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Surg Labs

Surgery

QuestionAnswer
Face and Neck: leave suture in for: 3 – 5 days
Trunk: leave suture in for: 7 – 10 days
Upper extremities: leave suture in for: 10 – 12 days
Lower extremities: leave suture in for: 12 – 16 days
Do not close: deep puncture wounds, human bites, grossly infected wounds (wounds should heal by secondary intention)
Wound closure: at 3-4 days if wound not infected: delayed primary closure
Maximum dose lidocaine 7mg/kg with epi, 4.5 mg/kg w/o epi
Keep sutures in longer in pts with: steroids, immunosuppression, poor nutrition
Suture size: chest 6 or 7
Suture size: abd closure 0 to 3
Suture size: skin 2-0 to 5-0
Suture size: CABG 6-0 to 8-0
Plain gut vs chromic: Plain gut is more rapidly absorbed than chromic
Least reactive non-absorbable sutures Nylon and polypropylene
Nylon sutures High tensile strength, low tissue reactivity, excellent elasticity and pliability; Favored for construction of interrupted percutaneous closure
3 parts of suture needle point; body; swage
On skin, always use this type needle: Cutting needle (4-0)
Suture blood vessel: 8-0 for CABG; about 6-0 atraumatic (not cutting) for vessel
Suture type easiest to handle: silk
Strength in properly tied square knot: 80-90% of strength of untied suture
Absorbable sutures: which are absorbed: chromic
Can use lido w/epi on scalp? Yes (not on fingertips, toes, ears, nose)
Plain gut: suture loses tensile strength after: 1-2 wks
Chromic: suture loses tensile strength after: 2-3 wks
Purposes of bandages protect wounds from contamination and may also provide compression, support, and/or absorption
Purpose of dry dressing where the skin is intact or the skin edges are approximated and present a dry surface
Purpose of non-adherent dressing used if a wound has a raw surface
5 categories of bandage material Gauze; Elastic adhesive; Muslin; Outing flannel; Cotton elastic
Gauze generally used to hold dressings in place.
Elastic adhesive preferred for fixation of dressings in areas where it is difficult to hold a bandage in place & where expansion and contraction is necessary (i.e. chest).
Muslin used as straps and to hold traction tape in place on extremities.
Cotton elastic woven in a manner that provides considerable elastic properties; used to lend support and apply even pressure.
Dressings may be held in place by: adhesive strips, collodion spray or by bandaging
Use of Montgomery Straps: (adhesive straps); when repeated dressing changes are required
Indication for: Circular bandage: used over tubular structures such as the arm
Indication for: reversed spiral bandage: used for tubular structures of changing diameter(leg or forearm)
Indication for: spica bandage: used to cover two parts of unequal size such as the shoulder and chest or thumb and hand and groin
Indication for: recurrent bandage: used on distal stumps
Indication for: figure-of-eight bandage: used over joints, (elbows and knees)
Collodion spray for small lacerations (esp scalp); saturate gauze layers w/ collodion
Wet dressings used for infected wounds, which are left open and treated with regular irrigations.
Wet compresses superficial applications; do not use wet compresses continuously for more than 24 hours or skin maceration and breakdown may occur
Types of supports used with dressings metal, wooden, fiberglass, or plastic splints; plaster-of-Paris
Synthetic casts advantages synth: hi cost, strong, light, short drying time, good for open fx
Plaster casts advantages moldable, cheap, good for fresh fractures
5 complications from casts Foreign body; Plaster burn; Pressure sores (fr wrinkles in the cast padding); Nerve Palsy & AV compromise; Loose-cast syndrome
Thumb spica splints for simple thumb sprain; immobilization after lac repair; sprain and scaphoid fracture
Ulnar gutter splints for 4th and/or 5th metacarpal fx
Radial gutter splints for 2nd and/or 3rd metacarpal fx
Upper extremity posterior splints for bicep tendonitis, radial head fx, stable distal humerus fx; following aspiration of olecranon bursa
Lower extremity posterior splints for stable ankle fractures
3 indications for chest tube placement pneumothorax; fluid in the chest (hemothorax, hydrothorax, chylothorax, empyema); prophylaxis for high risk patients undergoing pos pressure ventilation
3 types of pneumothorax open (sucking); tension (one way air leak); simple (air btw visceral & parietal pleura)
Site for routine chest tube insertion through the 4th or 5th interspaces in the anterior axillary line
Complications of tube thoracostomy hemorrhage; infection; lung laceration; cardiac injury; subcutaneous placement; re-expansion pulmonary edema; intraperitoneal placement of tube
Pros & cons of minimally invasive surgery pros: less pain; quicker; fewer complications. Cons: cost; training req; req genl anesthesia; loss of tactile sensation
Laparoscopic surgeries Chole; appy; herniorraphy; colon resection; gastric bypass
Laparoscopy: CI peritonitis; hypovolemic shock; abd distension / bowel obstruction; coagulopathy
Laparoscopy: complications vascular/ visceral injury; acidosis; arrhythmias; extraperitoneal insufflation; pneumothorax; wound infxn
Created by: Abarnard