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Phase I > Suture, Instruments, etc. > Flashcards

Suture, Instruments, etc. Flashcards

1
Q

Stapling devices

A

Green: 30-45-60-90; 4.8mm => 2.0mm (2 rows)
Blue: 30-45-60-90; 3.5mm => 1.5mm (2 rows)
White: 30; 2.5mm => 1mm (3 rows)

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2
Q

Polyglactin 910

A
  • Vicryl
  • Braided multifilament
  • 50% tensile strength at 2-3 weeks (0% for Rapid)
  • 25% loss at 14d
  • Absorbed in 8-10 weeks (6 for rapid)
  • Excellent suture handling, fair knot security, minimal tissue reactivity
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3
Q

Catgut (intestinal serosa/submucosa)

A
  • Twisted multifilament
  • 0% tensile strength at 2-3 weeks
  • Unpredictable absorption (proteolytic), 2-10 weeks
  • Fair suture handing, poor knot security, extreme tissue reaction
  • Made from the small intestinal submucosa of sheep or the intestinal serosa of cattle
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4
Q

Polyglycolic Acid

A
  • Dexon
  • Braided multifilament
  • 50% tensile strength at 2-3 weeks
  • Absorption in 60-90 days - initially slow for 2 weeks then more rapid hydrolysis
  • Minimal tissue reactivity, fair handling, good knot security
  • More rapid loss of strength in urine (sterile), very rapid in infected urine (esp. Proteus)
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5
Q

Poliglecaprone 25

A
  • Monocryl
  • Monofilament
  • 50% tensile strength at 1-2 weeks
  • 60% loss at 14d
  • Absorption in 119 days
  • Fair knot security, good suture handling, minimal reactivity
  • Degrade more rapidly in alkaline environement (glycolide)
  • Complete loss of strength/dissolution in 7d in proteus urine (less dramatic reduction in sterile or e.coli urine)
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6
Q

Polyglytone 6211

A
  • Caprosyn
  • Monofilament
  • 0% tensile strength at 2-3 weeks
  • 80% loss at 10d
  • Minimal tissue reactivity, good handling, fair knot security
  • Absorbed 56d
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7
Q

Polydiaoxanone

A
  • PDS II
  • Uncoated monofilament
  • 50% tensile strength at 5-6 weeks
  • 20% loss at 14d
  • Absorbed 180 days
  • Minimal tissue reaction, good handling, fair knot security
  • One study had loss of strength in 3d in sterile urine, 1d in proteus urine
  • Minimum 5 throws for secure knot at start or end of SC pattern, 3 turns & knot for abderdeen
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8
Q

Glycomer 631

A
  • Biosyn
  • Monofilament
  • 50% tensile strength at 2-3wk
  • 60% loss at 3 weeks
  • Absorbed at 90-110d
  • Minimal tissue rxn, good handling, fair not security
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9
Q

Polyglyconate

A
  • Maxon
  • Monofilament
  • 50% tensile strength at 4-5 weeks
  • 25% loss at 14d
  • Absorbed in 180d
  • More memory than PDS = worse handling
  • Minimal tissue reaction, fair handling, good knot security
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10
Q

Silk

A
  • Silk
  • Braided multifilament
  • Crystalline structure (fibroin & sericin) slowly degraded by hydration over 2 years, 56% of tensile strength at 12 weeks
  • High tissue reactivity - potential for gradual vessel attenuation but not documented
  • Excellent handling, good knot security
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11
Q

Polypropylene

A
  • Prolene
  • Monofilament synthetic suture
  • Strong suture with highest break point (AUC displacement-load) compared to silk, nylon, polyester, gut, Dexon
  • Significant memory - poor handling & knot security
  • Minimal tissue reactivity - used for tendons, ligaments, joints, fascia, etc.
  • No hydrolyzable bonds - resistant to degradation
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12
Q

Nylon

A
  • Ethilon
  • Monofilament (or multi version)
  • Strong with 2nd highest break point, high maximal tensile load
  • Classified as nonabsorb but subject to degradation via hydration
  • In acidic environment loss of 50% tensile strength in 12 weeks
  • Fair handling, poor knot security, low tissue rxn (mono; moderate multi)
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13
Q

Polymerized Caprolactam

A
  • Vetafil
  • Sinus formation - only skin
  • Strong, good knot security, fair handling
  • Twisted nylon multifilament
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14
Q

Polyester

A
  • Variety of polyester sutures: polyethylene, polybutester, composites
  • Mono or multifilament, moderate tissue reactivity
  • Polyethylene used in thrombogenic coils
  • Polybutester has marked elasticity
  • Polyblends (e.g. FiberWire) - very strong and fray resistant, good knot security, good strength in 3-point bending
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15
Q

Steel

A
  • 304, 316, 316L stainless steel
  • Replaced by polyblend as strongest sutures, poor handling characteristics
  • Mostly used for ortho; less displacement/more stable sternotomy closure comapred with polybutester (duh…)
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16
Q

Cerclage

A
  • Twist: Tension 70-100, load before loosening 260
  • SL: Tension 150-200, load before loosening 260
  • DL: Tension 300-500, load before loosening 666
17
Q

Gas Canisters

A 
-Oxygen: Green
E - 1900 PSI, 660L
H - 2200 PSI, 6900L
-Medical Air: Yellow
E - 2200 PSI, 6550L
-Nitrous: Blue
E - 745 PSI, 1590L
H - 745 PSI, 15,800L
-CO2: Grey
E - 838 PSI, 1590L
-Nitrogen: Black
H - 2200 PSI, 6400L
18
Q

Anesthetic Depth/Planes

A

-Stage I - Awake/aware through all levels of obtundation until loss of consciousness
-Stage II - Stage of excitement/spontaneous muscle movements, cessation of which and development of normal breathing => stage III
-Stage III - Surgical stage of anesthesia, subdivided (4 JT, 5 LJ):
1 (Light) - Eye central, large pupil, tight jaw tone, intact PLR/palpebral, physiologic +/- movement response to nociception. rapid resp rate.
2 (light-medium) - Ventromedial eye position, small to medium pupil, intact PLR, some jaw tone (JT/LJ difference) and possible physiologic response to nociception
3 (medium JT only) - Ventromedial eye, moderate jaw tone, even resp rate
4 (deep-medium) - Ventromedial eye, medium to large pupil, no PLR, mild jaw tone, slow RR, no response to nociception
5 (deep) - Central eye, large pupil, absent PLR, absent jaw tone, apneic, no response to nociception
-Stage IV - Extreme CNS depression and respiratory arrest, cardiac arrest to follow

19
Q

ASA

A

1 - No systemic illness, healthy patient
2 - Mild compensated systemic illness (e.g. hypothyroid, obese)
3 - Moderate to severe compensated illness (e.g. heart disease, CKD, liver disease, DM)
4 - Patient has disease that is constant threat to life (decompensated - e.g. CHF, sepsis, GDV, pneumothorax)
5 - Moribund patient not expected to survive 24h with or without treatment

Phase I (5 decks)

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