Surgical Prep Flashcards
What are some advantages of shorter surgery times?
less patient cooling, decreased chance of infection, fewer drugs used, less cost to clinic/owner
External pressure may control what?
internal bleeding
Epinephrine is a common hemostatic agent in what surgeries?
dental and ocular surgery
What does electrocautery do?
coagulates tissue and vessel edges to control bleeding
Define ligation.
tie know around the vessel with suture
Louis Pasteur is credited with what?
developing what is now known as pasteurization after demonstrating that fluid heated briefly to kill bacterial did not spoil
Define resident bacteria.
non-pathogenic bacteria located on the skin that also inhabit hair follicles, sebaceous, and sweat glands
Define transient bacteria.
mostly pathogenic bacteria, those that we pick up by simply touching any object in the environment
Define endogenous-direct transfer.
bacterial contamination of the host with its own bacterial flora
When does endogenous direct transfer occur?
when the bacteria from a body system inadvertently come in contact with the surrounding tissue, either from a break in aspetic technique or do to spillage
Define endogenous-indirect transfer.
transfer of bacteria via the bloodstream from a distant site in the body to the freshly created surgical wound
What are characteristics of an ideal surgical site scrub sgent?
non-irritating, non-staining, quick acting, bactericidal for all bacteria, residual effect of approximately one hour
How often should you change masks?
frequently (every two hours if needed)
What is an EKG?
measure of electrical activity of the myocardium
T wave is usually ____ in Lead 2.
positive
What is the R-R interval used to detect?
rhythm versus arrhythmia
A prolonged P-R interval indicates what?
first degree heart block
What is a first degree heart block indicated by?
prolonged P-R interval
Delayed impulse SA through AV node indicates what?
first degree heart block
What indicates a second degree heart block?
P without a QRS
Having a P without a QRS indicates what?
second degree heart block
How are the atria and ventricles acting in a third degree heart block?
independently
What happens in 3rd degree heart block?
impulse through AV node blocked
In what heart block is there no relationship between P waves and QRS complexes?
third
When speaking of an EKG, what are early signs of trouble?
tachycardia, bradycardia, premature ventricular contraction, 1st degree heart block, 2nd degree heart block
What does 4 VPC in a row mean?
ventricular tachycardia
What does change in polarity of the T wave mean?
hypoxia
What does the height and duration of P check?
the atrium at depolarization
The height of P is looking at what atrium?
right
What duration of P is looking at what atrium?
left
What does the height of R and duration of QRS check?
the ventricle at depolarization
The height of R looks at what ventricle?
left
What duration of QRS looks at what ventricle?
right
What is 60 cycle interference?
a very even sawtooth line
What kind of finish does a lower quality surgical instrument have?
shiny
Why do you want to keep contaminated (bloody) instruments moist?
so blood doesn’t dry on the instruments
When washing instruments, what kind of soap should you wash them with?
neutral pH soap
What do abrasive or chlorine based products promote in surgical instruments?
corrosion and pitting
Instruments have a protective coating of what to extend their usefulness as properly functioning devices?
chromium oxide
How does an ultrasonic cleaner work?
uses high frequency sound waves to clean by producing bubbles that collapse and cause scrubbing action
Tissue damage causes what?
inflammation
What does “wind up” mean?
nerve pain has involved spinal cord
Why should you control pain?
avoid “wind up”, increased survival with pain management, chronic pain can result from failure to control acute pain adequately at time of incident
What does pain cause?
stress, suppressed immune system (decreased healing), anorexia, increased protein catabolism, increased GI disturbances, increased vasoconstriction, adrenal exhaustion
What does constant stress do to the adrenals?
it depletes them and their ability to respond
What are some signs of pain in dogs?
abnormal sitting/lying, restless/limp, aggressive/dull, tense abdominal muscles, vocal, increased RR/expiratory grunt, bulged eyes, dilated pupils, decreased appetite/decreased grooming, lick/bite affected area, won’t lie down
What are some signs of pain in cats?
grumpier, purr, aggressive/frantic, vocal, withdraw to back of cage/withdraw from human contact, don’t use litter box,, decreased eating, decreased grooming/excess grooming, failure to jump/stiff gait/uneven gait
Long-term NSAID use is recommended in treatment of what?
osteoarthritis problems in addition to weight loss and exercise
Define agonist.
affinity for receptor and causes an effect
Define antagonist.
affinity for receptor and blocks agonist from producing effect. May reverse effect of agonist.
What is the most common use of acupuncture?
pain management
Acupuncture points are connected through what?
pathways that are called meridians or channels
What is moxibustion acupuncture?
dried leaves of Artemisia vulgaris (mugwort) are burned in stick form and moved slowly over the acupuncture point or touch to inserted needle
What is aquapuncture?
inject solution into acupuncture point. benefit is from pressure on point caused by solution or stimulation of nerve by solution
What is electroacupuncture used for?
paralysis or paresis, severe and chronic painful conditions, or conditions that aren’t responsive to dry needling
What do you do in electroacupuncture?
pass electrical energy through acupuncture points via electrical device connected to inserted needles
When would you use implantation acupuncture?
hip dysplasia in young dogs, coxofemoral arthritis, epilepsy in older dogs
What are 4 uses for cold laser acupuncture?
- stimulate acupuncture points
- enhance healing of wounds and burns
- treat acutely inflamed joints
- animals sensitive to needling
How does cold laser acupuncture work?
stimulate acupunture points with intense light therapy to promote positive physiologic changes within cells
What happens with microcurrent therapy?
machine generated microcurrent of electricity is used on acupuncture points or directly over areas of pain or muscle spasm
What do lasers commonly use?
- visible red helium-neon (HeNe)
- invisible infrared (IR) gallium-arsenide (GaAs) and gallium-aluminum-arsenide (GaA1As)
Laser light is usually what?
polarized (waves in same plane), small divergence (nearly parallel beam), high mean output power (MOP many watts are put out)
What are biological effects of atherapeutic laser?
accelerated cell division, increased leukocyte phagocytosis, stimulation of fibroblasts and collagen formation, degranulation of mast cells
Define peptide.
2 or more amino acids joined togehter
When clipping, how much around the incision site do you want to clip?
2-5 inches wide
What are disadvantages of a general scrub in the patient?
drying, cooling
What are advantages of a general scrub in the patient?
cuts through dirt and fat, thoroughly removes soap, disinfectant
Why should you use heavy blankets to keep a patient warm?
heavy blankets may compromise a patient’s respiratory capabilities
A heating source is required when a patient’s temperature is below what?
98 degrees
What are disadvantages of a water circulating blanket?
water leaks
What are advantages of a water circulating blanket?
safe, not as expensive, replaceable pieces and parts
Define sterilization.
use of a process to rid an object of all living microbes
What are the most common ways of sterilization?
heat, radiation, filters, ethylene oxide
What are examples of ways you could use steam to sterilize?
autoclave, pressure cooker
What is the most common method of sterilizing surgical instruments and supplies?
autoclave
What is an autoclave?
a self locking machine that sterilizes with steam under pressure
How many degrees does it take to achieve 15 lb pressure?
250
High pressure also ensures saturation of what in the autoclave?
wrapped surgical packs
What is the purpose of packaging and wrapping times for sterilization ?
to provide an effective barrier against contamination during storage, once the items have been sterilized
Why do you need to sterilize cotton, wool, or pads wrapped in paper or cotton bags?
to prevent the multi-purpose valve and the autoclave openings form becoming clogged with remnants of the material
What is “flashing”?
when an instrument is autoclave unwrapped for a shorter period of time
When is “flashing” often used?
when a critical instrument is dropped
What are the autoclave settings for “flashing”?
270 degrees F, 20 lbs pressure, 3 minutes, unwrapped
Where is autoclave tape located on a pack?
the outside of packs
Where should sterility indicators be?
on the inside of specific packs
What do biological sterilization indicators contain?
spores that are supplied in closed containers
What indicator is the most accurate sterilization indicators?
biological indicators
What are the two types of autoclaves?
gravity air-displacement autoclaves, high-vacuum sterilizers (prevacuum sterilizers)
What does proper sterilization depend on?
proper operation of the sterilizer, proper preparation of the packs, proper loading of the sterilizer
What is the most common type of autoclaves in veterinary clinics?
gravity air-displacement sterilizer
Which autoclave requires distilled water placed in the bottom of the sterilizers and then heated electrically?
gravity air-displacement sterilizer
What are the four steps of a high-vacuum sterilizer?
conditioning phase, sterilization phase, high-vacuum exhaust, drying cycle
What should you do daily with the autoclave?
wipe down all outside surfaces and the door gasket with mild detergent, water and soft cloth or sponge, wipe out inside of chamber at the end of each day
What kind of autoclave maintenance should you do every 1-4 weeks?
clean chamber, water reservoir and air jet
What is dry heat used for?
instruments made of tightly fitting movable parts that cannot be disassembled
What else is dry heat good for?
petroleum jelly, mineral oil and powders
What is ethylene oxide?
a flammable, explosive liquid that becomes an effective sterilizing agent when mixed with carbon dioxide or Freon
What can be safely sterilized with ethylene oxide?
endoscopes, cameras, plastics, power cables, laser equipment, ultrasound equipment, filters
What items can you not sterilize with ethylene oxide?
food, drugs, liquids, acrylics, some pharmaceutical products
What can ethylene oxide cause?
dizziness, headaches, nausea, abortions, cancer
What is boiling good for?
disinfecting but not sterilization
Define antiseptic.
a chemical used to inhibit or prevent the growth of microbes on living tissue
Define disinfectants.
a chemical used to inhibitor prevent the growth of microbes on inanimate objects
What do sanitizers do?
reduce the number of microbes to a safe level
What do sterilizers and germicides do?
eliminate all microbes
Antiseptics are designed for application to what?
animate surfaces (living tissue)
What are types of disinfectants?
phenols, alcohols, quaternary ammonia compounds, halogens, chlorhexidine
What is a phenol compound?
disinfectant
Phenol compounds are popular for what?
housekeeping and disinfection
Most phenol compounds are too toxic for what?
use on living tissue
Phenol disinfectants are commonly found in what?
mouth washes, scrub soaps and surface disinfectants
What are phenols effective against?
gram positive bacteria and enveloped viruses
Phenols maintain their activity in the presence of what?
organic material (such as pus)
What are phenols not effective against?
spores, fungus, gram negative bacteria, naked viruses
Phenol-Hexachlorophene is used for what?
pre-op hand scrub
Phenol-Hexachlorophene’s use has declined because of what?
causes skin irritation, some evidence indicating hat it might be teratrogenic and neurottoxins
Liquid chmicals used for sterilization must be what?
noncorrosive to the items being sterilized
Chlorine compounds are most valuable for disinfection of what?
water
What are chlorine compounds destructive to?
metals
Chlorine compounds are effective against what?
parvo, kennel cough, fungus, etc
T or F. Iodine is corrosive to metals.
true
What is iodine effective against?
bacteria, bacteria spores, viruses, fungi, protozoa, yeas
What are iodophors?
iodine in aqueous solutions
What is tincture of iodine used to treat?
thrush in horses, pyometra
What are alcohols used for?
topical disinfectants, presurgical wipe, instrument soak, ear cleaning
What should you not use alcohols on?
open wounds, reddened skin, infected areas
What is alcohol effective against?
bacteria (gram + and -), enveloped viruses, fungi and spores, yeast
What are alcohols ineffective against?
bacterial spores, naked viruses
Alcohols do not work in the presence of what?
organic material
Why shouldn’t you use alcohol on open wounds?
painful, denatures proteins (kills more tissue and delays healing)
What is chlorhexidine effective against?
highly bactericidal, viruses, fungi, yeast
Chlorhexidine is very tissue what?
friendly
When should you not use peroxides?
if the wound is open and showing sings of infections, if wound will be sutured shut, if wound is quite deep
What happens with radiation sterilization?
high energy ionizing radiation destroys micoorganisms
Why would you use radiation sterilization?
instruments that can’t be sterilized by heat or chemicals, food products, suture, gloves, disposable equipment
What are common sources of radiation for radiation sterilization?
electron beam and Cobalt-60
Define filtration.
the use of a filter to separate particulate material from liquids or gases
Gas plasma effectively what?
sterilizes most heat and moisture sensitive medical devices and surgical instruments
What does an autoclave sterilize?
heat, steam, pressure
List 5 items that ethylene oxide might be used for.
laser, endoscopic equipment, ultrasound equipment, fluids, filters, gloves, sharp instruments dulled by steam and heat
List 2 places filters might be used to trap bacteria before it reaches the patient.
IV line, syringe
What is a waterless scru?
an antiseptic provides rapid broad spectrum coverage by killing 99% of bacteria without soap or water
How can you use a waterless scrub?
surgeon’s scrub before surgery instead of timed scrub, antiseptic for health care personnel, surgeon’s scrub before surgery for additional scrubs after the timed scrub is done the first time
What are maternal reasons for dystocia?
uterine inertia, insufficient cervical dilation, birth canal narrow
What are fetal reasons for dystocia?
oversized, faulty presentation
What can oxytocin prevent?
breeding back
If you give oxytocin with an undilated cervix or malpositioned pup, what can it do?
rupture uterus
What are the three goals of a C-section?
viable young, undepressed dam, return to own environment ASAP
What are benefits of a C-section?
live pups/kittens/dam
What are some complications of a C-section?
fetal depression, dead pups/kittens/dam, hemorrhage/shock, infection
With a c-section, where is the incision made?
body of uterus, dorsal surface
What kind of anesthesia does ocular surgery?
deep
When doing ocular surgery,how wide around the eye should you clip and prep?
3-4 inches
Define enucleation.
removal of an organ or other mass intact from its supporting tissues
What does lateral subconjunctival enucleation involve?
involves a lateral canthotomy and a subconjunctival approach to the glove, extraocular muscles and optic nerve
What is transpalpebral enucleation?
removal of eyelids, conjunctiva and extraocular muscles along with eyeball
What is the branch of surgery dealing with the preservation and restoration of the function of the skeletal system, its articulations and associated structures; particularity associated with the correction of deformities of the musculoskeletal system?
orthopedics
What are benefits of onychectomy?
decrease mutilation of owner/furniture
How long after surgery do you take off declaw bandages?
12-24 hours
How long before declaw bandage removal do you give torbugesic?
20 mins before
What are complications of a declaw?
excess bleeding, infection, bone protrudes, regrowth of nail, chronic lameness, self trauma
With declaws, what age of cat tends to bleed more?
older cats
T or F. Some breeds require dewclaws present and more = better.
true
Are orthopedics usually considered an emergency?
no
Define reduction.
bringing the ends together
Where should you clip for a thoracic surgery?
axilla to umbilicus or pubis
What are indications of trouble in a thoracic surgery?
dyspnea, anxious, sudden death
What are noabsorbable sutures?
sutures that cannot be absorbed by the body cells and fluids in which they are embedded during the healing process
If nonabsorbable sutures are used as buried sutures, what happens?
they become surrounded or encapsulated in fibrous tissue and remain as innocuous foreign bodies
What are absorbable sutures?
sutures that are absorbed or digested by the body cells and tissue fluids in which they are embedded during and after the healing process
When are absorbable sutures used?
in tissues that heal rapidly to adequate strentgh
What is natural sutures made from?
animal or plant materials
How are natural sutures broken down?
by phagocytosis and this initiates inflammation
What are synthetic sutures made from?
man-made polymers
Why were synthetic sutures developed?
to avoid variation of resorptive rates in inflammed environments
Do synthetics cause less tissue reaction than natural fibers?
yeah
How is synthetic suture broken down?
by enzymatic hydrolysis (which doesn’t cause tissue inflammation)
What does monofilament suture avoid?
avoids capillary action
Does monofilament suture have low or high surface friction?
low
Does monofilament suture have “memory”
yes
Do monofilament sutures have poor knot security?
yes
What is multifilament suture?
small elements braided or twisted together
What does many multifilament sutures cause?
tissue reaction, harboring of bacteria if contaminated, allows “wicking” or “capillary action”, increased friction
What does “wicking” or “capillary action” cause?
fluids to travel along filament and can cause contamination
When should you not use multifilament suture?
hollow organs, when part of suture will be exposed to contamination
Why would you not use multifilament suture in hollow organs?
bacteria in lumen will travel to peritoneal/pleural cavity
Is silk absorbable or non-absorbable?
non-absorbable
Is silk natural or synthetic?
nature
Silk suture has what?
frequent tissue reaction or “spitting” of suture from the wound
Is silk monofilament or multifilament?
braided or twisted multifilament
Is cotton absorbable or non-absorbable?
non-absorbable
Is cotton natural or synthetic/
natural
What does cotton lose with each autoclaving?
tensile strength
Is linen absorbable or non-absorbable?
non-absorbable
Is linen natural or synthetic?
natural
Examples of synthetic non-absorbable suture.
nylon, stainless steel, prolene, Webpro
What is a problem with synthetic non-absorbable suture?
tendency for the knots to come untied
Is nylon absorbable or non-absorbable?
non-absorbable
Is nylon natural or synthetic?
synthetic
Why is nylon preferred over silk for face and lip areas?
silk too often causes tissue reactions, which causes more scarring
Can you use nylon in contaminated wounds and skin?
yes
What kind of filament is nylon?
mono and multi
Examples of nylon suture.
Polyweb, Braunamid white
Is stainless steel absorbable or non-absorbable?
non-absorbable
Does stainless steel have good knot security?
yes
What can multifilament stainless steel cause?
may fragment and cause sinus tracts
What would you use stainless steel suture in?
rib closure, tendon repair, skin to decrease licking, peritoneal suture line in some cases
What are some forms of stainless steel suture?
suture, michelle clips, hemoclips, staples
What is plain catgut?
raw guy that has been gauzed, polished, sterilized and packaged
What is chromic catgut?
undergone various intensities of tanning w/ one of the salts of chromic acid to delay tissue absoprtion time
What does tanning do?
takes out all moisture and fat to make more stable
Chromic catgut has an increased rate of absorption in what kind of environment?
infected
What does chromic catgut often cause? Why?
excessive tissue reaction because it’s broken down by phagocytosis and this causes inflammation.
What is cyanoacrylate glue/
tissue adhesives used for treatment of minor woundsa dn abrasions, vascular and opthalmic surgery and hemostasis
How does bovine collagen trigger clot formation?
platelet aggregation and release of coagulation factors
Collagen’s hemostatic capabilities are inactivated by what?
autoclaving
What is bone wax?
a non-absorbable agent that is used during orthopedic and neurologic surgery to control bleding from bone
What does bone wax function as?
a mechanical plug when pressed into bleeding bony surfaces
Drains should not what?
enter or exit at the incision line
When suturing, the best cosmetic effect is obtained by using numerous simple interrupted sutures placed how far apart?
1/8”
The distance of the needle bite from the wound edges should be equal to what?
the distance between sutures
What is an interrupted suture?
a solitary stitch or suture with a knot
What is a continuous suture?
several bites of suture taken to close a longer area with only a knot at the beginning and at the end of the line of stitches
What is a simple suture?
a single pass through tissue is made on each side of the incision
What is a mattress suture?
one the pattern is tied, the stitch pattern has two entrance/exit holes on each side of the incision so a mass of tissue is incorporated into the stitch on each side
What does evert mean?
cut edge rolls away from the body
What does invert mean?
cut edge rolls into the incision
What does apposing mean?
cut edges just come together with no rolling in or out
Examples of apposing suture patterns.
simple interrupted, simple continuous
Examples of everting suture patterns.
horizontal mattress, vertical mattress, continuous mattress
What are disadvantages of a horizontal mattress pattern?
difficult to apply without causing eversion, incarcerates blood supply if tight
What are advantages of a horizontal mattress pattern?
small amount of suture material used, rapid to do, tension type suture
What are advantages of a vertical mattress pattern?
tension suture, stronger than horizontal mattress, very little eversion
What are disadvantages of a vertical mattress pattern?
more suture material used, slow
When is a continuous mattress pattern used for skin closure?
continuous suture is okay, having a little eversion is okay, increased tension is needed
Examples of inverting suture patterns used for skin or hollow organs.
lembert, halstead
What is the gambee suture pattern used for?
to close anatomoses on GI tract rather than inverted suture by some surgeons
What are advantages of the gambee suture pattern?
minimal stenosis, minimal adhesions, minimal wicking (leakage), minimal infections
What does tension on tissues cause?
tear tissues, compromises blood supply
What is a quill?
vertical mattress with everting characteristics used to incorporate rubber, plastic, or gauze tube in external loop on each side of incision
What is a stent?
incorporate sterile gauze sponge roll in a large simple interrupted suture that presses sponge on previously sutured incision
What may excessive pressure with a stent cause?
necrosis
What are some causes of dehiscence?
excessive licking of site, infection, suture tearing, blunt trauma
Suture reactions are increased in what species?
cats
Benefits of castration.
decreased aggression, decreased roaming, decreased unwanted pups, decreased trauma, decreased disease, decreased adenocarcinoma of rectal area, decreased prostate problems when females in area in heat
How long may it take for improvements from a castration to show up?
6 months
What is scrotal ablation?
when the scrotum is removed for cosmetic or disease reasons
What are benefits of a cat castration?
creased aggression, decreased spraying, decreased roaming, decreased urine odor, decreased over population
What prevents herniation post-op with a rat castration?
fat pads
What is another word for laparotomy?
celiotomy
What is another word for celiotomy?
laparotomy
How would you clip for a laparotomy?
wide clip from sternum to pubis
Do you blot or wipe bleeding?
blot
What are 3 parts of a needle?
shank (body), eye, point
Shape and size of needle is selected for use by?
thickness of tissue being sutured, depth or incision, personal preference
Where are taper-point needles most often used?
in deep tissue where a leak would be a problem, when a sealed suture line is needed
Are taper point needles used on the skin?
no
What is the least traumatic kind of needle?
blunt
Loopuyt’s needle is popular for what?
livestock procedures
Define glycosaminoglycan.
carbohydrate that balances the water content in cartilage, which is crucial to normal function
What is often used in a dog spay to assist ligation of ovary area?
carmalts
What is often used in dog spay to assist in ligation of body of the uterus?
angiotribe
What do you clip for a spay?
xiphoid to pubis
Define hydrometra.
collection of watery or mucoid fluid in the uterus
What is a chain loop ecraseur used for?
in equine reproduction surgery as a mare spay
What are benefits of an ovariohysterectomy?
decreased roaming, decreased diseases and trauma, decreased mammary tumors, eliminates chances of pyometra, decreased unwanted pups, no heat mess
Why do a wide and long prep with a spay?
can extend incision to find a bleeder, can extend incision to reach suspensory ligament of ovary or body of uterus more easily without traumatizing tissue from stretching body wall, etc
What are the 3 broad ligament parts caudal to cranial?
mesometrium, mesovarium, mesosalpinx
Where is the mesometrium broad ligament part located?
at uterus
Where is the mesovarium broad ligament part located?
at ovary
Where is the mesosalpinx broad ligament part located?
at uterine tube
What ligaments do we break during a spay?
suspensory ligament, round ligament
Where is the suspensory ligament located when doing a spay?
cranial edge, anchors near kidney
Where is the round ligament located when doing a spay?
midway along mesometrium, achors at inguinal ring
Which uterine horn do you expose first during a spay?
left
During a spay, when is your first check for bleeders?
when you tag with a mosquito and lower it
During a spay, when is your second check for bleeding?
check abdomen for bleeders with clean gauze on a mosquito
During a spay, when is your third check for bleeding?
compress sides of abdomen and see if blood comes up through your incision line
During a spay, which layer is the main strength layer?
abdominal wall
What does the SQ closure in a spay do?
eliminate dead space
When using cold sterilization, instruments must be ___ before being immersed and _____ _____ before being used on the patient.
dry, rinsed thoroughly
When speaking about suture, the bigger the number, the ____ the diameter.
larger
What does “O” “ought” number indicate?
smaller diameter sizes
