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surgery > Test 2: Laparoscopy, Suturing, and Burns > Flashcards

Test 2: Laparoscopy, Suturing, and Burns Flashcards

1
Q

Kaolin, a compound used in quick-clot inhibits what two clotting factors?

A

10 and 11

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2
Q

What is the max mg/kg dose of 1% lidocaine?

A

5 mg/kg maximum

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3
Q

What is the max mg/kg dose of 1% w/ epi lidocaine?

A

7 mg/kg maximum

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4
Q

What does adding a buffer to lidocaine accomplish?

A

Less burning/pain on infusion by increasing the pH of the lidocaine (less acidic)

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5
Q

Sutures are which of the following…

a) more accurate skin closure, for deeper cuts
b) for superficial lacerations
c) quick, for deeper cuts

A

a) more accurate skin closure, and for deeper cuts

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6
Q

Glue (Indermil) is which of the following…

a) more accurate skin closure, for deeper cuts
b) for superficial lacerations
c) quick, for deeper cuts

A

b) for superficial lacerations (hold the approximation for 30 seconds)

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7
Q

Staples are which of the following…

a) more accurate skin closure, for deeper cuts
b) for superficial lacerations
c) quick, for deeper cuts

A

c) quick, for deeper cuts

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8
Q

What is the preferred method to covering a sutured or closed up wound?

A

Gauze, then a roll of gauze or ace bandage

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9
Q

When approximating and suturing/glueing wound edges, they should be…

a) inverted
b) everted

A

b) everted

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10
Q

Which of these is NOT a use for Indermil?

a) Microbial protection for external sutures?
b) Laparoscopic port sites
c) Abdominal incision protection
d) Facial lacerations
e) Sternotomy incision protection
f) Fasciotomy incisions

A

f) Fasciotomy incisions

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11
Q

Polysorb, an absorbable synthetic braided suture gives_____ weeks of wound support, and ____to____days to fully absorb

A

3 weeks

56-70 days to fully absorb

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12
Q

Caprosyn, an uncoated synthetic monofilament is used for only _____days of wound support, and absorbs in under_____ days.

A

10 days of wound support

Absorbs fully in < 56 days.

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13
Q

Maxon, an uncoated synethetic monofilament has the most protection with _____ weeks of wound support, and takes _____days to fully absorb

A

6 weeks of wound support
180 days to fully absorb
(great for fascia)

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14
Q

Describe the basic difference between gut and chromic gut, and how are they both absorbed?

A

Chromic gut lasts longer, both are broken down by proteolytic enzymes fairly quickly. Gut sutures are made naturally from bovine intestine.

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15
Q

Describe the key differences between gut and MSA/BSAs?

A

Gut is good for internal structures that can heal fast. Gut sutures sometimes causes a local tissue reaction. MSA/BSA’s are good for longer healing times, and will degrade by hydrolysis.

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16
Q

Which of these is a BSA (Braided Synthetic Suture) versus an MSA (Monofilament Synthetic Absorbable)?

a) Polysorb
b) Caprosyn
c) Biosyn
d) Maxon

A

a) Polysorb

Caprosyn, Biosyn, and Maxon are monofilament synthetics

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17
Q

What types of sutures are these?

Novafil, Monosof, Surgipro, Surgilon, Vascufil, Ti-Cron, Steel, Sofsilk, Silk

A

Non-absorbable

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18
Q

What type of suture is Prolene (not in his slides)

A

A synthetic non-absorbable monofilament

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19
Q

What are the three anatomical areas of the needle?

A

The point, body, and swage (the blunt end)

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20
Q

for the most part, every part of the face will get a _-0 nonabsorbable suture.

A

6-0 nonabsorbable

with the eyelid you can go smaller like a 7-0

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21
Q

for the most part the extremities and feet will get what three possible suture sizes?

A

3, 4, and 5-0

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22
Q

where are staples commonly used?

A

the scalp (no need to worry about train tracks, the hair will hide them)

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23
Q

single stiches, individually knotted for uncomplicated laceration repairs is called…

A

simple interrupted

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24
Q

This type of suture it best used for the heart or tendons…

A

Horizontal mattress

With TiCron

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25
Q

This “baseball stitch” is simple continuous stitch can be a useful technique for skin closure when speed is important, e.g. closing a scalp laceration on a screaming child.

A 
Continuous running
(but more difficult to adjust if approximation is off or the stitch breaks)
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26
Q

What type of suture is “far, far, near near” for approximating deeper wounds

A

Vertical mattress

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27
Q

This type of suture leaves no skin markings and can help close deeper tissues, and when aesthetics are important.

A

Subcuticular “subdermal” suture.

However, very difficult to adjust or correct if approximation is off or the suture breaks.

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28
Q

Which is NOT a benefit of doing a lap surgery?

a) morbidity reduction
b) reduced handling of bowel
c) reduced adhesion formation
d) exposure to drying and bacteria
e) reduction in electrosurgical risk

A

e) reduction in electrosurgical risk

other lap difficulties: suturing, depth perception, and limited space

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29
Q

What is the best position to operate large and small bowel?

a) supine
b) head up tilt
c) trendelenburg
d) lateral tilt

A

a) Supine

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30
Q

What is the best position for operating on the stomach, liver, and spleen?

a) supine
b) head up tilt
c) trendelenburg
d) lateral tilt

A

b) Head up tilt

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31
Q

What is the best position for operating on the paracolic gutters?

a) supine
b) head up tilt
c) trendelenburg
d) lateral tilt

A

d) Lateral tilt

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32
Q

What is the best position for operating on the pelvic cavity?

a) supine
b) head up tilt
c) trendelenburg
d) lateral tilt

A

c) Trendelenburg

reduce bleeding

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33
Q

you should prep your patient for laparoscopy from ______all the way up to the____ _____in case you have to insert new lines.

A

From mid-thigh to nipple line.

they also need a foley, NG tube, and grounding pad

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34
Q

What gas is inserted to create a pneumoperitoneum, and at what pressure?

a) o2 @ 12mmHg
b) Argon @ 18mmHg
c) Co2 @ 16mmHg
d) CO @ 8mmHg

A

Co2 (between 12-16 mmHg)

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35
Q

The most common access into the intra-abdominal cavity is with what type of needle?

A

Varess needle. Then elevate the abdomen and cut a 1mm incision with an 11 blade, then infuse saline. If saline enters, your in the abdominal cavity and can insert your trocar.

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36
Q

What MUST you palpate every time BEFORE you insert your trocar?

A

Palpate the aorta.

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37
Q

The trocar should be inserted how deep and at what angle?

A

Insert 2-3cm and angled at 45 degrees sacral (caudal)

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38
Q

To reduce the chance of abdominal lap adhesions, you could insert the lateral trocars where?

A

9th intercostal space, anterior axillary line

not sure if this is correct

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39
Q

another word for laparotomy

A

Celiotomy

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40
Q

The most laparascopic complication in general

a) GI injury
b) Post-op hemorrhage
c) Ureteral and bladder injury
d) Intra-abdominal infection
e) Injury to large vessels

A

a) GI Injury

port site hernias can also occur

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41
Q

In a lap you suddenly suspect retroperitoneal hemorrhage, immediately decrease co2 insufflation to______mmHg, and perform a ________procedure.

A

decrease to 8mmHg, and perform a midline laparotomy to clamp anything, then call vacular surgery ASAP.

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42
Q

Who refined the electrical generator?

A

William T. Bovie

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43
Q

What type of current is used in a bovie?

A

Monopolar VHF current (very high frequency?)

(bipolar can work in only instruments with a send and return

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44
Q

When cutting (vaporizing), do you….

a) hit the pedal then apply pressure to tissue
b) apply pressure, then hit the pedal

A

a) hit the pedal, then apply pressure to where you are cutting. (light pain brush pressure)

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45
Q

What does fulgeration do?

A

it coagulates

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46
Q

How do you dessicate tissue?

A

Touch the bovie to the hemostat forceps or whatever metal instrument you are using that’s holding the tissue

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47
Q

What type of cut is all cut, and minimal coag with the needle held just off the tissue, and the most minimal lateral tissue damage?

a) pure
b) blend
c) coag

A

a) pure

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48
Q

What type of cut has less cell explosion, and a moderate amount of dessication (coag)

a) pure
b) blend
c) coag

A

b) blend

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49
Q

What type of cut has no constant waveform, where tissue heats up and denatures proteins, causing dessication or fulgeration, and has the highest amount of collateral cell damage?

a) pure
b) blend
c) coag

A

c) coag

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50
Q

This type of cutting is with the tip NOT in direct contact with tissue, an arch is made to target tissue, and eschar forms.

A

fulgeration

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51
Q

This instrument uses a special gas to conduct monopolar RF current to the tissue. Less smoke and eschar (good for the liver). But can’t cut, can overheat, and increase intra-abdominal pressure in a lap (7/liters/min)

A

Argon beam coagulator

52
Q

This instrument produces vibrations at 55,000 cycles/second, producing less heat than electrosurgery, and no smoke/arc/neuromuscular stimulation/eschar. It can be used in patients with defibrillators.

A

Harmonic scalpel (cold knife)

53
Q

What does betadine have in it that can be set on fire?

A

Alcohol

Chlorhexidine is alternative

54
Q

How many people receive treatment for burns each year?

A

450,000

55
Q

How many people die from burns each year?

A

3,400

56
Q

What is your chance of surviving a burn if being treated at a burn center?

A

96.1%

57
Q

The most common source of a burn is….

a) scald
b) contact
c) fire/flame
d) electrical
e) chemical

A

c) fire/flame

in peds 4 is fire/flame

58
Q

What household item can easily remove tar, but the patient could be allergic to it?

a) Ketchup
b) Mayonnaise
c) Goo-gone
d) Soap and water
e) Simple green

A

Mayonnaise

good for tree sap too, but not on your car

59
Q

What risk of complication increases with circumferential burns?

A

Compartment syndrome (fasciotomy can deal with that)

60
Q

A patient has burns to the chest and shows poor chest expansion/excursion, what is the best procedure to perform?

a) Chest tube thoracostomy
b) Fasciotomy
c) Escharotomy
d) Needle decompression

A

c) Escharotomy

61
Q

what type of electrical current do you want to know when dealing with an electrical burn?

a) Amperage
b) Wattage
c) Voltage
d) Ohms

A

Voltage (500 and it can damage internal structures)

62
Q

What vaccine will you likely give them if you can’t get a vaccination history?

A

Tetanus

63
Q

More than 100 milliAmps of domestic house AC of 110 volts at 60 Hz is very dangerous to what organ?

A

the heart (causing v-fib)
(its not in the lecture, just nice to know)
(direct current DC is more likely to cause asystole)

64
Q

What degree of burns DON’T we use rule of nines?

a) 1st degree
b) 2nd degree
c) 3rd degree

A

First degree

65
Q

What method of estimating burns is most specific in pediatrics?

a) Rule of 9’s
b) Rule of palm
c) Lund and Browder Chart
d) Rule of 13’s

A

Lund and Browder chart

but use the modified rule of nines in the initial evalution

66
Q

When estimating small burns, how does the rule of palms work?

A

The patients palmar surface (hands and fingers both) is about 1% of their TBSA.

67
Q

The entire front of one arm is burned, what is the %?

A

4.5%

68
Q

The genitals are burned, what is the %?

A

Genitals: We are the 1 %

69
Q

The back of the head and anterior right leg are burned, what is the %?

A

13.5%

posterior head = 4.5, anterior leg = 9

70
Q

The entire hand is dipped in hot lava, what is the %?

A

2% (using palmar method)

71
Q

The entire body is dipped in hot lava except for one arm holding on to a Skynet microchip, what is the % burned?

A

91% (100-9)

72
Q

The font of one arm and the front of one leg is burned, what is the %?

A

13.5% (4.5 arm, 9 leg)

73
Q

The torso is burned circumferential, the palmar surface of one hand, and gentials, %?

A

38%

torso 36, hand 1, genitals 1

74
Q

The anterior FOREARM ONLY is burned….%?

A
  1. 25%

4. 5 if it were the whole anterior arm

75
Q

Which doctors who tried to save President John F. Kennedy after he was shot in Dallas on Nov. 22 came up with a formula for fluid resuscitation in burn patients?

a) Dr. Baxter
b) Dr. Dubowitz
c) Dr. Morton
d) Dr. Alison Tendler

A

Dr. Baxter created The Parkland formula. (modified for 2010 ABLS standards)

4ml of LR x Kg x BSA

76
Q

How much of that initial fluid resuscitation is given in the…..
first 8
second 8 hours
third 8 hours

A

1/2 within the first 8 hours
1/4 within the second 8 hours
1/4 within the third 8 hours

77
Q

A patient arrives in your ED with burns to both arms circumferentially plus the genitalia, and the bottom of one foot . You estimate his weight at 50 kg. How much fluid should you administer in the first 8 hours?

a) 4000ml Normal Saline
b) 2000ml Lactated Ringers
c) 2000ml Normal Saline
d) 3,040ml Lactated Ringers

A

C. 2000mL NS

(He has burned 20% of his body, 9 each arm, 1 for the genitals, and 1 for the bottom of one foot...just to make the math easy)
20% x 50kg x 4ml = 4000ml total
1st 8 hours: 2000ml
2nd 8 hours: 1000ml
3rd 8 hours: 1000ml
78
Q

The burned area itself should be managed with…

a) Cold water soaks
b) Dry sterile dressing
c) Wet-to-dry dressing
d) Leave open for optimum healing

A

b) Dry sterile dressing (DSD)

79
Q

Dry powder on the skin should be….

a) rinsed off with normal saline
b) rinsed off with Lactated ringers
c) brushed off
d) covered with dry sterile dressing

A

c) brushed off

80
Q

We have to intubate a burn patient who just arrived to the ED. You have chosen to give succinylcholine as a muscle depolarizer. Is it safe to give?

A

Yes, but only in the first 24 hours of the initial burn or else they get a big K+ rush.

81
Q

What is the half life of Carbon Monoxide in the lungs at 100% oxygen?

A

40 minutes.

82
Q

Which of these patients WOULDN’T you refer to a burn center?

a) inhalation burn
b) chemical burn
c) 2nd degree burn < 10% of BSA
d) third degree burn

A

c) 2nd degree < 10% BSA

83
Q

Which of these burned areas of the body wouldn’t you refer to a burn center?

a) Hands
b) Face
c) Buttock
d) Large joints
e) Feet
f) Genitalia

A

c) Buttock

84
Q

Which of these patients wouldn’t you refer to a burn center?

a) burns w/ accompanying co-morbidiites
b) burns w/ trauma, where the burn is the significant factor.
c) pediatric burns in hospitals w/o peds service
d) burns to multiple locations on the body
e) patients w/ social/emotional/rehab needs

A

d) Burns to multiple locations on the body

its not the number of “locations”, its the % we care about. >10% of BSA 2nd degree will go to burn center

85
Q

What are the systemic neurogenic effects of a burn injury?

a) Increased PVR, decreased CO
b) Increased PVR, increased CO
c) Decreased PVR, increased CO
d) Decreased PVR, decreased CO

A

a) Increased PVR, decreased CO

86
Q

Why would we give FFP or Albumin 24 hours post-burn?

A

To keep blood colloid osmotic pressure elevated to avoid 3rd spacing (capillary leakage).

87
Q

Is a lower hematocrit normal in the fluid resuscitated burn patient?

A

Yes, it’s due to dilutional anemia. An acceptable crit is around 30-35%. DO NOT GIVE RBCs unless you know its due to bleeding or trauma.

88
Q

Pediatric burns are considered as such under 40kg or less than 14. What is the only thing we change in the revised Parkland formula for them?

A

We give 3ml (instead of the adult 4ml)

3ml x kg x TBSA

89
Q

On top of fluid resuscitation in peds burns pts, what other fluid do they need?

A

A maintenance drip of D5LR (100-50-20 rule) (Glycogen stores are low in kids so they need the D5)

90
Q

In electrical burns, what is the parkland formula changed to?

A

Same as regular resuscitation requirements…

4ml LR x kg x TBSA = adult electrical burn
4ml LR x kg x TBSA = adults
3ml LR x kg x TBSA = peds (+ maintenance fluid)

91
Q

While adults need to put out atleast .5ml/kg/hour of urine. Peds (<40kg) need to output ____/kg/hour

a) .5
b) 1
c) 2
d) Not necessary to measure b/c they are too small to catheterize

A

b) 1ml/kg/hr

92
Q

A burn patient’s urine output is less than expected, you should…

a) Administer a bolus infusion of IV fluids
b) Administer diuretics
c) Increase titration rate of current fluids
d) All of the above

A

c) Increase titration rate

93
Q

Cellular/tissue damage occurs above what temperature?

A

111F, 44C

94
Q

From inside to out of a burn the three zones are…

a) Zone of Stasis, Zone of Hyperemia, Zone of Coagulation
b) Zone of Hyperemia, Zone of Coagulation, Zone of Stasis
c) Zone of Coagulation, Zone of Stasis, Zone of Hyperemia

A

c) Coag –> Stasis –> Hyperemia

95
Q

Pain and redness, heals in a few days, outer epithelial cells will peel.

a) 1st degree
b) 2nd degree (aka partial thickness)
c) 3rd degree (aka full thickness)

A

a) First degree

96
Q

Entire epidermis and portion of dermis involved, with pain, blisters, cap refill intact. Heals in 2-3 weeks.

a) 1st degree
b) 2nd degree (aka partial thickness)
c) 3rd degree (aka full thickness)

A 
2nd degree
(skin graft may help improve function and cosmetics)
97
Q

Entire thickness of epidermis and dermis, DECREASED pain, ABSENT cap refill. Heals by contracture and epithelial ingrowth.

a) 1st degree
b) 2nd degree (aka partial thickness)
c) 3rd degree (aka full thickness)

A 
3rd degree
(definately skin graft them)
98
Q

If transfer to a burn unit is delayed, which is these should you NOT do?

a) Premedicate with analgesic
b) Debrid loose epidermis and blisters
c) Soap and water wash
d) Apply wet dressings
e) Apply topical antimicrobial such as Silvadene

A

d) Apply wet dressings

should always be a DSD

99
Q

Which of these is least helpful as an indication for a peripheral escharotomy or fasciotomy?

a) cyanosis of the distal limb
b) presence of edema
c) unrelenting deep tissue pain
d) progressive numbness
e) progressive decrease/absence of pulse

A

b) presence of edema
(not in itself an indication for an escharotomy)

(if a multi-incision escharotomy is not sufficient, perform a fasciotomy)

100
Q

Antibiotic of choice in facial burns

A

Erythromycin

101
Q

Diagnotic test of choice in ocular burns

A

Fluoroscein Stain

102
Q

True or False: Burns in a child that appear partial-thickness may actually be full thickness.

A

True

103
Q

A 130 degree burn will cause sever damage to an adult in 30 seconds, whereas in a child it will occur in ______seconds?

A

10 seconds

104
Q

Whats the song for the modified pediatric rule of nines?

A

15-16-18-10, Legs-chest-head-out-to-my-hand

105
Q

What movie starred Al Pacino and Robert DeNiro as cops in Bridgeport”s burn unit?

a) The Godfather pt II
b) Heat
c) Ritcheous Kill
d) Weekend at Bernie’s

A

Ritcheous Kill

106
Q

A mother brings her badly burned young son into your ER. He has burns to both hands and both feet that end at the wrist and ankle with a well demarcated transverse line, you immediately think…

A

child abuse

107
Q

What suture material is the most irritative to local tissue?

A

Silk

108
Q

The point of entry of a burn tends to be….

a) scattered and vesicular
b) more extensive and explosive
c) large but not painful
d) depressed and leather

A

d) depressed and leathery

109
Q

The exit point of a electrical burn tends to be…

a) depressed and leathery
b) large but not painful
c) more extensive and explosive
d) scattered and vesicular

A

b) more extensive and explosive

110
Q

What is best probe and setting to use for a Focused Assesment of Sonography in Trauma scan?

a) Phased Array, 5mHz
b) Linear Probe, 7.5mHz
c) Convex Probe, 3.5mHz
d) Concave Probe 3.5mHz

A

c) Convex probe, 3.5mHz

2. 5-3.5 range

111
Q

Which of the following is the worst INITIAL procedure in evaluating hemoperitoneum in blunt abdominal trauma?

a) exploratory laparotomy
b) CT scan
c) DPL
d) FAST scan

A

a) exploratory laparotomy

112
Q

What year was ultrasound technology first described?

a) 1954
b) 1971
c) 1997
d) 2009

A

b) 1971

113
Q

What year did we coin the phrase Focused Abdominal Assesment for Trauma?

a) 1954
b) 1971
c) 1997
d) 2009

A

c) 1997

114
Q

Who studied 1540 patients and reported that ultrasound was the most sensitive and specific modality for the evaluation of hypotensive patients with BAT (sensitivity and specificity, 100%)>

a) Johnson & Johnson
b) S. Wozniack et al
c) Rozycki et al
d) Ditcher, Quick, and Hyde

A

c) Rozycki et al

115
Q

When U/S waves contact an organ, some are reflected and some are transmitted through the organ or tissue. Reflected return to the transducer and generate electrical impulses that are converted to the image seen on the monitor, this is known as….

a) Piezoelectric effect
b) Pulse echo principle
c) Path of least resistance principle
d) Tesla phenomenon

A

b) Pulse echo effect

116
Q

When crystals expand and contract to interconvert electrical and mechanical energy, this is known as the…

a) Piezoelectric effect
b) Pulse echo principle
c) Flux capacitator principle
d) Drift velocity

A

a) Piezoelectric effect

117
Q

The FAST pericardial window is best viewed on which axis?

a) Coronal
b) Transverse
c) Oblique
d) Saggittal

A

d) Saggital

118
Q

In a FAST scan, Morrison’s Pouch (perihepatic) and Perisplenic windows are best viewed on which axis?

a) Coronal
b) Transverse
c) Oblique
d) Saggittal

A

a) Coronal

119
Q

In a FAST scan, Douglas’ Pouch (bladder) window is best viewed on which axis?

a) Coronal
b) Transverse
c) Oblique
d) Saggittal

A

b) Transverse

120
Q

Who developed a scoring system based on the identification of hemoperitoneum in specific areas, to help the FAST scan identify the need for immediate abdominal surgery?

a) Dewey, Screwum, and Howe
b) PT Barnum
c) Nguyen et al
d) Huang et al

A

d) Huang et al

121
Q

Which of these is NOT indicated in applying to the burn patient with a delayed transfer to the burn unit?

a) Silver Sulfadiazine
b) Bacitracin
c) Gauze wrap
d) Mefanide Acetate

A

b) Bacitracin

Silver Sulfadiazine and Mefanide are both antimicrobials, but Bacitracin is not indicated

122
Q

Which of the following is THE BEST ANSWER regarding the management of inhalation burns?

a) Bleeding is highly likely, prevent via insertion of a Blakemore
b) Airway structures will likely swell significantly, intubate earlier than usual
c) Nausea and vomiting are likely to be aspirated and should be prevented with Ondansetron
d) Do not stabilize the c-spine because of risk to airway occlusion

A

b) Swelling is likely to occlude the airway, intubate earlier than usual.

123
Q

What is the most important additional test to perform in the initial assessment of a patient with an electrical burn?

a) Chest x-ray
b) Venous blood gas
c) EKG
d) CT Head and Neck

A

c) EKG

Although a chest x-ray should be performed in addition to an ABG, it is not the going to evaluate the most serious complication from an electrical injury (arrhythmia, v-fib, asystole)

124
Q

True or False: Venous CO sampling is just as reliable of an indicator for CO poisoning as Arterial CO sampling?

A

True

according to two different published studies comparing the two, i didn’t look at the peds test yet

125
Q

What type of suture is best for deep wounds?

A

Vertical mattress

126
Q

desired urine output in hemochromogenuria (red pigmented urine)?

A

1.0-1.5 typically from high voltage injury or soft tissue mechanical trauma

127
Q

What carbonic anhydrous inhibitor antimicrobial cream causes lactic acidosis?

A

Mafenide acetate (Sulfamylon)

surgery (4 decks)

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