Term
| splints - made of what? used for what purpose? |
|
Definition
made of metal, fiberglass, plaster of paris
used for acute injuries to allow for swelling
|
|
|
Term
| casts - what are they made of? |
|
Definition
| fiberglass or plaster of paris |
|
|
Term
| can be utilized in some cases after acute sx have dissipated - allows for immobility of fx site but mobility at joints above and below site. also used for sprains and strains |
|
Definition
|
|
Term
| two potentially serious dangers of casting |
|
Definition
pressure - skin/tissue breakdown
constriction - compartment syndrome |
|
|
Term
| Warning signs in casting - 5 P's |
|
Definition
pain
pallor (pulselessness)
poikilothermia (cool)
paresthesia/paralysis
poor capillary refill |
|
|
Term
| what is a waterproof cast and when is it ok to use? |
|
Definition
just doesn't have the cotton - may not hold as well or may not be as stable
ok for minor fractures - torus, buckle |
|
|
Term
| indications for splinting |
|
Definition
anytime you anticipate significant swelling
- fxs
- sprains
- joint infections
- tenosynovitis
- laceration over joint
- puncture wounds
- wounds requiring daily care
- circumferential rigidity not required
|
|
|
Term
Known as a cockup splint. wrist is in 10-15 degrees extension
used for hand or wrist sprains
carpal tunnel
carpal or metacarpal 2-5 fxs |
|
Definition
|
|
Term
used for proximal tibial or distal femur fxs
knee is in 20-30 deg flexion |
|
Definition
|
|
Term
doesn't fully eliminate pronation/supination
used for distal humerus fx or both-bone forearm fx or unstable proximal radius or ulnar fx |
|
Definition
|
|
Term
jones dressing - bulky cotton for soft tissue/ligamentous injuries
for:
distal tibial or fibular fx
reduced dislocations
severe sprains
tarsal or metatarsal fx
addition of stirrup eliminiates inversion/eversion
ankle at 90 deg flexion |
|
Definition
|
|
Term
used for disatal radius or ulna fx (3x35 splint)
humerus fx (3x35 or 4x30 splint)
prevents supination/pronation and immobilizes elbow |
|
Definition
|
|
Term
elbow and proximal/middle/distal radius and ulnar fx
limits flexion and extension and pronationa nd supination
arm in 90 deg flexion at elbow and 10 deg flexion at wrist |
|
Definition
|
|
Term
used for phalangeal or metacarpal fx and soft tissue injuries
radial --> just index and long fingers
ulnar --> just little and ring fingers
MCP --> 45-70 deg of flexion, 90 deg for metacarpal neck fx |
|
Definition
| radial or ulnar gutter splint |
|
|
Term
for ankle sprains
distal tibial/fibular fx
reduces inversion/eversion and plantar flexion |
|
Definition
|
|
Term
scaphoid fx (seen or suspected)
dequervain's tenosynovitis
Place hand in wine glass position - wrist with 10-15 deg extension and thumb in abduction |
|
Definition
|
|
Term
| advantages and disadvantages of splinting |
|
Definition
advantages: lightweight, can apply ice, allows for swelling
disadvantages: may result in excessive motion, not ideal to stabilize fx |
|
|
Term
|
Definition
immobilize a fx, dislocation, or ligamentous injury to promote healing
secondary pain relief
allow earlier ambulation by stabilizing a fx
improve fx by stabilization (ex: wrist drop following radial nerve injury)
correct deformities (clubfoot)
prevent deformity |
|
|
Term
| Advantages and disadvantages to casting |
|
Definition
advantages: immobilize fx better than splints, improve deformity, improve healing
disadvantages: heavier, can't get wet, hygiene |
|
|
Term
| possible complications of casting |
|
Definition
too loose or too tight
compartment syndrome
burns
skin breakdown
nerve compression
patient non-compliant (weight bearing)
too much or too little padding
DVT |
|
|
Term
1. Confined collection of pus surrounded by inflamed tissue
2. abscess that resolves w/o rupture
3. abscess from which bacteria cannot be cultured
4. abscess w/ classic signs of inflammation
5. abscess w/o signs of inflammation and in association w/ liquefactive necrosis or TB lesion |
|
Definition
1. abscess
2. dry abscess
3. sterile abscess
4. hot abscess
5. cold abscess |
|
|
Term
1. abscess formed from a sweat gland or hair follicle
2. furuncle that extends into subcu tissue
3. abscess involving the nail
4. found on extremities, buttocks, breasts or hair follicles |
|
Definition
1. furuncle/boil
2. carbuncle
3. paronychia
4. perifollicular abscess |
|
|
Term
| most common causative organism of abscess |
|
Definition
|
|
Term
|
Definition
small (<5mm) -- warm compress and/or abx
Large (>5mm) - I&D |
|
|
Term
| indications and contraindications to I&D of an abscess |
|
Definition
Indications: localized collection of fluctuant infection
contraindications: extremely large abscess that needs surgery, abscesses to palms/soles/nasolabial folds/rectum/genitalia, cosmetic concern, loss of function concerns, DM, immunocompromised |
|
|
Term
|
Definition
cellulitis
fever
chronic anal fistula
infection of deep palmar fascia of hand
deep infection or recurrence of infection
bleeding
pain
necrotizing fasciitis
nerve or vessel damage
scarring |
|
|
Term
| areas taht should be aspirated prior to drainage |
|
Definition
peritonsillar
retropharyngeal
supraclavicular
deep axilla
antecubital
groin
popliteal |
|
|
Term
|
Definition
1. sterilize
2. anesthesia
3. drapes
4. incision
5. blunt dissection
6. aspirate culture
7. get all contents out
8. explore cavity with hemostat or swab
9. irrigate w/ NS
10. iodoform gauze
11. sterile dressing |
|
|
Term
3 types of informed consent:
1. used in emergencies when immediate action is required
2. used for routine services and touching by healthcare staff. If they came to the office tob e evaluated, that's their consent
3. required for specific high-risk procedures and treatments |
|
Definition
|
|
Term
| things that shuold be included in a procedure note |
|
Definition
Identifying pt data
name of procedure
indications
contraindications
consent
assistants
anesthesia used & how much
Description of procedure
findings
significant PE chagnes after procedure
complications
pt instructions/FU
length of procedure and pt condition |
|
|
Term
1. the degree of closeness of measurements of a quantity to that quantity's actual (true) value.
2. also called reproducibility or repeatability, is the degree to which repeated measurements under unchanged conditions show the same results |
|
Definition
|
|
Term
| examples of cut off values |
|
Definition
PSA
immunologic tests
fasting glucose
|
|
|
Term
|
Definition
make a list of ddx
confirm a diagnosis
r/o a diagnosis
suggest diagnostic possibilities |
|
|
Term
| When is it appropriate to order labs stat? |
|
Definition
ER - always
hospital - mostly
outpatient - rare |
|
|
Term
| whats the difference between blood, plasma, and serum? |
|
Definition
blood: everything
plasma: everything except suspended cells
serum: no cells, no clotting factors |
|
|
Term
| indications for suture, staples, or skin adhesive |
|
Definition
decrease wound healing time
reduce risk of infection
decrease amount of scar tissue
repair loss of structure or function of tissue
imrpove cosmetic appearance |
|
|
Term
| Wounds with these characteristics should be left unclosed or very careful consideration should be given before suturing |
|
Definition
high likelihood of contamination
wounds that require suturing to minimize infection and scar should be closed w/in 8 hours of injury
presence of foreign bodies in underlying tissues
extensive wounds involving tendons, nerves, or arteries |
|
|
Term
|
Definition
epithelium
connective tissue
muscle tissue
nerve tissue |
|
|
Term
| factors affecting tissue strength (and therefore should affect suture material choice) |
|
Definition
size of wound
size of pt
age
weight of pt
thickness of tissue
presence of edema
induration |
|
|
Term
What suture material?
time efficient
associated with decreased wound infection rates
composed of stainless steel
requires minimal skin penetration
more expensive
requires great care in placement to avoid inversion of wound edges
scar is cosmetically equivalent to other techniques |
|
Definition
|
|
Term
ex of what kind of closure material?
steri-strips, clozex
not good for wide lacerations
good for wounds that follow langer lines |
|
Definition
|
|
Term
what type of closure material?
used for superficial skin closure, NOT subcu
used as a barrier against common microbes |
|
Definition
|
|
Term
What type of closure material?
created from autologous blood - used for hemostasis and sealing tissues |
|
Definition
| fibrin-based tissue adhesives |
|
|
Term
| tensile strength of the suture should never exceed ...? |
|
Definition
| tensile strength of the tissue |
|
|
Term
what kind of suture?
single strand
less taumatic/less resistance
fewer organisms
more likely to slip -- requires more throws on knots |
|
Definition
|
|
Term
what suture?
several strands that are twisted or braided together
greater tensile strength, pliability, and flexibility
harbor organisms
may be caoted
tends to be easier to handle and tie |
|
Definition
|
|
Term
what kind of suture?
prepared from collagen of healthy mammals or synthetic polymers |
|
Definition
|
|
Term
| how does disintegration of absorbable suture happen? |
|
Definition
2 ways:
- enzymatic breakdown of organic material
- hydrolysis of synthetic material |
|
|
Term
| limitations of absorbable suture |
|
Definition
may be accelerated by infection, fever, or protein deficiency
can degrade too quickly if gets wet before use
not a good choice in pts with impaired healign |
|
|
Term
non-absorbable suture
uses |
|
Definition
| uses: skin closure, permanent suture of body tissue, pt hx of keloid/rxn to absorbable tissue/tissue hypertrophy, prosthesis attachment (pacemaker) |
|
|
Term
sutures:
monofilament absorbable
multifilament absorbable
monofilament nonabsorbable
multifilament nonabsorbable |
|
Definition
monofilament absorbable: surgical gut (plain or chromic), PDS, monocryl, biosyn, caprosyn, dexon
multifilament absorbable: vicryl, dexon, polysorb
monofilament nonabsorbable: nylon, prolene, stainless steel wire, novafil
multifilament nonaborbable: ethibond, surgical silk, ticron, surgilon |
|
|
Term
what kind of suture?
plain and chromic
absorbed rapidly (within 70-90 days)
tensile strength 7-10(plain) or 10-14 days(chromic) |
|
Definition
|
|
Term
what kind of suture?
multifilament absorbable
passes through tissue w/ minimal drag
easy to handle
smooth tie down
knot security
superficial soft tissue approximation
absorption essentially complete by 56-70 days |
|
Definition
|
|
Term
what kind of suture?
monofilament, absorbable
higher initial tensile strength that diminishes over 2 weeks
absorption essentially complete in 91-119 days
used right underneath skin |
|
Definition
|
|
Term
nonabsorbable suture specifics
Class I: silk or synthetic
Class II: cotton or linen fibers or coated natural or synthetic fibers where the coating contributes to suture thickness without adding strength
Class III: metal wire |
|
Definition
|
|
Term
| __ is considered the ideal suture |
|
Definition
|
|
Term
| Advantages and disadvantages to using class III stainless steel suture |
|
Definition
Advantages
Flexibility
Absence of toxic elements
High tensile strength
Low tissue reactivity
Hold knot well
Disadvantages
Possible cutting, pulling and tearing patient’s tissue
Fragmentation, barbing, kinking
Wire fracture
Wire fatigue
Postoperative pain
Cannot be used in when a prosthesis of another alloy is used-electrolytic reaction may occur
Safety risk- may easily tear surgical gloves
Difficulty in handling
|
|
|
Term
suture used in ER and FP for skin lacerations
synthetic nonabsorbable
strands have "memory" when wet
easier to handle in wet tissues |
|
Definition
|
|
Term
suture used in slow healers (diabetics) because it lasts longer (up to 2 years)
synthetic nonabsorbable
minimal tissue reaction |
|
Definition
|
|
Term
what kind of needle?
smooth
gradually comes to a point
used for easily penetrated tissues - bowel, vessels, NOT skin |
|
Definition
|
|
Term
what kind of needle?
triangular
apex provides a cutting surface faciliating tough tissue penetration
used on skin |
|
Definition
|
|
Term
what kind of needle?
cutting edge faces down rather than up
may decrease the likelihood of sutures pulling through tissue
used on ligaments |
|
Definition
|
|
Term
What kind of scalpel blade for each?
1. used for long, straight incisions
2. short, tortuous incisions. good for tissue debridement |
|
Definition
|
|
Term
most common kind of forceps
fine toothed
used for skin closure to avoid crushing skin with other forceps |
|
Definition
|
|
Term
| technique to prevent wound inversion |
|
Definition
make sure needle enters skin at 90 deg or more
suture should be deeper than it is wide |
|
|
Term
| what type of suture technique is good for closure of wounds under tension and for everting skin edges? |
|
Definition
|
|
Term
what type of suture technique?
is good in closing deeper wounds in which closure occurs at two levels (superficial and deep), elminiating dead space
main indication - to evert wound edges
permits greater closure strength and is better distribution of wound tension
most often used on posteior neck and cancave surfaces |
|
Definition
|
|
Term
what type of suture technique?
lie in a plane parallel to skin
everts suture to spread tension along wound edge
typically used for pulling wound edges together over a distance
as initial suture to anchor two wound edges
for flaps of tissue
when tension needs to be on one side
effective for fragile skin |
|
Definition
|
|
Term
| advantages& disadvantages of running baseball stitch |
|
Definition
advantages: quick
can be locked tightly
disadvantages: if one loop broken, the entire wound may open. cannot be partially removed, may leave cosmetically unacceptable scar |
|
|
Term
what suture technique?
used to close a surgical incision or a very clean wound
absorbable suture used often
done to decrease tension
done by creating an initial buried knot to anchor suture
advantages and disadvantages? |
|
Definition
subcuticular
advantages:
disperses tension evenly
disadvantage: if suture at top pops, you've lost tension across entire wound |
|
|
Term
|
Definition
| to avoid pulling suture that has been outside the wound through the wound |
|
|
Term
| general time frame for suture removal from: face, scalp, ear, neck, trunk, back, arm, leg |
|
Definition
face: 3-5 days
scalp: 5-9
ear: 4-5
Neck: 5-7
trunk:10-14
back: 12-14
arm: 10-14
leg: 10-28 |
|
|
Term
| advice to give pts who've received adhesive to close their wound |
|
Definition
no scratching, rubbing, or picking at it
do not scrub, soak, or expose area to wetness
no meds/ointment |
|
|
Term
| follow-up instructions after wound closure |
|
Definition
keep area clean and dry
elevate to decreased throbbing
cold compress
activity restrictions/immobilization
written instructions for care & signs of infection |
|
|
Term
| what are some high risk wounds for which you should consider abx? |
|
Definition
older than 12 hr
human or animal bites
crush wounds
heavily contaminated wounds
wounds involving joints, tendons, or bones
severe paronychia or felon
hx of valvular heart disease
immunosuppression |
|
|
Term
| when should you consider closing a wound? |
|
Definition
|
|
Term
Skin layers:
1. thicker. connective tissue (fibroblasts, macrophages, lymphocytes, mast cells). some small blood vessels and nerve endings
2. thin layer of squamous epithelium. outermost. no blood vessels or nerve endings
3. layer of loose connective tissue. many blood vessels and nerve endings. contains fat
4. relatively thick, dense, discrete fibrous layer that lies above muscle tendon or bone. |
|
Definition
1. dermis
2. epidermis
3. subcu
4. deep fascia |
|
|
Term
| linear clefts in the skin that indicate the direction of orientation of the underlying collagen fibers |
|
Definition
|
|
Term
incision made during a planned (not emergency) surgical procedure in which aseptic technique is followed
no GI, GU or resp involvement
<2% risk of infection
warrants routine primary closure
75% of all wounds |
|
Definition
|
|
Term
wound from planned surgery using aseptic technique but involves GI, GU, or resp system with no evidence of infection or break in technique
ex: appendectomy, cholecystectomy |
|
Definition
|
|
Term
gross spillage from GI tract, Gu or biliary procuedures in presence of infected bile or urine
open, traumatic wounds from soft-tissue laceration. open fxs or penetrating wounds
major break in aseptic technique
microorganisms multiply so rapidly that w/in 6 hours, the wound may be infected |
|
Definition
|
|
Term
heavily contaminated or established infection prior to wound being made
ex: I&D of abscess. perforated viscera, neglected traumatic wound |
|
Definition
|
|
Term
| infection present at the time of surgery can increase infection rate by an average of __x |
|
Definition
|
|
Term
|
Definition
achieve healing w/:
no infection
normal fxn
excellent cosmetic result |
|
|
Term
What kind of intention?
all layers are closed
best chance for minimal scarring and separation of wound edges
usually performed in clean and clean-contaminated wounds
wound is close as soon as possible after injury
surgical procedures
takes place in phases |
|
Definition
|
|
Term
|
Definition
1: hemostasis and inflammation
- day 0-5 after injury. vasoconstriction then dilation. platelet aggregation, coagulation, neutrophils, macrophages
2. fibroplasia
- well established by day 5. wound contraction beings, capillaries invade wound
3. maturation/remodeling
- cross linking of colagen and progressive increase in tensile strength
- continues for a year or more |
|
|
Term
1. first cell to react to injury - initiates phagocytosis and antimicrobial defense
2. dominant cell type by day 3-4. phagocytosis. angiogenesis, fibroplasia |
|
Definition
1. neutrophil
2. macrophage |
|
|
Term
what kind of intention?
deep layers are closed, superficial layers left open to granulate on their own
used for excessive tissue loss and infection |
|
Definition
|
|
Term
what kind of intention?
deep layers close primarily
superficial layers left open for 3-5 days, then reassessment
wound irrigated
nonviable tissue removed
if clean at this point, close
done for contimated wounds, excess tissue loss, high risk of infection, fasciotomy |
|
Definition
| third intention/delayed primary |
|
|
Term
| 4 steps in wound management |
|
Definition
1. irrigation
2. anesthetization
3. suture
4. tetanus shot |
|
|
Term
|
Definition
>6 hours old
>1cm deep
stellate corners, avulsion
devitalized tissue
contaminated
gunshot wound
puncture or crush
burn
frostbite |
|
|
Term
| what tetanus prophylaxis should be used in pregnant women? |
|
Definition
|
|
Term
| different anesthetics used for derm procedures |
|
Definition
amides - lidocaine, bupivicaine
esters - procains
- only used w/ pts w/ allergic reaction to amide |
|
|
Term
| why add epinephrine to lidocaine? |
|
Definition
prolongs duration of anesthetic
reduces bleeding through vasoconstriction
permits larger volume of anesthesia
70 kg adult: 28ml of lidocaine, 49 ml of lidocaine + epi |
|
|
Term
| where should you NOT use epineprhine? |
|
Definition
| fingers, nose, toes, ears, penis |
|
|
Term
| what kind of anesthesia for excision/shave biopsies? |
|
Definition
|
|
Term
| indications & contraindications for shave biopsy |
|
Definition
pendunculated lesions above skin (skin tag)
indications: angioma
fibroma
dermatofibromas
seb k
verrucous
molluscum contagiosum
superficial basal cells
benign nevi
contraindications: pigmented lesions except benign nevi
infiltrative dermatoses
sclerosing basal cell
lesions w/ dermal component
infection
bleeding disorders
pts on warfarin or plavix |
|
|
Term
| indications & contraindications for punch biopsy |
|
Definition
indication: lesion covers a large surface area and dx needed before tx is started
contraindication: if it has malignant potential and can be completely excised at initial visit |
|
|
Term
| indications and contraindications for fusiform excisions (excisional biopsy) |
|
Definition
| indications: suspected melanoma, epidermal inclusion cyst, large basal or squamous cells, der lesion larger than 1 cm, subcu tumor |
|
|
Term
| what is really bad on CBC? |
|
Definition
WBC <500 or >30K
Hct <20% or >60%
Hgb <5 or >20
Platelt <20K or >1M |
|
|
Term
| significant increase in WBC - giving picture of leukemia but it is not permanent or progresive |
|
Definition
|
|
Term
| gram neg bacteria stains ___ on gram stain. gram pos is ___ |
|
Definition
|
|
Term
| best meds for gram + and gram - |
|
Definition
gram +: PCN, amoxicillin, Keflex
gram -: cipro, ceftriaxone |
|
|
Term
| common causes of thrombocytopenia |
|
Definition
1. decrease plt survival (hypersplenism, TTP, DIC)
2. decreased plt production (bone marrow disorder)
3. ineffective production (megaloblastic anemia) |
|
|
Term
| disorders of platelet function |
|
Definition
|
|
Term
|
Definition
1. myeloproliferative disorder (polycythemia vera)
2. secondary thrombocytosis (cancer, inflammation) |
|
|
Term
| normal hct is about _x the hbg |
|
Definition
|
|
Term
| when would you consider transfusion? |
|
Definition
|
|
Term
| causes of macrocytic and microcytic anemias |
|
Definition
macrocytic: megaloblastic, alcoholism, chronic liver dz
microcytic: iron deficiency, thalassemia, anemia of chronic disease |
|
|
Term
anisocytosis
poikilocytosis
target cell |
|
Definition
anisocytosis - variation in size of RBC
poikilocytosis - variation in shape of RBC
target cell - abnormal RBC w/ dense center and unstained ring -- seen after splenectomy and in certain anemias |
|
|
Term
| causes of Low, normal and high mcv |
|
Definition
Low (microcytic) - Hgb problem
normal - not enough rbc (hemolysis) hemorrhage
high (macrocytic) - DNA problem - liver dz, megaloblastic anemia |
|
|
Term
| ___ is the most significant indicator of renal disease on UA |
|
Definition
proteinuria
if present, get 24 hr urine specimen |
|
|
Term
| gross hematuria w/o other sx, think ? |
|
Definition
|
|
