Wound Inf. +AntimicrobUse/ Tissue Handling/Sx Hemostasis Flashcards
Which of the following is FALSE regarding surgical site infections?
a.Risk of infection increased by 2x with every hour increase in surgery time
b.With each hour of anesthesia there is a 30% increase in risk for surgical site
infection
c.With surgery, you have a increase in circulating total lymphocytes, CD4+
T-lymphocytes, and CD8+ lymphocytes
d.Propofol use can increase risk of surgical site infections in dogs and cats
c.
With surgery, you have a DECREASE in circulating total lymphocytes, CD4+
T-lymphocytes, and CD8+ lymphocytes
Which of the following has not been shown to have an increased risk for surgical site infection? a.Patients with hyperadrenocorticism b.Patients with diabetes mellitus c.Patients with hypothyroidism d.Intact male dogs and cats
B
b.Patients with diabetes mellitus
Which is true?
a.Gram positive activity increases and Gram negative activity decreases as one
progresses from first to third-generation drugs.
b.The antibiotic is administered within a 2 hour period before the surgical incision is
made.
c.The antibiotic should not be administered beyond 24 hours post surgery, unless a major break in sterile technique or an unexpected change in
contamination classification.
d.Time-dependent antibiotic growth inhibition is dependent on the peak
concentration of the drug (Cmax) at the site of infection.
C
a.Gram positive activity DOWN and Gram negative activity UP as one
progresses from first to third-generation drugs.
b.The antibiotic is administered within a 1 hour period
d. concentration dependent (Cmax)
Bacterial load throughout GI tract? (Dudley question)
a. Stomach
b. SI
c. Colon
a. Stomach - 10^3
b. SI - 10^6
c. Colon - 10^12
Which of the following is false?
a. Heuristics are elements of skill and are especially needed for surgery
b. There are 3 types of heuristics
c. Cognitive heuristics is being able to recognize tissues
d. Motor heuristics is being able to handle tissues
e. Haptics is a form of perceptual heuristics
C
False - perceptual
Name the 7 Halsted principles:
•BADHATG
or
Go Down PATH A
Gentle tissue handling eliminate Dead space Preserve blood supply to tissues strict Aseptic technique minimize Tension appropriate Hemostasis Appose tissues accurately
True or false: The blood supply in the wound edge is directly proportional to the wound closure tension.
(False, inversely proportional)
Which of the following is not an appositional suture pattern? • Simple interrupted • Modified gambee • Half-buried vertical mattress • Horizontal mattress
D Horizontal mattress
Which of the following is false regarding continuous Lembert sutures?
• It is used to close large hollow viscera (e.g. stomach, urinary bladder, stomach)
• It has parallel purchase
• It has partial thickness purchase
B (false, this is Cushing and Conell, Lembert is perpendicular)
Which is FALSE?
• Two-handed knots offer the advantage of allowing the greatest precision in maintaining constant suture tension during tying
• One-handed ties utilizing the nondominant hand are efficiently placed but provide less suture tension control.
• Hand ties generally use more suture than instrument ties
• Knot security is related to the coefficient of friction of the suture and represents the force required to cause a knot to form.
D (…knot to slip)
What are the five tenets of suture tying?
The simplest secure knot for the suture material and the situation is the goal.
• When tying a knot, avoid friction between strands, as suture weakening may result. Avoid vertical tension on suture strands when tying knots, to minimize friction.
• Use appropriate tension when tying knots.
• Tie each knot by pulling the two suture ends in opposite directions with uniform rate and horizontal tension.
• Avoid damage to the suture material when tying knots by never applying needle holders to any portion of the suture that is to remain in the patient
Which is FALSE?
• Net tensile strength of the suture line or ligature is determined by the initial tensile strength of the suture and the knot security.
• The weakest point in a suture line or ligature is practically always the knot.
• Relative knot security is defined as knot-holding capacity in percent of the tensile strength of the suture.
• Synthetic absorbable suture materials tend to have a relative knot security approximating 42%.
D (67%)
Which of the following is a technique for blood flow reduction as a method of hemostasis? • Topical ephedrine • Hypotension • Distant vascular clamps or snares • Tourniquets • All of the above
D all
also hypothermia, reduced perfusion
Which vessels can be permanently ligated in dogs, but not in cats?
• Both common iliac veins, hepatic vein
• Both jugular veins, both common carotid arteries
• Femoral arteries, both jugular veins
• Left renal vein, femoral arteries
B (if vertebral artery is present and circle of Willis is functional)
A(both species)
C(femoral arteries in both)
D(dog only for left renal vein)
Which of the following is a false statement about tourniquets?
• Consequences of tourniquet use include intramuscular swelling, and degeneration of myelin of compressed nerves
• Application of a tourniquet does not vary between different sized patients.
• The recommended cuff pressure to achieve tourniquet affect is 100 mm Hg above the patient’s systolic pressure
• The maximum time for a tourniquet is 1.5-2 hrs.
B (False P = T/ RW so a tourniquet applied with the same pressure as a larger patient would result in a higher pressure on a smaller patient because of the smaller limb radius) similar to LAPLACE’S LAW - NxT/RxW
rec time (thought to correspond to the point at which muscle ATP stores are depleted)
Name risk factors associated with SSI (6)?
Duration of surgery Duration of anesthesia Surgical site preparation Method of wound closure Antimicrobial prophylaxis Comorbidities
The risk of SSI increases with _____ hour of surgery
each
Name some potential problems/complications associated with surgical site preparation (6)
Traumatic clipping, poor maintenance of clipper care, excessive scrubbing, use of harsh biocides, recontamination of prepared sites, inadequate contact time for biocides
True or false: Although stainless steel skin staples provide rapid wound closure with a tighter seal, they may induce an exaggerated inflammatory response and have increased bacterial attachment
True
According to Turk et al., 2015- what is the SSI rate of all surgical procedures?
3%
Redosing every \_\_\_ half-lives of the drug is indicated for time-dependent antimicrobials 1 1.5 2 2.5
2
What is the half-life of cefazolin?
47min
A large prospective TPLO study in Canada found (A. Nazarali et al.);
An increase in SSI was observed when the initial dose was administered > __ minutes from first incision.
50
70
90
100
100
Name arteries/veins that can be occluded temporarily? (7)
Hepatic artery and portal vein Femoral A Renal A Caudal VC Carotid A Aorta tumor A blood supply
Name arteries/veins that can be permanently ligated in both dogs and cats? (11)
Brachiocephalic V Brachial A Hepatic V Femoral A; femoral V both external iliac A both common iliac V abdominal VC caudal to liver in case of chronic compression and established collateral circulation OR concurrent right nephrectomy
Name arteries that can be permanently ligated in DOGS only (2)?
both common carotid A if vertebral A is preserved and circle of willis is fxnl
Left renal vein
What vessels can up temporarily ligated up to 30 min?
Hepatic A; Renal A + V; Abdominal aorta
What vessels can up temporarily ligated up to 15-20 min?
splenic A+V
What vessels can up temporarily ligated 10-15 min?
Portal triad (hepatic A, portal V, common bile duct)
What vessels can up temporarily ligated 5-10 min?
descending thoracic aorta
Which hemostatic mineral forms a clot independent of the clotting cascade, and can therefore form a clot in the presence of heparin and warfarin?
chitosan
Which is true?
A Ethamsylate improves platelet formation in the presence of vascular injury.
B Desmopressin can improve pancreatic blood flow in the presence of acute necrotizing pancreatitis in dogs and may have an antiinflammatory effect
C Zeolite is a crystalline mineral compound with a high surface area. Zeolite absorbs water to concentrate clotting factors and platelets, activates platelets, and releases calcium ions that activate the coagulation cascade
D Chitosan is thought to stimulate the “glass effect,” which is seen when the surface negative charge of glass promotes rapid onset of blood clotting
Ethamsylate: adhesiveness and aggregation of platelets, pancreatic blood flow
C true and has glass effect
D Chitosan has a high surface area, which rapidly forms a stable gel-like clot on contact with blood
Which is true?
A Desmopressin (DDAVP) is a synthetic analogue of guanine vasopressin that stimulates the release of von Willebrand factor and factor VIII from endothelial cells
B Desmopressin can be used to prevent and treat bleeding in patients with and without von Willebrand factor (vWF) deficiencies
C The main side effects are related to the antidiuretic effects, causing hypernatremia and water retention.
D There are no publications on the use of DDAVP in cats
A Arginine vasopressin
B Desmopressin Does NOT affect hemostasis in normal patients
C The main side effects are related to the antidiuretic effects, causing__and water retention. HYPOnatremia
D true
What are two categories of antifibrinolytics? What are their differences?
- serine protease inhibitors (aprotinin)
- Lysine analogues (epsilon-aminocaproic acid, tranexamic acid),
* both inhibit plasmin- or plasminogen-mediated fibrinolysis
* Lysine analogues generally are much more potent than serine protease inhibitors
What is the most common active hemostatic agent? Alginates Thrombin gelatin matrix Thrombin fibrinogen/collagen fleece
C thrombin
Which of the following is not a mechanical hemostatic agent? A Gelatins B Chitin C Collagens D Wax
B Chitin (hemostatic polymer/mineral) Gelatins, Collagens, Wax \+ include oxidized cellulose and polysaccharide spheres +/- oxidized cellulose
Which of the following is not a group of hemostatic agents? What do each of them do? A Mechanical B Biologic C Active D Hemostatic sealant
A Mechanical - absorb blood to provide a mechanical barrier or tamponade further bleeding, also create matrix for clot formation
B is BS ;)
C Active - stimulate normal hemostasis or improve hemostasis
D Hemostatic sealant - products created for sealing of vascular or dural defects without utilizing endogenous hemostatic mechanisms - like glue
Whats the suggested maximum time a Esmarch tourniquet should be applied for?
Most recommendations suggest a maximum time of 1.5 to 2 hours, which is thought to correspond to the point at which muscle adenosine triphosphate (ATP) stores are depleted.
When can you define an infection as nosocomial infection?
arises 48hrs after hospitalization
what gene accounts for MRSA
mecA gene → methicillin resistance
