Surgery 2 Flashcards by lauren hudson

Analgesia defintion

And examples

Pain relief
W/o loss of consciousness or feeling

Opiods
Volatile anesthetics

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Anesthesia definition

Loss of physical sensation
W or without loss of consciousness

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Adjuncts to anesthesia

Dexmedtiomidine

Ketamine

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Ideal character of anesthesia
(4)

Short latency
Superficial penetration
Non addictive
Completely reversible

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Benzos have what properties

Amnesia
Anxiolytic

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What is a depolarizing muscle relaxant

Succinylcholine

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What drugs can alter level of consciousness

Propanolol
Etomidate

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What happens when NA channels are blocked

Impairs propagation

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What type of nerve fibers are more easily blocked

Thin nerve fibers

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How does bicarbonate help

Buffer to decrease the sting of non ionized particles

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What does alkalinity do to local tissues

Decreases ionization which = greater effect on local tissue

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MC local anesthesia in general surgery

Amides

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Time of action for :

Lidocaine

Bupivacaine

Rapid 60-120 mins

Slow 20 mins to 8 hours

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What does the mix of lidocaine and bupivacaine do

Rapid action that lasts

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What are advantages for adding epi

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

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What are disadvantages to adding epi

Increaed myocardial activity
Tachy
HTN
Dysmenorrhea

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Best benefit of epinephrine adjunct

Stasis

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Greatest benefit of epi adjunct

Stasis ]

And prolonged duration of action

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What patients should you avoid epi in

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

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Examples of hypersensitive reactions

Urticaria
Erythema
Edema
Dermatitis

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Describe a hypersensitive reaction

IgE
Type 1
Within 1 hour of meds

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Mgmt of hypersensitive reaction

02
Epi
Fluids
AH
Steroids

cover ABCs

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Mc prodrome of toxicity

Metallic taste in mouth

Tinnitus
Light head
Dizzy
Numb mouth and tongue

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Cardiac effects from toxicity

HTN to HYPOTN
Tachy or Brady
Vfib
Cardio Collapse

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Severe CNS effects

Tonic clonic activity ] Unconscious duration increase

What is the best way to avoid intravascular injury from injection

Aspirate

Max dose of lidocaine With epi?

4mg kg or 300mg 500mg

1% of lidocaine = how many mg?

Onset and duration of lidocaine

2-5 mins 1/2 hr - 2 hours

Bupivicaine can not be used in what age group

Less than 12 yrs

Max dose of bupivacine

2mg/kg or 100mg

Onset and duration of bupivacaine

5-10mins 2-4 hours

Mgmt for toxicity Persisting seizure HYPOTN Txt arrhythmia

STOP BZD - seizure HYPOTN = IV fluids Arrythmia = ACLs

When is malignant hyperthermia mc

Volatile agents and succinylcholine

What is happening in malignant hyperthermia TXM

Ionized ca increase Hypermetaobold = fever tetany hyperK TXM = bicarbonate and dantrolene

Best way to prevent toxicity

Combine small amounts

Ways to administer local anesthetic

Longer small needs Bend @ 45 degrees Avoid intravascular injection Injection with withdrawal

What type of tissue can benefit from a bended needle

Sub Q

Sequence of clinical analgesia

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

What type of procedure could benefit from peripheral nerve blocks

Rib Digital

What does aseptic technique do

Prevent deep join surface infection

Where do you adisntyer a central nerve spinal block

Lower abd Admin anesthesia / anesthetic (subarachnoid space)

Best position for spinal block

Recumbent position

What sxs is common post spinal block

TXM options for post spinal block

Conservative Epidural blood patch

Subarachnoid space spinal block will induce what type of block

Sympathetic Sensory Motor

Epidural block requires what

Continuous infusion

What does an epidural injection block Good for where

Sensory Motor function Rib fx

3 complications of epidural blocks

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

3 later complication from an epidural nerve block

Urinary retention Spinal HA Epidural hematoma

What is the recommendation for anesthesia if pt on anticoags

General endotracheal anesthesia

What can drugs can depress LOC

Benzo’s and Narcotics (propofol)

BENZO’s can provide what

Antegrade amnesia

Propofol is good in what

TBI’s

Propofol characteristics

Hydrophobic Needs lipid emulsion Induction and Mx Turn on and off fast Liver clearance Central action

What ASA class is okay for broad anesthetics

1 and 2

Narc reversal and BZD reversal

Naloxone Flumazenil

When is the most critical time for assessment in general anesthesia

Under and OUT

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

Gag Airway Aspiration

What tests are important pre op for general anesthesia

EKGs CXR PFTs

2 keys to intraoptive management

Induce the anesthesia Mx the airway

What two points need to be protected in general anesthesia

Eyes and pressure points

What should you try to prevent with general anesthesia

Hypothermia

3 complications of general anesthesia

Hypoxemic cardiac events Aspiration Nerve injury

What pts are okay for discharge post op RUSVAN

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

Which has a more intense reaction natural fibers or synthetic material

Natural fibers

Two types of material common in sutures

Braided and monofilament

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

Braided

Types of absorbable sutures GMV

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

Non absorbable suture types EPS

Ethilon Prolene Silk (multi)

What is the largest size of suture

0-0

Characteristics of braided material

Stands together Holds well Most pliable ~ Does harbor bacteria ~

Character of monofilament

Smooth stiff Good for wound infection Hard to tie

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

Needle driver

Adsons refers to what

Outside the body = better traction

Debakeys refers to what

Inside the Body length may vary Hold like a pencil AVOID OUTSIDE SKIN

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

90 degree insertion Sufficient depth

Recommend number of drives to take with suture closure

How should the wound look at closure

Everted

Simple interrupted

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

Large lacerations should get what kind of mattress

Horizontal Reduces the tension over the wound

Running suture is done commonly with what kind of material

Monocryl

5 procedures that can require simple suture

Lipoma EIC Pilar Ingrown toe nail Nevi moles / skin tags

All specimens collected in or should go where

Pathology for histology

What size scalpel is best for punctures or cuts

What is a good anesthetic combo for subq operative mamangemt

Lidocaine : Marcian 1:1

What is the correct order for cutting along the skin

With langerhan lines Ext surfaces = longitudinal (outside knee) Flex surface = transverse (inside elbow)

Minor bleed control management Severe Alternate

Minor = cauterize Severe = figure 8 stitch Alt= hemostat

All sponges should be what

Radiopaque

Staples character

High tensile strength Pulsatile quick Infection low and scar high

Recommended site follow up time

7-10 days

What can be helpful when removing sutures or staples

Water soak Hemostat

Should you close infected wounds?

NO!

What is a good technique for wound infection management

Wet Dry and r2 daily Only gauze use!

What can be used for severe wound infection

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*

Granulation tissue overgrowth can be treated with what

Silver nitrate on a flat surface