Term
|
Definition
| diligence, wisdom, compassion |
|
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Term
|
Definition
|
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Term
|
Definition
|
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Term
|
Definition
|
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Term
|
Definition
| to create an artificial opening (mouth), mean to be maintained after completion of procedure |
|
|
Term
|
Definition
| creation of a temporary surgical opening to be closed by completion of procedure, often to remove or retrieve something |
|
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Term
|
Definition
| fixation (e.g. as in stomach to body wall) |
|
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Term
|
Definition
|
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Term
|
Definition
|
|
Term
| what is the least traumatic method for incising tissue? |
|
Definition
|
|
Term
| what is the most common scalpel blade used in small animal sx? |
|
Definition
| #10 (linear incisions in skin or connective tissue) |
|
|
Term
| what are #11 blades used for? |
|
Definition
| stab incisions and delicate procedures (e.g. incise ureter) |
|
|
Term
| what are #12 blades used for? |
|
Definition
| sickle shape often used for onychectomy |
|
|
Term
| what are #15 blades used for? |
|
Definition
| stab incisions in hollow viscera |
|
|
Term
| which blades go with #4 Bard Parker handles? |
|
Definition
|
|
Term
| what are the three scalpel grips? |
|
Definition
|
|
Term
| what are scissors used for (2)? what is the drawback of each? |
|
Definition
dissection or sharp cutting
risk of dead space/seroma and increased trauma due to shearing |
|
|
Term
| which scissors improve visibility and control during dissection/sharp cutting? |
|
Definition
|
|
Term
| what is an advantage of scissors over scalpels? |
|
Definition
| increased control in cutting redundant tissue |
|
|
Term
| which scissors are used in fine dissecting of delicate tissue? |
|
Definition
|
|
Term
| which scissors are used in cutting dense connective tissue (fascia)? |
|
Definition
|
|
Term
| what are Adson (rat-tooth) tissue thumb forceps used for? what is a drawback? |
|
Definition
grasping skin or fascia.
trauma in delicate tissue |
|
|
Term
| what are the pros and cons of smooth-tip forceps? |
|
Definition
| increased crushing injury in tough tissues, minimal trauma in blood vessels |
|
|
Term
| what are the most commonly used tissue thumb forceps in small animal surgery? |
|
Definition
|
|
Term
| what are DeBakey tissue thumb forceps used for? |
|
Definition
| grasping blood vessels or delicate organs such as bladder or bowel |
|
|
Term
| serrations are generally __________ in hemostatic forceps. |
|
Definition
| perpendicular to blood flow |
|
|
Term
| what are Halstead mosquito and Kelly forceps used for? |
|
Definition
| grasping small, isolated vessels |
|
|
Term
|
Definition
| the junction of the needle and suture |
|
|
Term
| what are the three grips for needle holders? |
|
Definition
palmar
thenar-eminence
thumb-third finger |
|
|
Term
| what are Castroviejo needle holders used for? what grip is used? |
|
Definition
ophthalmic procedures (or extremely delicate tissue)
pencil grip |
|
|
Term
| when using retractors, one must always consider (2): |
|
Definition
1. trauma that can be caused to neurovascular structures
2. drying and evaporative heat loss |
|
|
Term
| what are Balfour retractors used for? |
|
Definition
|
|
Term
| what are Finochietto retractors used for? |
|
Definition
|
|
Term
| what are Gelpi perineal retractors used for? |
|
Definition
| retract muscle and skin during approaches to spine or long bones |
|
|
Term
| what are Senn retractors used for? |
|
Definition
| muscle retraction of muscle during orthopedic approaches |
|
|
Term
| what are malleable retractors used for? |
|
Definition
| abdominal sx for friable organs |
|
|
Term
| what are Hohmann retractors used for? |
|
Definition
| lever tibia cranially during stifle arthrotomy to assess menisci |
|
|
Term
| what do Poole suction tips look like and when are they used? |
|
Definition
fenestrated cover
abdominal sx |
|
|
Term
| what do Yankauer suction tips look like and when are they used? |
|
Definition
basket shaped tip with holes
thoracic sx |
|
|
Term
| what do Frazier suction tips look like and when are they used? |
|
Definition
angled metal tube, max trauma
neuro or ortho sx |
|
|
Term
| what are four types of suction tips? |
|
Definition
| Poole, Yankauer, Frazier, Adson |
|
|
Term
| what forceps are used to occlude bowel to remain in the animal? what about bowel to be removed? |
|
Definition
Doyen intestinal forceps
Carmalts |
|
|
Term
| instrument size is chosen based on the: |
|
Definition
| strength of tissue, NOT size of surgeon |
|
|
Term
| ________ instruments that cannot tolerate repeated steam sterilization can be sterilized by ___________ |
|
Definition
|
|
Term
| _______ and _______ can cause pitting of surgical instruments |
|
Definition
|
|
Term
| T or F: instruments of different materials can be cleaned/sterilized together. |
|
Definition
|
|
Term
| what should be used to lubricate instruments? |
|
Definition
| instrument milk (water-based) |
|
|
Term
|
Definition
| polyglycolic acid (glycolic acid) |
|
|
Term
|
Definition
| polyglactin 910 (glycolic + lactic acid) |
|
|
Term
|
Definition
| poliglecaprone 25 (glycolide + e-caprolactone) |
|
|
Term
|
Definition
| polydioxanone (paradioxanone) |
|
|
Term
|
Definition
| polyglyconate (glycolic acid + trimethylene carbonate) |
|
|
Term
|
Definition
| surgical gut (intestine-not cat) |
|
|
Term
| Vetafil/Supramid/Braunamid is: |
|
Definition
| polymerized caprolactam (polyamide +protein sheath) |
|
|
Term
| name two braided absorbable synthetic sutures. |
|
Definition
| polyglycolic acid and polyglactin 910 |
|
|
Term
| name three monofilament synthetic absorbable sutures. |
|
Definition
| poliglecaprone 25, polydioxanone, polyglyconate |
|
|
Term
| surgical gut is braided/mono, synth/natural, absorbable/non? |
|
Definition
| braided, natural, absorbable |
|
|
Term
| what is Prolene/surgilene? |
|
Definition
|
|
Term
| surgical hemostasis is important because blood (4): |
|
Definition
| 1. obscures sx field 2. ideal media for bacterial growth (and hence post-sx infections) 3. delays healing 4. may lead to CV shock and death |
|
|
Term
| what drugs affect bleeding times? |
|
Definition
| NSAIDs, estrogens, warfarin, heparin, phenylbutazone, acetylsalicylic acid, adequan, flunixin meglumine |
|
|
Term
| what disease processes affect bleeding times? |
|
Definition
| neoplasia, liver disease, biliary duct obstruction, DIC-related dz |
|
|
Term
| what are the hereditary conditions that affect bleed times and their factors/breed dispositions? |
|
Definition
von Willebrand-dobermans
hemophilia A-factor VIII
hemophilia B-factor IX
canine thrombopathia (platelet) Basset hounds |
|
|
Term
| vascular factors of physiologic hemostasis include: |
|
Definition
| reflex vasospasm, vasoconstriction, vascular retraction, inversion of intima |
|
|
Term
| what is Virchow's triangle? |
|
Definition
1. Hypercoagulability
2. Hemodynamic changes (stasis, turbulence)
3. Endothelial damage |
|
|
Term
|
Definition
| ...a plug involving blood vessels and platelets |
|
|
Term
| Secondary hemostasis is.... |
|
Definition
| stabilization of the platelet plug by formation and polymerization of fibrin |
|
|
Term
| failure of secondary hemostasis would present with |
|
Definition
Bleeding into muscles and joints
Bleeding into body cavities
Delayed or repeated bleeding |
|
|
Term
| what do Adson suction tips look like? |
|
Definition
| pop-off hole, angled at end |
|
|
Term
| tissue factor_____, in subendothelium is exposed and activates clotting cascade |
|
Definition
|
|
Term
| petechiae and ecchymoses are signs of: |
|
Definition
| failure of primary hemostasis |
|
|
Term
| electrocoagulation can be used in blood vessels up to ______ in diameter |
|
Definition
|
|
Term
| monopolar electrocoagulation cannot be used: |
|
Definition
in bloody field
near spinal cord or heart |
|
|
Term
| name the benefits of electrocautery. and drawbacks? |
|
Definition
no current thru patient
works in a bloody field
relatively cheap
drawbacks: causes tissue destruction, only used on small vessels, tip gets very hot |
|
|
Term
| when using pressure pads for hemostasis, never: |
|
Definition
|
|
Term
| which coag factors are vit K dependent? |
|
Definition
|
|
Term
| hemostatic forceps should only be used on what vessels? |
|
Definition
| those that will be sacrificed |
|
|
Term
| the most common method of surgical hemostasis is |
|
Definition
|
|
Term
choose the more secure ligation:
circumferential or transfixed? |
|
Definition
|
|
Term
| what is used to arrest bleeding from cancellous bone? |
|
Definition
|
|
Term
| what are the indications for lyophilized concentrations? |
|
Definition
|
|
Term
| what is a topical hemostatic that works by vasoconstriction? |
|
Definition
|
|
Term
|
Definition
| the absolute destruction of all living organisms including vegetative forms of bacteria and spores. |
|
|
Term
|
Definition
| the destruction of most pathologic microorganisms on inanimate objects |
|
|
Term
|
Definition
| the destruction of most pathologic microorganisms on animate objects |
|
|
Term
| the three forms of physical sterilization are: |
|
Definition
| filtration, radiation, heat |
|
|
Term
| the two types of filters for sterilization are: |
|
Definition
|
|
Term
| the two types of radiation used for sterilization are: |
|
Definition
|
|
Term
| the benefit of wet heat is: |
|
Definition
| achieves bacterial death at lower heat for shorter amount of time |
|
|
Term
fill out the chart:
temp steam press min time
250
262
270 |
|
Definition
temp steam press min time
250 15 15
262 20 5
270 (flash) 27-30 3 |
|
|
Term
| what is flash sterilization? |
|
Definition
| 270 F, 27-30 lbs/sq in, 3 min |
|
|
Term
| what instruments should not be flash sterilized? |
|
Definition
|
|
Term
| what is the only gas that sterilizes? what should it be used for? |
|
Definition
| ethylene oxide. for plastics, electrosurgical cords, endotrach tubes, delicate instruments |
|
|
Term
| what are the drawbacks of ethylene oxide? |
|
Definition
| flammable, unpleasant odor, toxic, irritating, burns trachea, |
|
|
Term
| how does ethylene oxide work? how long does something need to be exposed to ethylene oxide to be sterilized? |
|
Definition
| alkylination. exposure time 48 min up to hours. aerate for 24 hours or with commercial aeration unless implant (48 hours) |
|
|
Term
| what are the four liquid methods of sterilization? what are their uses? |
|
Definition
gluteraldehyde-last choice
formaldehyde- tissue samples
beta propriolactone-(phasing out)
plasma sterilization (H2O2)-plastic or metal with lower risk, currently too expensive |
|
|
Term
| T or F: alcohols have residual activity. |
|
Definition
|
|
Term
| above _______Hz, current can pass through the body without pain or muscle contraction. |
|
Definition
|
|
Term
| what is the disadvantage of ligation clips? |
|
Definition
| permanent, will show up/interfere with imaging |
|
|
Term
| T or F: the treatment electrode is hot in electrocoagulation. |
|
Definition
| False. resistance provided by tissue generates heat. |
|
|
Term
| what are the mechanisms behind wet and dry heat sterilization? |
|
Definition
| denaturation and oxidation respectively. |
|
|
Term
| why is steam sterilization so effective? why is pressure necessary? |
|
Definition
| steam penetrates every pack. pressure helps attain a higher temperature. |
|
|
Term
| the only indicator that truly indicates sterility is: |
|
Definition
| the biological indicator (test org in a liquid medium in a glass vial) |
|
|
Term
the three wrapping materials for steam sterilization are:
which should be double layered? |
|
Definition
muslin fabric (should double layer)
paper (w/ or w/o cellophane)
plastic tubing |
|
|
Term
| why should sterilized packs not be handled until surgery? |
|
Definition
| increased risk of "breathing" and hence contamination |
|
|
Term
| which sterilization wrapping has the longest shelf life? which has the shortest? |
|
Definition
plastic/paper pouches-6mos-1 yr
single wrapped muslin-2 days to 1 week |
|
|
Term
| how does plasma sterilization work? |
|
Definition
| H2O2 heated to 50C to generate reactive ions, electrons, atomic particles to sterilize heat sensitive items |
|
|
Term
| the practice of soaking instruments in disinfectant solutions is called: |
|
Definition
|
|
Term
| tourniquets should not be in place for more than ______hours because it can cause ___________ |
|
Definition
no more than 3 hours
neg effects- ischemia and pressure, neuropathy, myopathy, edema, increased bleeding after removal, cardiac arrest, hypertension, I-R injury |
|
|
Term
| 3 adverse effects to remember with chlorhexidine are: |
|
Definition
CORNEAL IRRITATION
OTOTOXICITY
REDUCED CONTRACTION AND EPITHELIAZATION |
|
|
Term
|
Definition
| is an agent that is applied to an inanimate object to destroy vegetative forms of bacteria, but not necessarily spores. it destroys microorganisms and inactivates viruses |
|
|
Term
| the functions of skin include (6): |
|
Definition
o maintain hydration and thermoregulation
o defense against pathogens and chemicals
o Vitamin D synthesis
o sensory (e.g. mechanoreceptors)
o storage (H2O, electrolytes, fat, proteins)
o insulation |
|
|
Term
|
Definition
| reduce the microbial population to safe levels (public health-wise) |
|
|
Term
| alcohol's mechanism of disinfection is through: |
|
Definition
|
|
Term
| good bactericidal activity for alcohol is at what percent? at what percent does which alcohol's efficacy actually decrease? |
|
Definition
70-80% is a good concentration.
Ethyl alcohol actually loses efficacy past 90%, unlike isopropyl alcohol |
|
|
Term
| how is ethyl alcohol superior to isopropyl alcohol? |
|
Definition
| ethyl alcohol is a superior virucide. |
|
|
Term
| the two types of bacteria on skin are: |
|
Definition
| resident and transient. (resident can multiply and live on skin) |
|
|
Term
| substances ordinarily do not adhere as well to ______ as to skin. |
|
Definition
|
|
Term
| what are the most common agents used in perioperative skin prep in the dog? |
|
Definition
| chlorhexidine, and iodophor compounds |
|
|
Term
| following the use of Lugol's solution, _____and ______have been reported, so caution should be taken on its use in large areas. |
|
Definition
| severe burns and systemic iodism |
|
|
Term
| iodophors have ______% available iodine, and are non____and non_____ |
|
Definition
| 1%; non-irritating, non-toxic |
|
|
Term
| the disadvantages of iodophors include: |
|
Definition
| diminished effectiveness in the presence of organic matter, high incidence of dermal irritation, and potentially unreliable residual activity and toxicity |
|
|
Term
| how does chlorhexidine work, against what organisms, and what are the other advantages? |
|
Definition
alters permeability of cell wall;
gram +/-
surgical prep, hand scrub, extremely non-irritating, bactericidal activity not diminished by blood/pus, no systemic absorption |
|
|
Term
| when used in open wounds, chlorhex should be diluted to ____%? |
|
Definition
|
|
Term
| the skin is composed of _______ and ______, the first which is ______, receiving nourishment from the _______, which is viscoelastic due to _________ |
|
Definition
outer epidermis
inner dermis
avascular
dermis
collagen |
|
|
Term
| what is the hypodermis composed of? |
|
Definition
| fat, loosely organized collagen, and elastic fibers |
|
|
Term
| why is the panniculus important? where is it found? |
|
Definition
| landmark in cutaneous reconstruction. subdermal plexus runs deep and superficial to it, which supplies much blood supply to skin. it is found on most of the body, except mid/lower legs |
|
|
Term
| what innervates the panniculus? |
|
Definition
| 8th cervical and 1st thoracic nerve |
|
|
Term
| what is the panniculus called in various areas of the body? |
|
Definition
platysma-head and neck
cutaneous truni-trunk
suprammammarius-abdomen
preputialis-inguinal region of male dogs |
|
|
Term
| what provides blood supply to the skin in dogs and cats? |
|
Definition
| direct cutaneous arteries |
|
|
Term
| what are the extrinsic, intrinsic, and common pathway coag factors? |
|
Definition
• intrinsic (12, 11, 9, 8)
• extrinsic (7, 3)
• common (10, 5, 2, 1) |
|
|
Term
place the following the correct order:
debridement, proliferative, coagulation, maturation, inflammation |
|
Definition
| coagulation, inflammation, debridement, proliferation, maturation |
|
|
Term
| what are the approximate times for wound healing phases? |
|
Definition
coag: 5min
inflam: 0-24 hours
debridement: 2-5 days
proliferation: 4-21 days
maturation: 21 days-2 years |
|
|
Term
| describe primary coagulation and the 3 important components involved. |
|
Definition
damaged endothelium exposes neg charged collagen. vWF and platelets bind with this subendothelial collagen to form a platelet plug.
• platelets, vWF, subendothelial collagen |
|
|
Term
| what is secondary coagulation? |
|
Definition
| process by which coag factors form a fibrin meshwork around platelet plug and wound |
|
|
Term
| what is the purpose of the fibrous plug? |
|
Definition
| protects wound bed from environment |
|
|
Term
| what are the two leukocytes seen during inflammation and when and what are their roles? |
|
Definition
neutrophil: 24-48 hours, phagocytize bacteria, release free radicals and proteolytic enzymes
macrophage: 2-5 days, necessary to wound healing-phagocytize necrotic tissue and organic debris |
|
|
Term
| what cell is most significant in debridement? what is another term for debridement phase? |
|
Definition
|
|
Term
| what stage of wound healing is an important step of intervention? |
|
Definition
|
|
Term
| what methods are used for mechanical debridement? |
|
Definition
| pressure lavage, sharp dissection, adherent bandages |
|
|
Term
| what signals the end of debridement? when do these cells peak? |
|
Definition
| macrophage release cytokines to attract fibroblasts that peak at 7-10 days. |
|
|
Term
| what are the processes of proliferation? |
|
Definition
angiogenesis >>VEGF
granulation tissue formation
(glistening pink tissue)
epithelialization
begins early 1-2 days, peak 5-7
slide and divide; contact
inhibition
contraction 5-7 days
myofibroblasts>>actin and myosin
grab ECM (1mm/day) |
|
|
Term
| what affords tensile strength to a healing wound? what phase is this also known as? |
|
Definition
| type-1 collagen accumulation, otherwise: suture proliferation "log phase" |
|
|
Term
| in contact inhibition, the migrating epithelium: |
|
Definition
| migrates under the initial fibrous plug and over granulation tissue until like cells contact each other |
|
|
Term
| second intention wound healing occurs by |
|
Definition
| contraction, wherein myofibroblasts which contain actin and myosin grab the ECM and exert tensile forces to pull wound closed |
|
|
Term
what is the "second lag phase"?
what is involved? |
|
Definition
| maturation. collagen fibers reorient in linear fashion parallel to lines of muscular and gravitational tension |
|
|
Term
| of: skin, GI, LI, and urinary bladder, which heals the fastest and slowest? |
|
Definition
| urinary bladder fastest, skin slowest |
|
|
Term
| what intrinsic factors can affect wound healing? |
|
Definition
| hypoproteinemia, anemia/blood loss, malnutrition, uremia, DM, Cushing's, infection, antibiotics |
|
|
Term
| why does infection affect wound healing? |
|
Definition
| bacteria produces metalloproteinase and collagenase, change pH |
|
|
Term
| what are the three wound classifications based on time? |
|
Definition
class I: 0-6 hours; minimal contamination (fresh)
primary closure=common
class II: 6-12 hours; moderate contamination 10^5/gram of tissue=infection
primary closure=? reality
class III: >12 hours; gross contamination
primary closure=always never |
|
|
Term
| what constitutes and infection? |
|
Definition
| 10^5 organisms/gram of tissue=infection |
|
|
Term
| what are the extrinsic factors that affect wound healing? |
|
Definition
| injury type (crushing, shearing, laceration), foreign material, irradiation, antiseptics |
|
|
Term
| why do antiseptics interfere with wound healing? |
|
Definition
|
|
Term
| which injury type requires the least tissue debridement? |
|
Definition
|
|
Term
| T or F: bite wounds should be cleaned and closed at time of presentation. |
|
Definition
| F. contraindicated. wet-to-dry bandages or neg pressure wound therapy are initial treatments of choice after thorough exploration, lavage, and viability assessment |
|
|
Term
| what are the surgical wound classifications? |
|
Definition
clean: sx procedure, not entering GI or resp, no contamination or break in asepsis; risk of SSI=5%
clean-contaminated: GI or resp. SSI-10%
contaminated: >GI with gross contamination, inflammation, major break in asepsis; SSI 30%
dirty: devitalized or necrotic tissue, gross debris, pus. =infected |
|
|
Term
| what is a preferable way to lavage a wound, and what is an easy method to deliver this? |
|
Definition
| saline (0.9%) bag in a 300mmHg pressure cuff. needle gauge unimportant |
|
|
Term
| "________ is the _________ to __________" |
|
Definition
| solution is the solution to pollution |
|
|
Term
| T or F: chemical indicators indicate sterility. |
|
Definition
| False. only that the proper temperature was reached. |
|
|
Term
| Electrocoagulation can be used on tissue to: |
|
Definition
Cut
Coagulate
Desiccate
Fulgurate |
|
|
Term
| What waveform is used for cutting with electrocoagulation? |
|
Definition
|
|
Term
| What waveform is used for coagulation for electrocoagulation |
|
Definition
|
|
Term
| what are the two coag methods with electrocoagulation? |
|
Definition
| obliterative (direct) and coaptive (conduct through hemostat) |
|
|
Term
| what are the three supplies needed to prep a wound? |
|
Definition
o gloves
o clean clipper blade #40
o sterile lubricating jelly |
|
|
Term
| a new method of wound debridement is ________ |
|
Definition
|
|
Term
| what are the two types of drains? what is the disadvantage of one of them? |
|
Definition
passive and active
passive requires gravity, is affected by movement, and is susceptible to infection |
|
|
Term
| drains are never to be used as a.... |
|
Definition
| shortcut to wound closure in place of proper exploring and monitoring of traumatic wounds |
|
|
Term
| what are the four types of wound closure? |
|
Definition
o primary-immediate closure of wound <6 hours
o delayed primary-after 6 hours, before granulation< 2 days
o late secondary-after appearance of granulation tissue >2 days
o second intention-leaving wound open to heal without any surgical intervention |
|
|
Term
| which method should be used when passing a needle? |
|
Definition
| wrist action, not elbow pushing (causes trauma) |
|
|
Term
| what is a taper point needle like and what is it used for? |
|
Definition
sharp, non-cutting, cylindrical
soft tissue |
|
|
Term
| what is a cutting point needle like and what is it used for? |
|
Definition
triangular point, 3 cutting edge body
conventional: sharp concave surface
reverse: flat concave surface (minimizing cutting through tissue)
tough tissue like skin, fascia, joint capsule |
|
|
Term
| what is a tapercut needle like and what is it used for? |
|
Definition
triangular point, cylindrical body
delicate fibrous tissue |
|
|
Term
| what is a spatula needle like and what is it used for? |
|
Definition
flattened convex and concave side of point (trapezoid), side cutting
thin tissue like the cornea |
|
|
Term
| what is a blunt point needle like and what is it used for? |
|
Definition
cylindrical body
solid organ friable tissue like liver and kidney |
|
|
Term
| name the three parts of a suture: |
|
Definition
|
|
Term
| why do surgical knots fail? |
|
Definition
o improper technique
o breakage of suture material |
|
|
Term
| when selecting a needle, select: |
|
Definition
| the smallest that will work |
|
|
Term
| if a needle is sharp on convex surface, it is likely: |
|
Definition
| a reverse cutting needle (spares tissue on inside of suture loop) |
|
|
Term
| when spacing simple interrupted sutures, the width and spacing should be: |
|
Definition
| width: 2X skin thickness, spacing 2X width (4x skin thickness) |
|
|
Term
| the advantages/drawbacks of simple continuous over interrupted are: |
|
Definition
| quicker, maximal appositional strength/puckers, not as safe |
|
|
Term
| which is not used in live animals: running or continuous? |
|
Definition
|
|
Term
| what are miller's knots used for? |
|
Definition
|
|
Term
| what suture has the strongest knots? |
|
Definition
|
|
Term
| the _____ is the weakest part of the suture line |
|
Definition
|
|
Term
| _______sutures require more knots than ________ products |
|
Definition
|
|
Term
| what are three general types of suture patterns? |
|
Definition
| everting, inverting, appositional |
|
|
Term
| when would a mattress pattern be used over a simple one? what is a drawback? |
|
Definition
| closing an incision under tension. compromises local blood supply |
|
|
Term
| between vertical and horizontal mattress, which is stronger and which minimizes strangulation? which everts less? |
|
Definition
|
|
Term
| when is figure 8 (cruciate) pattern used? |
|
Definition
| skin closure or abdominal organ biopsy |
|
|
Term
| what pattern would be used in a large animal with thick skin? |
|
Definition
| interrupted vertical mattress |
|
|
Term
| what is the width and spacing of the Ford interlocking pattern and interrupted vertical mattress? |
|
Definition
| 5-10mm bites 5-10mm apart |
|
|
Term
| what is the width and spacing for horizontal mattress pattern? |
|
Definition
| 3-5mm from cut edge, 5-10 mm apart |
|
|
Term
| which hollow organ closure patterns do not penetrate the lumen? |
|
Definition
| Lembert, Cushing, Czerny, possibly simple interrupted, purse string |
|
|
Term
| when dealing with hollow organs, try not to penetrate the lumen of the: |
|
Definition
|
|
Term
| when are tension sutures used? |
|
Definition
| when delayed wound healing is anticipated, to close abdominal wounds and wounds over joints where movement would break suture line, when suturing contaminated wounds is delayed |
|
|
Term
| what are the characteristics of the ideal suture? |
|
Definition
o dissolves by natural processes
o dissolves completely and predictably
o strength not lost until wound has strength
o bioinert
o non-reactive
o non-toxic
o non-allergenic
o non-carcinogenic
o does not promote infection
o no capillary/wicking action
o sterilizable without affecting characteristics
o great mech strength
o ties in secure knots
o handles easily
o CHEAP |
|
|
Term
| when are far-near-near-far and far-far-near-near sutures indicated? |
|
Definition
| when skin is widely separated |
|
|
Term
| what are stent and quilled sutures indicated? |
|
Definition
| to obliterate dead space and reduce postop edema and hemorrhage |
|
|
Term
| degradation of absorbable suture is by: |
|
Definition
| phagocytosis by macrophages and enzymatic hydrolysis by esterase |
|
|
Term
| absorbable suture degrades and loses tensile strength in how many days? |
|
Definition
|
|
Term
| the drawbacks of monofilaments are: |
|
Definition
| tend to have memory, cracking and weakening at knots, less flexible/harder to handle |
|
|
Term
| the drawbacks of multifilaments are: |
|
Definition
| nidus for infection in interstices between strands, greater capillary potential, need to be coated to slide easily |
|
|
Term
| the drawbacks of surgical gut are: |
|
Definition
| inflammatory due to chromium salts and unpredictable absorption |
|
|
Term
| what should a surgeon do when using polyglycolic acid? |
|
Definition
|
|
Term
| what is a drawback of polydiaxonone? |
|
Definition
|
|
Term
| what is a drawback of poliglecaprone? |
|
Definition
|
|
Term
| how long does polyglyconate last? |
|
Definition
|
|
Term
| what are a few drawbacks of silk? |
|
Definition
| reactive, weaker when wet, not great knot security, capillary action |
|
|
Term
| what is a caution with polymerized caprolactam? |
|
Definition
| comes not sterile on a reel. should not be buried. |
|
|
Term
| what is a drawback of polyester? |
|
Definition
|
|
Term
| what are some advantages of nylon? |
|
Definition
| inert, minimally reactive, slowly absorbable |
|
|
Term
| which suture is least likely to induce clots? |
|
Definition
|
|
Term
| which suture can be autoclaved and irradiated? |
|
Definition
|
|
Term
| what are the drawbacks of cyanoacrylic tissue adhesive? |
|
Definition
| poor adhesion in wet, contaminated, or high mechanical load tissues |
|
|
Term
| what are the advantages of surgical staples? |
|
Definition
rigid, no additional tension applied to tissue (less strangulation)
fast
precise apposition
well tolerated by skin
may reduce chance of contamination |
|
|
Term
| _________incisions should be avoided |
|
Definition
|
|
Term
| in fascial closure, what are the holding layers, preventing herniation in the abdomen? |
|
Definition
| o linea alba and external rectus abdominus fascia |
|
|
Term
| in USP, what is the range of suture size? |
|
Definition
|
|
Term
| the linea alba is thinner and wider... |
|
Definition
|
|
Term
| why should large bites of muscle be avoided? |
|
Definition
| muscle necrosis “loosens” closure, increases inflam and assoc risks |
|
|
Term
| T or F: peritoneum should be sutured. |
|
Definition
False. o does not contribute to wound strength
o suturing actually INCREASES risk of adhesions |
|
|
Term
| for the body wall (linea or external rectus), what size suture should be used for what body weight? |
|
Definition
<5kg 3-0
5-15 2-0
20-40 0
>40kg 1
horse 3 |
|
|
Term
| what is one systemic condition in which non-absorbable suture should be considered? which sutures are appropriate? |
|
Definition
Cushing's (inc. cortisol, delayed healing) or hypoalbuminemia
propylene, nylon |
|
|
Term
| which sutures should be used for vascular ligation? |
|
Definition
| polyglactin, chromic gut, silk |
|
|
Term
| which is the least thrombogenic suture? where is it used for this reason? |
|
Definition
| polypropylene. vascular repair |
|
|
Term
| which are the least reactive sutures? where are they used? |
|
Definition
nylon and polypropylene
cardiac, fascia, skin, nerve |
|
|
Term
| which two sutures are avoided in urinary bladder, especially if the lumen is penetrated? why? |
|
Definition
polyglactin, polyglycolic acid
since urine quickens their degradation |
|
|
Term
| which suture pattern is most commonly used by experienced surgeons when closing abdominal wall in small animals? |
|
Definition
|
|
Term
| a surgeon should incise _______to lines of _________ (Langer’s lines), and close _____________ |
|
Definition
parallel
tension
perpendicularly |
|
|
Term
|
Definition
| closing layers by shifting underlying tissues to make closure line up. don't do it |
|
|
Term
| why is the subcutaneous layer closed? |
|
Definition
| to minimize dead space and appose skin |
|
|
Term
|
Definition
| attaching to external rectus fascia every other bite to eliminate dead space |
|
|
Term
| skin closure techniques include_____and ______. which suture is indicated for which? |
|
Definition
| cutaneous sutures (nylon)or intradermal sutures (polyglactin, polydioxanone, or polyglecaprone 25) |
|
|
Term
| what suture material is appropriate for an otherwise healthy small animal for midline fascial closure? |
|
Definition
| polydioxanone or polyglyconate |
|
|
Term
| what sutures are indicated for a small animal subcutaneous closures? |
|
Definition
| polydioxanone, polyglyconate, polyglecaprone 25 |
|
|
Term
| advancing between bites in intradermal patterns causes: |
|
Definition
|
|
Term
| the three goals of first aid for traumatic wounds in LA include: |
|
Definition
preventing further injury
attenuating blood loss
minimizing contamination |
|
|
Term
| in LA wound care, it is important to protect against this infection |
|
Definition
|
|
Term
| the two causes of post sx laminitis? |
|
Definition
| endotoxemia and support-limb laminitis (weight bearing on one favored side |
|
|
Term
*B*
wound contamination may arise from these two sources: |
|
Definition
|
|
Term
| *B* what are the 4 basic assumptions when using Abx prophylaxis? |
|
Definition
| 1. one or more bacteria will contaminate the surgical wound, and will be inhibited by the drug selected 2. effective conc of the drug will be reached at the sx site at proper dose 3. therapeutic effect not markedly reduced by pH, fibrin, cellular debris 4. Abx must be given before contamination of tissues in order to be effective |
|
|
Term
*B*
When in a clean wound is Abx prophylaxis appropriate? |
|
Definition
| TTT: time, trauma, or trash(implant) |
|
|
Term
*B*
when are prophylactic Abx appropriate in clean-contaminated wounds? |
|
Definition
| should be present at time of contamination to have any effect |
|
|
Term
*B*
dirty wounds utilize Abx for these two purposes: |
|
Definition
| prophylactic and therapeutic |
|
|
Term
*B*
T or F: infections will always have positive cultures and negative cultures indicate a lack of an infection |
|
Definition
|
|
Term
*B*
What are the potential advantages of Abx prophylaxis? |
|
Definition
1. prevention of infection
2. decreased hospitalization and cost
3. decreased Abx usage and decreased resistance |
|
|
Term
*B*
what are the potential disadvantages of Abx prophylaxis? |
|
Definition
1. Abx coverage may lead to relaxation of aseptic tech
2. May not see a reduction in infection rate
3. development of resistance
4. toxic reaction-allergic and metabolic
5. superinfections
6. may mask localized infection needing drainage
7. may get phlebitis/cellulitis/abscesses/fevers from injections |
|
|
Term
*B*
prophylactic Abx should be discontinued without exception no later than: |
|
Definition
| 3 days after surgery (or 24-48 hours) |
|
|
Term
*B*
the route of prophylactic Abx should be: |
|
Definition
| IV. oral discouraged bc it can cause enteric salmonellosis |
|
|
Term
*B*
if the horse develops a fever on postop Abx, what should be done? |
|
Definition
| discontinue. some Abx can induce fever. reassess |
|
|
Term
*B*
what Abx is usually used prophylactically in LA, and for what procedures? |
|
Definition
| penicillin for respiratory, dental/oral, GI |
|
|
Term
| all animals under general anesthesia should have: |
|
Definition
|
|
Term
| the death rate for healthy horses undergoing anesthesia is approximately? |
|
Definition
|
|
Term
| what time of day is LA surgery most risky? |
|
Definition
| middle of the night emergencies |
|
|
Term
| what grooming should be performed on LA before surgery? |
|
Definition
|
|
Term
| what is the dehydration status of skin tenting 2, 4, and 6 seconds? |
|
Definition
Dehydration % Skin tent (sec)
4-6 2-3
7-9 3-5
>9 >5 |
|
|
Term
| what are the three DDx for swelling following sx? how can you tell? |
|
Definition
edema, seroma, herniation.
palpate, FNA, US |
|
|
Term
|
Definition
| can tap, may come back, but do nothing. usually self-resolve |
|
|
Term
| ______ and ______ should never be fasted before surgery. |
|
Definition
| neonates and horses (although for some special procedures for horses....) |
|
|
Term
| restricting water for horses before sx can lead to: |
|
Definition
|
|
Term
| what are the maintenance and shock rates for fluid therapy for LA? |
|
Definition
o maintenance 65mL/kg/day
o shock rate 45mL/kg/h |
|
|
Term
| what is the treatment for hypovolemia? |
|
Definition
o hypertonic saline for hypovolemia
o 2-4 mls/kg over 15 min
o oncotic effect: pulls fluid from interstitium into vascular space
o lasts 30-60 min
o follow immediately with isotonic fluids to prevent dehydration |
|
|
Term
| T or F: PCV is accurate even in acute hemorrhage. |
|
Definition
|
|
Term
| what is the protocol for inducing a horse? |
|
Definition
1. flush mouth
2. presedate to 5-legged stance
3. lean against a wall
4. lift nose to promote sitting
5. use heavy padding and remove halters |
|
|
Term
| how many lavages should be done? |
|
Definition
|
|
Term
| the three complications of open wound drainage are: |
|
Definition
dehydration
hypoproteinemia
hi mortality |
|
|
Term
| what is a great new drain? |
|
Definition
|
|
Term
| for LA surgery, one should: _____drape |
|
Definition
|
|
Term
| recumbency patterns for horses include: |
|
Definition
lateral recumbency: dependent limb pulled forward, support upper limb, protect down eye
dorsal recumbency: keep hind limbs in flexion, shoulder trough well padded |
|
|
Term
| checking ______ and ______ especially postop is important in horses: |
|
Definition
| manure production and casts |
|
|
Term
| how much blood does an adult horse have and when should transfusion be considered? |
|
Definition
adult horse has ~40 L 8% of BW
if lost more than 10 L, think transfusion |
|
|
Term
| the three dog types most sensitive to anesthesia are: |
|
Definition
| yorkie, pinscher, and brachycephalics |
|
|
Term
| what should be done to prevent nasal edema and asphyxiation in horses following extubation? |
|
Definition
| phenylephrine sprayed up the nose |
|
|
Term
| the most common complication of colic surgery is: |
|
Definition
|
|
Term
| the most common myopathy following sx on horses is what? what stance may indicate this? |
|
Definition
| triceps. with dropped elbow |
|
|
Term
| what is the most common neuropathy following sx on horses? what are the other top two? |
|
Definition
|
|
Term
| an ortho exam should assess: |
|
Definition
ambulation
swelling, instability
range of motion
pain |
|
|
Term
| what are the ASA classes? |
|
Definition
1. A normal healthy patient.
2. A patient with mild systemic disease.
3. A patient with severe systemic disease.
4. A patient with severe systemic disease that is a constant threat to life.
5. A moribund patient who is not expected to survive without the operation. |
|
|
Term
| transfusion should be considered if: |
|
Definition
| surgical PCV<20-25%; >30% blood loss |
|
|
Term
| the formula for blood required in transfusion is: |
|
Definition
BW x 60 (cat) or 90 (dog) x ((desired PCV-recipient PCV)/donor PCV)
packed cells: 1ml/kg increases PCV by 1% |
|
|
Term
| what are the requirements for prophylactic Abx? (not per dr. b) |
|
Definition
o for prophylaxis MUST be given within <60 min but >30 min from start of Sx
o q2h for soft tissue, q90min for ortho
o no greater than 24hr after sx
-none if you need to culture something |
|
|
Term
| in renal disease, _____ and ______ should be avoided. |
|
Definition
|
|
Term
| recumbent patients should be turned every ______ hours to prevent _____ and _____ |
|
Definition
4 hours
decubital ulcers
atelectasis |
|
|
Term
| name the factors that contribute to wound infection/dehiscence |
|
Definition
| poor aseptic technique, self-mutilation, over-activity, improper suture technique, drugs (corticosteroids, cushings, chemo, anemia). propofol (bc of lipids?), surgery time, hypothermia |
|
|
Term
| iatrogenic burns come from: |
|
Definition
| rough clipping, excessive heat, dull blades, heating lamps, electric pads, electrosurgery ground plates |
|
|
Term
| what are the 4 (5) types of peritonitis? |
|
Definition
| local, generalized, chemical, septic, (combined) |
|
|
Term
| serum amylase of ________ indicates _______ |
|
Definition
| amylase>1000=pancreatic inflammation |
|
|
Term
| when peritoneal lavage shows creatinine>serum , there is: |
|
Definition
|
|
Term
| is peritonitis from surgery common? |
|
Definition
| no, unless perforated or ascending infection from urogenital |
|
|
Term
packed cells: 1mL/kg increases PCV by:
|
|
Definition
|
|
