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Surgery Lab Office
Common Office Procedures
| Question | Answer |
|---|---|
| lIdocaine | AmIde (longer half life than esters) |
| Procaine | Ester (shorter half life than amides) |
| MOA of local anesthetics | block action potentials |
| ___ fibers are blocked bfore __ fibers | C (pain) before A (motor). Clinically, loss of pain, temp, touch, then motor |
| Procaine, Benzocaine adn Cocaine are | Esters |
| Lidocaine, Bupivacaine are | Amides |
| What is used for long acting peripheral infiltration | Bupivacine (Marcaine) |
| ____ are prone to causing "allergic" rxns (PABA metabolite) | Ester. |
| If someone has liver failure, choose an | Ester |
| Where are amides metabolized? | In the liver. Don't use in someone who has liver failure or severe compromise |
| _______ is a local anesthetic that causes local vasoconstriction | Epinephrine. Increases local duration of action, decreases systemic toxicity. |
| If lidocaine burns, what can you add to it to decrease the pain? | SODIUM BICARBONATE; neutralizes pH of anesthetic, decreases timem of onset of conduction blockade |
| Which sx occur first neuro or cardio? | Neurologic: early - lightheaded/dizzy, visual disturbance, tinnitus. Late - perioral numbness, muscle twitches/tremors, seizure. Cardiovascule sx - hypotension (vasodilation), cardiac arrhthymia. |
| Is slurred speech an early neurological sign? | NO. Early sx: lightheaded/dizzy, visual disturbance and tinnitus |
| Safe dose of Lidocaine | 3-5mg/kg. |
| Right before injecting, what should you do once you've entered skin? | Pull back on syringe to make sure you haven't entered a vessel |
| What should you do to Xylocaine before using it? | Warm it to body temperature (Lecturer has never done this, ideal) |
| Buffered Lidocaine is made of | Bicarb:Xylocaine in 1:9 part ratio |
| List the types of biopsies | Shave, punch, incisional, excisional |
| Downside of Shave biopsy | No architecture, no orientation (anterior, superficial), so can't stage it. |
| When should you do shave biopsy? | If you have low suspicion of malignancy. Do not do it in any pigmented thing where you suspect malignancy |
| Use this for all pigmented lesions for full-thickness skin and subcutaneous fat | Punch biopsy. Sizes 1-8mm. Usually needs one or two sutures |
| When would you do an incisional biopsy? | Large sarcoma. |
| What type of incision should you make for an excisional biopsy? | Eliptical;. Length to width ratio of 3:1. Benefits: architecture and margins |
| Deep dermal suturing | Deep to superficial on one side, superficial to deep on the opposing side |
| treatment for paronychia | I&D |
| Felon (infection of terminal phalanx) can cause | tissue necrosis or Osteomyelitis. Treatment is I&D. |
| Subungual Hematoma Tx | Drill a hole in the nailbed with a sharp-pointed scalpel blade |
| Furuncal Definition | an infection/abscess of the hair follicles caused by obstruction. |
| Carbuncle definition | cluster of furuncles |
| Tx of Furuncle | I&D, insert scalpel at most fluctuant spot. Make a cross incision. |
| Nontender, freely mobile, soft are charactersitcs of | limpomas. Benign fatty tumor. Tx: excision if symptomatic only. |
| ______ arise from obstructed follicles and contain cheesy and fetid debris | Epidermal Inclusion Cyst. I&D and remove cyst lining |
| Seborrheic Keratosis | "crusty brown sugar appearance". benign |
| Actinic Keraotosis | may be pre-cancerous. Appear in sun-exposed areas. |
| Basal Cell Cancer | Pearly (less dangerous than Squamous). |
| Squamous Cell Cancer | more crusty looking, more dangerous than Squamous. |
| Tx for Basal and squamous cell cancer | Excision with at least .3cm radial margins, Mohs micrographic surgery, radiation therapy (after resection depending on staging) |
| Most worrisome skin cancer | Melanoma. Rx: punch biopsy or excisional biopsy (NOT SHAVE BX). Need to know depth. Definitive Rx: excise all the way down to fascia. |
| Wound with a flap is known as | avulsion |
| What is the critical number of bacteria needed to be present to call a wound infected? | > or equal to 10 to the 4th power of bacteria/gram of tissue |
| <12 hours old is a | contaminated wound. Infection rate 1-21% |
| Definition of dirty wounds | >12 hours, presence of Fb, gross contamination. Infection rate 7-38% |
| Most important factor when deciding to close a wound? | Age of the wound. If >24 hours, don't close |
| What solution should be used for wet to dry packing? | Saline, not sterile water |
| Important points of wet to dry dressings | Wet (not soaked), use saline solution, facilitates mechanical debridement of the wound, DOES NOT prevent bacterial colonization of infection |
| Suture for face? | 6-0 prolene |
| Thigh wound where you can see muscle? | Absorbable deep, nylon superficial. 2-0 or 3-0. Keep in for two weeks unless DM or on Immunosuppressants (then keep in longer) |
| Where is Vicryl (absorbable used)? | utilized below the skin, inside mouth, or where suture removal is difficult. Vicryl lasts 90-120 days |
| What will you use for most skin closures? | Non-absorbable |
| What may be a good option for scalp, trunk or some extremity wounds? | Staples |
| What suture size do you use for trunk and extremities? | 3-0 or 4-0 |
| Antibiotics are indicated when? | Open fracture where you can see bone |
| Clostridium tetani is what type of bacteria? | Gram-positive anaerobe |
| Not appropriately immunized people who have a dirty, tetanous prone wound are given | Tetanus toxoid and Tetanus immunoglobulin |
| When should tetanus toxoid be given? | patients tetanus immunization unknown or <3 doese, wound >24 hours old, if the pt's last booster dose was >5 yrs (if dirty wound) or >10 years (if clean wound) |
Created by:
ltm12