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NPLEX Clin
Minor Surgery
| Question | Answer |
|---|---|
| Forceps with teeth cause more or less trauma to tissue? | Less |
| What are hemostats for? | Clamps to remove scalpel blades, hold tourniquets, hold skin tags, toenails, etc. |
| What scalpel do you use for I & D? | #11 |
| What scalepel do you use for excision? | #15. Also use for trimming, dissecting. |
| What scalpel do you use for thick, tough skin excising, trimming, or dissecting? Like back, scalp... | #10 |
| Most reliable method of sterilization | autoclave |
| Which will have more tissue reaction, natural or synthetic sutures? | natural has more tissue reaction because destroyed by enzymes |
| Multifilament sutures are | braided, stronger, but harbor more microorgs. |
| What do you apply with steri-strips? | Benzoin |
| How many knots do you use for 4-0 suture? | 5, always sew one more knot than gauge of suture. |
| What are things for sterile field? | 1. drapes, 2. gloves, 3. syringes/needles/sutures, 4. wound/skin prep |
| How do you prep when doing elective excision on intact skin? | 10% betadine |
| How to you clean open trauma wounds? | irrigate with normal saline (0.9%), flush with 35 ml syringe + 19 gauge needle. |
| Which layer of skin has keratinocytes | epidermis |
| which layer of skin is CT, most imp for wound healing? | dermis |
| which layer is loose CT and fat cells? | subcutaneous |
| What are 4 stages of wound healing? | hemostasis, inflammation, granulation, remodeling. |
| What is partial thickness wound? | loss of epi and some dermis. Heal with 1* intention (stitches) |
| what is full thickness wound? | loss of epi and full dermis (heal with 2* intention- close naturally) |
| bites, large puncture wounds | delayed 1* intention or 3* intention (clean with ab, let heal a little bit, then stitch). |
| What is most common, easy, versatile suture? | simple interrupted |
| con of simple interrupted? | can cause railroad scarring, difficult to evert. |
| How do you do simple interrupted? | distance b/t sutures should = length of suture across incision. Use nylon or prolene. |
| When use vertical mattress stitch? | Better eversion, good for cosmetic, wounds with tension (palms, soles of feet), or loose skin which tends to invert. Con: railroad tracks. Use nylon, prolene. Far, far, near, near. |
| When do you do deep or buried stitch? | Decrease tension and dead space in larger, deeper wounds (removal of lesions). |
| How do you do deep/buried stitch? | Knots inverted, below skin, used speringly. vicryl or dexon (absorbable) suture. Buried= level of dermis deep= level of subq/muscle |
| When do you use subq, intradermal running stitch? | good for cosmetic clean wounds, like surgical incisions. In dermis, not visible. No tracks. |
| What are non-absorbable sutures made of? | nylon/prolene |
| What are absorbable sutures made of? | vicryl, dexon. |
| What do you use for a fast stitch, like scalp or episiotomies? | continuous running stitch |
| What do you use for high tension support to hold skin together to stop bleeding on thin, fragile skin? NOT ON FACE! | Horizontal Mattress Stitch |
| What do you use for triangular wounds? | 3 pt half-buried mattress stitch |
| What is most common wound infection on day 4+ | staph aureus. |
| How do you treat purulent wound with sutures? | systemic ab, if purulence then remove sutures, and leave wound open to heal by 2* intention without ab. |
| What is mech of action to local anasthetics? | block Na uptake into cell, preventing threshold potential. |
| What is topical lidocaine strength? Onset/duration? | 2-4% solution. Onset 4-10 mins. Duration 30-60 mins. |
| What is dose of injected lidocaine? | Max dose is 300 mg or 30cc of 1% solution in 1.5-2 hr increments. |
| What is max dose of epi? | Less than 0.2mg of 1:200,000. |
| What size needle do you administer anasthetic? | Smallest, 27-30 gauge. slowly. buffer maybe with sodium bicarb. |
| How do you tx puncture wounds? | Clean, tetanus shot, leave open! |
| How do you tx abrasions? | Clean, remove contaminants, dress. |
| What is boiling point of cryotherapy? What chemical? | -50*C, with liquid nitrogen. |
| What is ratio of elliptical excision? | 3:1 length:width, corners 30 degrees. |
| How do you orient ellip excision? | Parallel to RSTL. |
| anasthesia for ellipt excision? To clean? | field block, then betadine. |
| blade for ellipt excision? | #15 |
| store biopsy for ellip excision? | 10% formalin with label. |
| What do you use for punch biopsy? | Trephine, 4 mm most common. |
| What do you do I & D on abscess? | When fluctuant |
| What blade for I & D? | #11. |
| WHat do you do after incise, break up adhesions/loculations, irrigate with normal saline? | Then loosely pack with 1/4 to 1/2 iodoform gauze or plain gauze, leave protruding tails, apply thick, clean , dry dressing. |
Created by:
DrMel