Infection resistant

More permanent scar is left

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

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

Adsons or hemostat

Microfilaments can act as foreign body

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When is silver nitrate used in would closing?

What effect does this cause?

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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Local anesthetics are normally weak acids between ? How do most work?

5.5-6 Block Na Impair propagation of action potential

What types of nerves are more easily blocked by local anesthetics? Do not place local anesthetics into ? tissue?

Thinner/myelinated Infected tissue, inc acidity

Local amides are classified into ? and ? Which one is the MC used local anesthetic in GenSurg and how can this category be identified?

Amides- metabolized by liver Esters- metabolized by plasma cholinesterase into PABA, allergen Amides- have 'i' before '-caine'

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

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

What are the MC adverse effects of local anesthetic use? How are these adverse effects Tx

Dermatitis Urticaria Edema Erythema Steroid Antihistamine Fluid Epi O2

What are the prodromal Sxs of local anesthetic toxicity What are the Sxs of CV toxicity?

Metallic taste Circumorla numbness Light headed Tinnitus HTN to HOTN Tachy/brady arrhythmias V-fib leading to collapse

What are the Sxs of severe local anesthetic toxicity? How is toxicity due to anesthetic injections avoided?

Tonic clonic activity AMS Avoid intravascular injections Aspirate prior to injecting

Max doses for Lidocaine w/ or w/out Epi How much Epi is in 1% or 2% Lidocaine? What is Lidocaines onset and duration?

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

Bupivacaine is not for PTs under ? age? What is its max dose? What is the onset? What is the duration?

<12y/o 2mg/kg, 100mg 5-10min 2-4hrs

How is anesthetic toxicity managed?

D/c anesthetic Hyperventilate to dec pCO2, Benzos for seizures CV Sxs: IV fluids for HOTN Shock wide arrhythmias, Drugs for narrow arrhythmias

What type of drugs are more likely to induce malignant hyperthermia? How does this present? How is it Tx?

Volatile, Succinylcholine Hypermetabolism causing fever, tetany, HyperK Cooling blankets, BiCarb, Dantrolene

What is the sequence of loss after administering clinical anesthesia? When is the use of peripheral nerve blocks preferred?

Sympathetic tone- dilation Pain/temp Pressure Motor ``` Rib blocks Digital blocks (plantar/palmar aspects) ```

Central nerve blocks administer ? drugs and are injected into ? This form of nerve block is used for ? procedures

Anesthetic Narcotic +/-Epie Subarachnoid space, CSF Abdominal LE GU Gyn

Central nerve blocks inhibit ? sensations What is the MC complication?

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

Epidural anesthesia is done by injecting drugs into ? This type of nerve block requires ? What type of sensation does this inhibit?

Epidural spaces Continuous infusions Larger volume of anesthetic Sensory, not motor

Epidural anesthesia is good for ? type of injuries? What are the acute complications from central nerve blocks?

Rib Fxs ``` Neurogenic shock (HOTN) Tx w/ pressors/fluid ```

What are the complications that can arise from high spinal central nerve blocks? How does Cauda Equina Syndrome present?

Bradycardia HOTN Arm tingling Respiratory distress- ventilate, IV Naloxone Bowel/bladder dysfunction Motor/sensory change in legs

What part of the spine innervates the diaphragm? What is the MC later complication to arise from central nerve blocks?

C3-5 Urinary retention

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

Anti-coagulated Loss of neuro function below infusion site Endotracheal

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

Analgesia Anxiolysis Benzo or Propofol + Narcotic

Why is conscious sedation preferred? What are the 3 goals of general anesthesia

PT maintains own airway, responds to stimuli Antegrade amnesia Pain control Amnesia Muscle relaxation

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?

Antacids Sellick maneuver

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?

``` Out of bed x 30min/ambulatory Stable VS ANO Controlled pain/nausea PO intake and voiding ``` X-ray and wand

What post-op complications can occur within 0-48hrs? What can occur 48hrs-30 days later?

``` Resp/Cardio: Failure to maintain ventilation Aspiration Sudden cardiac event HOTN ``` UTI/Pneumonia SIRS MODS

What post-op complication is one of the MC of general anesthesia? How can this be reduced/prevented in the pre-op setting?

Atelectasis Cessation 2wks piror

How does pneumonia present in post-op setting How does it appear on CXR if it's early/late How is it Tx

Fever Tachy +cough ``` Early= infiltrate Late= consolidation ``` ABX/Pulm toilet Intubate/ventilate w/ goal of PCO2 35-45 and O2>95%

How is VAP prevented? How is aspiration pneumonia avoided?

HOB at 30-45* Daily liberation trials PUD/DVT prophylaxis PO hygiene NPO x 6hrs prior NG decompression Cricoid pressure to avoid insufflating stomach

How is aspiration pneumonia managed? How is pulmonary edema managed?

Bronchoscopy w/ suction Bronchial hygiene ABX Mechanical ventilation Sit up Diuretics PRN

ARDS can be AKA ? and resembles ? How is ARDS different? How is it Tx?

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

Why are central lines placed? What are the complications that can occur?

Administer caustic agents (TPN, ABX, Blood) Monitor hemodynamics Longer term placement Ptx Arterial injury Tamponade Infection

Well's Criteria

Sxs of DVT No other Dx explains Sxs Tachy Immobile DVT/PE Hx Hemoptysis Ca >6- high probability 2-6: mod <2: low

What will be seen on PE of PE What images are ordered

O2 <95 Hypoxemia/Hypocarbia CXR Spiral CT VQ if pregnant/renal failure Pulm arteriogram- Dx and Thx bu invasive, reqs central line

How are PEs Tx w/ anticoags? What is used it PTs are c/i to receiving PO anticoagulation?

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

How can surgically induced ileus be avoided? How are GI bleeds mitigated?

Pre-op Entereg (Alvimopan) PPI/H2 blockers

What ABX are most likely to cause C Diff When is this Dx considered? How is it Tx?

Clina Cephalosporins Floroquinolones >3 loose stools/24hrs PO Vanc/Metronidazole

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

Pre renal dehydration/hypovolemia IV contrast ABX and diuretics Alpha blockers

What is the MC complication of bladder catheterization ? procedures can damage peripheral nerves and cause neurological issues

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

DIC is initially a ? problem that progresses into ? How is it Tx

Prothrombotic Consuption of all coagulation proteins FFP

Why does HypoCa occur after blood transfusions How is Transfusion Related Acute Lung Injury Tx

Ca binds to citrate D/c transfusion, support respiratory care No diuretics

What is the lethal triad? How are large hematoma/seromas Tx

Metabolic acidosis Coagulopathy Hypothermia Aspirate/open decompression

How does early/late fascial dehiscence present? How are surgical site infections Tx

Early: Salmon colored fluid Late: incisional hernia Open Irrigate Pack Do not reclose

Late sign of Compartment Syndrome How are decubitus ulcers Tx

Loss of function/pulse Incise/darin Debride necrotic tissue

How is a fever worked up? What cultures are ordered?

Wind: atelectasis, pneumonia Water: UTI Wound: SSI BUS: blood urine sputum

What causes parotiditis What causes epistaxis What causes ototoxicity

Inadequate PO hygiene Dehydration Unhumidified O2 Aminoglycosides Vanc

What is used for anaphylaxis Tx What are the top 3 causes of nosocomial infections

Epi Diphenhydramine Steroids SSI C Dif Catheter UTi

Define ICU death spiral

SIRS: two or more of- Temp >101.5, Tachy/Tachy, Leukocytosis Sepsis w/ SIRS source Septic shock- end organ failure/MODS Death