Surgery

Question 1

First Degree Burn

Answer 1

Erythema of skin
minimal edema
minimal pain
capillary refill intact

Question 2

Second degree burn

Answer 2

parital thickness
more painful than 3rd degree because pain fibers still in tact
skin is red, mottled, blistered, wet/weeping

Question 3

Their degree burn

Answer 3

damage to all skin layers, sub cutaneous and nerve endings

skin is pale or charred, fat exposed, painless to pin prick

Question 4

Worse burn, alkali or acidic?

Answer 4

Alkali burns because they penetrate deeper

treat with IRRIGATION. Do not try to neutralize

Question 5

Intrathecal administration of opioids

Answer 5

morphine (.1 mg) pain relief 18-24 hours, onset 45 mins

fentanyl (10 mcg) pain relief 1-2 hours, onset 5-10 mins(use in hepatic or renal insufficiency or morphine allergy)

Question 6

Hydromorphone (Diludid)

Answer 6

rapid onset opiate of 30 mins
4-6 x more potent than morphine
hepatic ally metabolized, eliminated in urine

Question 7

Fentanyl

Answer 7

inactive metabolite so can use in renal impairment unlike morphine
rapid onset of action, eliminated in 2-4 hours

Question 8

When to not add epinephrine to local anesthetics

Answer 8

end arteries: finger/toes, penis, ear/nose, skin flaps

Question 9

Von Willebrand Disease

Answer 9

reduced activity of factor VIII
autosomal dominant
prolonged PTT, normal PT (extrinsic, III, VII, X)
treat with factor 8 cryoprecipitate or DDAVP

Question 10

Hemophilia A

Answer 10

Factor VIII defecincy
only in MALES
red, swollen joints
Prolonged PTT, normal PT

Question 11

6 W’s of post op fever

Answer 11

Wind (1-2 days) atelectasis, PNA, PE
Water (2-3 days) UTI
Wound (3-5 days) surgical site infection
Walking (5-7 days) DVT, PE
Wabscess (7-10 days)
Wonder drugs... IV line infection or blood products

Question 12

Drug most likely to cause Malignant Hyperthermia

Answer 12

Succinylcholine

Question 13

Treatment of Malignant Hyperthermia

Answer 13

Dantroline

Question 14

When to DC foley post op

Answer 14

Day 2

Question 15

Ticlodipine side effect

Answer 15

Agranulocytosis
Antiplatelet agent
DC 5 days before surgery and begin immediately after

Question 16

When to DC NSAIDs prior to surgery

Answer 16

DC 7-10 days prior to surgery

Question 17

Timing of Suture Removal

Answer 17

Face 4-5 days
Scalp 6-8 days
chest/abdomen 8-10 days
arm/leg 8-10 days
hand 8-10 days
finger tip 8-12 days 
back 10-14 days
foot 12-14 days

Question 18

4 stages of wound healing

Answer 18

hemostasis/coagulation
inflammation
migration/proliferation (angiogenesis, epithelialization)
remodeling (synthesis of collagen by fibroblasts)

Question 19

Pre op antibiotics

Answer 19

Cefazolin (Ancef) 1-2 g IV within 60 mins of surgical incision

Question 20

Most common cause of SSI

Answer 20

staph aureus