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Surg Labs
Surgery
| Question | Answer |
|---|---|
| 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
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