Surgery concepts/ Terms
Terms
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- How long should wet compresses be used?
- No more than 24 hours, may result in skin maceration
- When is posterior splinting most useful?
- For quick and initial mobilization of acute injuries, such as nondisplaced fractures and severe ankle sprains
- What type of environment is optimal for wound healing?
- 1.)Free from dead tissue 2.)Free and protected from infection 3.) Moist at the wound surface (but not wet)
- What are the signs of an infected wound?
- 1.Increased pain 2.Erythema around wound 3.Discoloration of wound bed tissue 4.Pus or increased drainage 5.Odor 6.Wound dehiscence
- Indication for Thumb spica splint
- Thumb sprain, scaphoid fracture, immobilization following laceration repair
- Indication for Ulnar gutter
- 4th and 5th metacarpal fractures
- indications for a Radial gutter
- 2nd and 3rd metacarpal fractures
- 4. Upper extremity posterior splints
- Bicep tendonitis, radial head fracture, stable distal humerus fracture
- Lower extremity posterior splints
- Stable ankle fractures
- What are indications for use of cast braces?
- Used to hold a fractured bone immobile while allowing for joint motion above and below the fracture site, allowing for early ambulation and rehabilitation
- Name the different layers that are applied to create a cast
- 1.Stockinette 2.Webril (soft cotton roll) - two to three layers, more over bony prominences 3.Plaster or fiberglass bandages
- Name the pre and post splint checks
- FACTS - Function, Arterial pulse, Capillary refill, Temperature of skin, Sensation
- How long do you leave sutures on the face for?
- 3-5 days
- How for sutures on the trunk
- 7-10 days
- How long for sutures on the upper extremities?
- 10-12 days
- How for sutures on the lower extremeties?
- 12-16 days
- In which patient populations should sutures be kept in longer than usual?
- In those who are immunosuppressed, on steroids, or who have poor nutrition, including those with diabetes and peripheral vascular disease
- In those who are immunosuppressed, on steroids, or who have poor nutrition, including those with diabetes and peripheral vascular disease
- On tissues with poor collateral circulation, such as the nose, fingers, or ears, as it may cause ischemia
- List four types of absorbable sutures
- Plain gut, chromic gut, Dexon and Vicryl
- What is the source of plain and chromic gut?
- Bovine small intestine
- Which has more tensile strength, plain or chromic?
- Chromic (14-21 days) Plain (7-14 days)
- How long is tensile strength retained in Dexon and Vicryl?
- 14-21 days
- Name the most common nonabsorbable sutures
- Silk, nylon, polypropylene, steel
- Surgical wound classification: CLEAN
- Breast biopsy, inguinal hernia repair without break technique
- Surgical wound classification: Clean Contaiminated
- GI,GU, Gyn organs entered. NO gross contamination, minor break in technique
- Surgical wound classification: Contaiminated
- Perforated appendectomy, colectomy for diverticulitis, perforated ulcer or bowel, penetrating GI trauma
- Surgical wound classification: Dirty
- Traumatic wounds, burns older than 72 hrs, free colon perforation.
- What size suture would you use in the following areas? 1.Chest 2.Abdomen 3.Skin 4.Blood vessels 5.Eye surgery
- Largest is No. 7, smallest is 11-0 1.No. 6 2.No. 1 3.3-0 4.5-0 through 7-0 5.8-0 through 10-0
- When should perioperative antibiotics be given?
- One hour prior to skin incision
- Which antibiotic should be given perioperatively?
- Depends on type of operation: First gen cephalosporin if no anaerobes expected Second gen cephalosporin if anaerobes likely
- What are the 5 W's of post-operative fever?
- Wind (within 48 hours) - Atelectasis Wound (5-7 days) Water (3 days) - UTI Walk (7-14 days) Wonder Drugs (anytime)
- Wet Dressings
- used for infected wounds, which are left open and treated with regular irrigations
- Wet Compresses
- indicated for a variety of problems DON"T LEAVE ON FOR LONGER THAN 24 HRS- skin maceration and breakdown can occur
- Penrose Drains
- used to drain small wounds
- Sump drains
- used to decrease fluids from large abscesses, peritoneal cavity or biliary fistulas. -Hooked up to suction. -Suture down -Dressing applied
- Scalpel blade #10
- General purpose; hold handle parallel to cutting surface; used with a #3 handle; Cutting edge is midway between tip and its attachment to the handle. DON'T hold like a pencil.
- Scalpel blade #15
- Cutting edge close to the tip; used for fine, delicate cutting; This scapel/blade combo should be held like a pencil.
- Scalpel blade # 11
- "Stab blade" Cysts, abscesses etc.
- Scalpel blade #12
- "hook blade" Used to cut into the side of a vessel; avoid going all the way through the other side
- Intrinsic factors for infection
- 1) malnutrition 2) Age 3) obesity 4) chronic dz 5) remote focus of infection ( UTI, Resp tract) 6) impaired defense mechanisms' 7) stress
- Power of pathogenicity
- infection= # organisms x Virulence/ Host resistance
- 9 D's of infection
- Delayed healing Discomfort Distress Dependency Disability Deformity Dollars Death "De-Lawyer"
- Sources of contaimination
- #1=PEOPLE 2 Fromites 3 Air 4 human errors
- 4 specific clinical signs of appendicitis
- 1. Dunphy's sign: Pain with coughing 2. Rovsing's sign: pain in RLQ during palpationof LLQ 3. Obturator Sign: pain on internal rotation of the hip ( pelvic appendix) 4. Iliopsoas sign: Pain on extension of the right hip
- Simple Appendicitis
- WBC is mildly elevated
- Complicated ( gangrene & perforation)
- High WBC >20,000
- US for a appendicitis?
- sensitive 85% Specific 90% Use for children and Pregnant pts. Disadvantage: operator-dependent; patient factors ( obesity & bowel gas)
- Serum Albumin
- > 3.5 g/dL normal 3.0 - 3.5 g/dL mild depletion 2.5 - 2.9 g/dL moderate depletion < 2.5 g/dL severe depletion
- Signs of hypovolemic shock
- CO decreases HR increases LV filling dec systemic resistance increases
- Signs of Neurogenic shock
- CO dec or no chng HR dec or no chng LV fill press= dec or no chng Systemic resistance DECREASES
- Signs of septic shock
- CO increases HR increases LV fill press= dec or no chng Systemic resistance DECREASES
- Compressive Shock
- CO dec HR inc LV fill press= INCREASES
- Cardiogenic shock
- CO DECREASES HR can go all ways LV filling press= inc systemic resistance= no chng/ inc
- <20% blood vol loss
- Mild hypovolemia dec pulse pressure postural hypotension cutaneous vasoconstriction collapse neck veins conc urine hemoconcentration
- 20-40% blood loss
- Moderate hypovolemia Thirst Tachy moderate hypotension Oliguria
- >40% blood loss
- Severe hypovolemia AMS arrhythmias ischemic EKG changes profound hypotension
- Physical signs of Neurogenic shock
- warm flushed skin bradycardia
- Septic shock clinical manefestations
- fever chills bounding pulses warm flushed skin in the setting of Hypotension
- Late septic shock
- hypothermia coagulopathy Pulmonary failure (ARDS) renal failure