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Surgery Ipap > Surgery 2 > Flashcards

Surgery 2 Flashcards

1
Q

Analgesia defintion

And examples

A

Pain relief
W/o loss of consciousness or feeling

Opiods
Volatile anesthetics

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2
Q

Anesthesia definition

A

Loss of physical sensation
W or without loss of consciousness

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3
Q

Adjuncts to anesthesia

A

Dexmedtiomidine

Ketamine

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4
Q

Ideal character of anesthesia
(4)

A

Short latency
Superficial penetration
Non addictive
Completely reversible

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5
Q

Benzos have what properties

A

Amnesia
Anxiolytic

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6
Q

What is a depolarizing muscle relaxant

A

Succinylcholine

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7
Q

What drugs can alter level of consciousness

A

Propanolol
Etomidate

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8
Q

What happens when NA channels are blocked

A

Impairs propagation

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9
Q

What type of nerve fibers are more easily blocked

A

Thin nerve fibers

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10
Q

How does bicarbonate help

A

Buffer to decrease the sting of non ionized particles

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11
Q

What does alkalinity do to local tissues

A

Decreases ionization which = greater effect on local tissue

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12
Q

MC local anesthesia in general surgery

A

Amides

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13
Q

Time of action for :

Lidocaine

Bupivacaine

A

Rapid 60-120 mins

Slow 20 mins to 8 hours

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14
Q

What does the mix of lidocaine and bupivacaine do

A

Rapid action that lasts

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15
Q

What are advantages for adding epi

A

Vasoconstriction causes increased duration of action
Decreases bleed
Decreases volume req’d for anesthesia

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16
Q

What are disadvantages to adding epi

A

Increaed myocardial activity
Tachy
HTN
Dysmenorrhea

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17
Q

Best benefit of epinephrine adjunct

A

Stasis

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18
Q

Greatest benefit of epi adjunct

A

Stasis ]

And prolonged duration of action

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19
Q

What patients should you avoid epi in

A

Known cardiac dz
DM
HYPERTHYROID
Distal body tissue (fingers, toes, penis, ears, nose)

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20
Q

Examples of hypersensitive reactions

A

Urticaria
Erythema
Edema
Dermatitis

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21
Q

Describe a hypersensitive reaction

A

IgE
Type 1
Within 1 hour of meds

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22
Q

Mgmt of hypersensitive reaction

A

02
Epi
Fluids
AH
Steroids

cover ABCs

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23
Q

Mc prodrome of toxicity

A

Metallic taste in mouth

Tinnitus
Light head
Dizzy
Numb mouth and tongue

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24
Q

Cardiac effects from toxicity

A

HTN to HYPOTN
Tachy or Brady
Vfib
Cardio Collapse

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25
Q

Severe CNS effects

A

Tonic clonic activity ]
Unconscious duration increase

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26
Q

What is the best way to avoid intravascular injury from injection

A

Aspirate

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27
Q

Max dose of lidocaine

With epi?

A

4mg kg or 300mg

500mg

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28
Q

1% of lidocaine = how many mg?

A

10

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29
Q

Onset and duration of lidocaine

A

2-5 mins

1/2 hr - 2 hours

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30
Q

Bupivicaine can not be used in what age group

A

Less than 12 yrs

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31
Q

Max dose of bupivacine

A

2mg/kg or 100mg

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32
Q

Onset and duration of bupivacaine

A

5-10mins

2-4 hours

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33
Q

Mgmt for toxicity
Persisting seizure
HYPOTN
Txt arrhythmia

A

STOP

BZD - seizure

HYPOTN = IV fluids

Arrythmia = ACLs

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34
Q

When is malignant hyperthermia mc

A

Volatile agents and succinylcholine

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35
Q

What is happening in malignant hyperthermia

TXM

A

Ionized ca increase
Hypermetaobold = fever tetany hyperK

TXM = bicarbonate and dantrolene

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36
Q

Best way to prevent toxicity

A

Combine small amounts

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37
Q

Ways to administer local anesthetic

A

Longer small needs

Bend @ 45 degrees

Avoid intravascular injection

Injection with withdrawal

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38
Q

What type of tissue can benefit from a bended needle

A

Sub Q

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39
Q

Sequence of clinical analgesia

A

Vasodilation = loss of sympathetic tone (locally)
Loss of pain and temperature
Loss of pressure sedation
Loss of motor function

40
Q

What type of procedure could benefit from peripheral nerve blocks

A

Rib

Digital

41
Q

What does aseptic technique do

A

Prevent deep join surface infection

42
Q

Where do you adisntyer a central nerve spinal block

A

Lower abd
Admin anesthesia / anesthetic (subarachnoid space)

43
Q

Best position for spinal block

A

Recumbent position

44
Q

What sxs is common post spinal block

A

HA

45
Q

TXM options for post spinal block

A

Conservative

Epidural blood patch

46
Q

Subarachnoid space spinal block will induce what type of block

A

Sympathetic
Sensory
Motor

47
Q

Epidural block requires what

A

Continuous infusion

48
Q

What does an epidural injection block

Good for where

A

Sensory
Motor function

Rib fx

49
Q

3 complications of epidural blocks

A

HYPOTN : pressors and IV Fluid
High spinal injury : Brady respiratory distress
Cauda equina : epidural hematoma

50
Q

3 later complication from an epidural nerve block

A

Urinary retention
Spinal HA
Epidural hematoma

51
Q

What is the recommendation for anesthesia if pt on anticoags

A

General endotracheal anesthesia

52
Q

What can drugs can depress LOC

A

Benzo’s and Narcotics (propofol)

53
Q

BENZO’s can provide what

A

Antegrade amnesia

54
Q

Propofol is good in what

A

TBI’s

55
Q

Propofol characteristics

A

Hydrophobic
Needs lipid emulsion

Induction and Mx
Turn on and off fast
Liver clearance
Central action

56
Q

What ASA class is okay for broad anesthetics

A

1 and 2

57
Q

Narc reversal and BZD reversal

A

Naloxone

Flumazenil

58
Q

When is the most critical time for assessment in general anesthesia

A

Under and OUT

59
Q

What are you concerned for when a pt foes under general anesthesia

A

Gag
Airway
Aspiration

60
Q

What tests are important pre op for general anesthesia

A

EKGs
CXR
PFTs

61
Q

2 keys to intraoptive management

A

Induce the anesthesia
Mx the airway

62
Q

What two points need to be protected in general anesthesia

A

Eyes and pressure points

63
Q

What should you try to prevent with general anesthesia

A

Hypothermia

64
Q

3 complications of general anesthesia

A

Hypoxemic cardiac events
Aspiration
Nerve injury

65
Q

What pts are okay for discharge post op

RUSVAN

A

Stable for 30 mins
Vital good
Respire and oriented
AMBULATORY
Not in pain or nauseous
UOP good (1000mL; if not catheter)

66
Q

Which has a more intense reaction natural fibers or synthetic material

A

Natural fibers

67
Q

Two types of material common in sutures

A

Braided and monofilament

68
Q

What type of suture material has the most increased risk of infection

A

Braided

69
Q

Types of absorbable sutures

GMV

A

Gut (mono = inside)
Monocry (mono = to close)
Vicry (Multi)

70
Q

Non absorbable suture types

EPS

A

Ethilon
Prolene
Silk (multi)

71
Q

What is the largest size of suture

A

0-0

72
Q

Characteristics of braided material

A

Stands together
Holds well
Most pliable

~ Does harbor bacteria ~

73
Q

Character of monofilament

A

Smooth stiff

Good for wound infection

Hard to tie

74
Q

What tool type is designed to obtain a perpendicular angle when attempting to penetrate skin for suture closure

A

Needle driver

75
Q

Adsons refers to what

A

Outside the body = better traction

76
Q

Debakeys refers to what

A

Inside the Body length may vary

Hold like a pencil

AVOID OUTSIDE SKIN

77
Q

Insert perpendicular to the skin and wrist with pronation so that you can have what

A

90 degree insertion
Sufficient depth

78
Q

Recommend number of drives to take with suture closure

A

2

79
Q

How should the wound look at closure

A

Everted

80
Q

Simple interrupted

A

Good for inflammation 7-10 days then remove
5 days for the face

81
Q

Large lacerations should get what kind of mattress

A

Horizontal

Reduces the tension over the wound

82
Q

Running suture is done commonly with what kind of material

A

Monocryl

83
Q

5 procedures that can require simple suture

A

Lipoma
EIC
Pilar
Ingrown toe nail
Nevi moles / skin tags

84
Q

All specimens collected in or should go where

A

Pathology for histology

85
Q

What size scalpel is best for punctures or cuts

A

11

86
Q

What is a good anesthetic combo for subq operative mamangemt

A

Lidocaine : Marcian

1:1

87
Q

What is the correct order for cutting along the skin

A

With langerhan lines

Ext surfaces = longitudinal (outside knee)

Flex surface = transverse (inside elbow)

88
Q

Minor bleed control management
Severe
Alternate

A

Minor = cauterize

Severe = figure 8 stitch

Alt= hemostat

89
Q

All sponges should be what

A

Radiopaque

90
Q

Staples character

A

High tensile strength
Pulsatile quick
Infection low and scar high

91
Q

Recommended site follow up time

A

7-10 days

92
Q

What can be helpful when removing sutures or staples

A

Water soak

Hemostat

93
Q

Should you close infected wounds?

A

NO!

94
Q

What is a good technique for wound infection management

A

Wet Dry and r2 daily
Only gauze use!

95
Q

What can be used for severe wound infection

A

Vacuum over wound
Black sponge
Material cut to wound and placed on top

Air tight dressing (Lilly pad)
Puls out exudate 125mmHg

Beeps if there is air

96
Q

Granulation tissue overgrowth can be treated with what

A

Silver nitrate on a flat surface

Surgery Ipap (3 decks)

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