Surgical Hemostasis Flashcards
why do we use a TQ?
for surgery requiring bloodless field
-makes for better visualization of structures, speed, saftey, precision
when don’t you use a TQ?
sickle cell-hypercoag in low O2
advanced pad
prior h/o dvt
stasis or ulceration at tq site-put tq more proximal
What is the TQ pressure supposed to be?
70-125 mmHg greater than SBP
Normal tq pressure values for ankle and thigh?
less than 300 for ankle and 400 for thigh
peds is 100 less than adults
How long can the tq be on?
2-3 hours safe
deflate 10-15min or 5min ever half hour of inflation
- prevents muscle atp depletion
- better to have more short periods of reperfusion and few longer periods
- release tq prior to closure with infx and trauma
when do you give abx?
before tq inflation to ensure adequate deliver to tissue
when do you give pre op abx?
30-60min before
why is thigh tq better than ankle?
thigh has greater surface area and adipose tissue, more protection
characterized by neuropraxia, edema, stiffness, pallor, paresis, but no ischemia
post tq syndrome
characterized by abnormality of peripheral nerve distal to TQ site, decreased sensory and motor function, and muscle atrophy, variable duration (CRPS type1)
TQ paralysis syndrome
Increase in HR due to increase in BP in right atrium secondary to increased PR and flow in great veins at entrance to right atrium
bainbridge reflex
thigh tq is more likely to give cv complication than ankle
d
how long do you wait to use TQ if they have h/o dvt
6 months on affected extremity
secondary intracellular k+ release from cell lysis secondary to necrosis from ischemia-> H acidemia
in 1st hour of tq use:
pH decrease
dec p02
inc pc02
hyperkalemia and acidemia
decrease blood supply leads to skeletal muscle breakdown and increase in serum CPK
-dark urine
rhabdomyolysis
