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143 Cards in this Set
- Front
- Back
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define disinfection and list some things that do it.
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destruction of most pathogens or inanimate objects
alcohol, chlorine, iodine, gluteraldehyde |
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define sterilization
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destruction of all microorganisms including spores on an item
steam, gas, plasma, ionizing radiation, cold chemical |
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how does steam sterilization work?
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coagulation of cellular protein and microbe denaturation
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what is the chemical for cold chemical sterilization and what is it used for?
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gluteraldehyde....
endoscopes, cytoscopes etc |
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overall % of wound infection in dogs and cats?
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5.5%
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what about preop food and water?
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no food 12-24 hr
water fine pee/poop is fine |
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when do you want to clip?
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immediately prior to sx.
blade flat against skin |
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2 times when you want to use a U-cath in sx?
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major abdominal sx
monitoring output |
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T/F chlorhexidine is inactivated by lavage, alcohol and debris
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FALSE
2 day residual activity too |
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what is 1 step prep?
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iodophor + alchohol
for spay dogs! |
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what is considered sterile once you're scrubbed in?
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front of the gown down to the waist
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what are halsted's 7 principles of surgery?
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asepsis
gentle tissue handling tissue apposition blood supply minimal tension no dead space hemostasis |
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what blades go on a #3 handle
#4? |
#3 = 10, 11, 12, 15
#4 = 20 through 23 |
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what do you use a 10 for? a 15?
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10 - skin
15 - deeper than skin |
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name of needle drivers?
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mayo-hegar
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big scissor blades name and use?
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mayo
dense tissue. |
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little scissors blade name and use?
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metzembaum
fine dissection |
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when do you use your left hand with scissors?
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NEVER!
use a back hand grip! |
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what kind of cutting on the linea?
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push cutting! not scissor style!
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T/F you want to completely close scissors as you use scissor cutting
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false.
series of consecutive short cuts |
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what's the difference between halstead mosquito hemostats, crile and kelly hemostats?
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halstead mosquito - grooves on whole jaw
crile - grooves on whole jaw, but bigger than mosquito kelly - grooves only on distal half of jaw |
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what are rochester-carmalt hemostats?
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longitudinal grooves
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what do you use on fascia?
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allis tissue forceps!
traumatic as funk |
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what do you use on ingesta-filled intestines?
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doyen (non-traumatic)
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thumb forceps: 3 kinds and uses
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adson = rat tooth for skin/fascia
brown-adson = tissue and needle debakey = longitudinal grooves for delicate tissue |
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towel clamps name?
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backhaus
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sharp prong little finger-held retractors? bent forkish.....
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senn
superficial muscle layers |
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broad blade hand-held retractors? + use
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army-navy
large muscle retraction |
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abdominal retractor name?
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balfour
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thoracic retractor name?
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finochietto
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what do the finochietto and balfour look like?
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finochietto look like reverse garage clamps
balfours have 2 sliding rods |
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how long does "absorbable" suture last?
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60 days
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multifilament pros and cons
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pros = superior handling and less affected by trauma
cons = can harbor bacteria and cause tissue drag. |
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when should braided material never be used?
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contaminated wounds cuz they wick
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how are synthetic absorbables degraded and what is their tissue reaction?
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hydrolysis not phagocytosis
minimal rxn |
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dexon, vicryl, PDS, maxon and monocryl are all what?
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synthetic absorbable
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which is NOT true about vicryl:
-braided multifilament -moderate tissue drag -poor knot security -complete absorption 70d |
they have GREAT knot security
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what is NOT true about PDS:
-multifilament -strong and good handling -complete absorption 180d |
it's a monofilament
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what has less memory and better handling than PDS or maxon?
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monocryl
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ethilon (nylon)
-strength loss -knot security and handling |
30% loss at 2 years
poor security and handling |
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check out page 5 of the suture material lecture.
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yeah its dense.
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T/F tissue glue is biodegradable
also, what is TG used for? and what polymerizes it? |
NO must be extruded from body
used for superficial cuts, declaws, tail docking, oral sx works via moisture |
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T/F dehiscence is often caused by defective suture material
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FALSE technique or poor choice of material
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we tend to use suture that is too _____
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LARGE
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T/F the finer the suture, the less reaction
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true.
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T/F tissue tensile and breaking strength increase with age
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TRUE
but decline with elderlyness |
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T/F larger species have stronger tissues
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true
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what is the order of strength:
bladder, skin, fascia, intestine, tendons |
skin/fascia > stomach, LI > bladder
tendons and muscle vary |
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T/F, skin regains it's tensile strength 120 days after wound healing.
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FALSE
Never happens |
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what is the % of original tensile strength of skin at 10, 42, 120, and 1/2 years post wounding
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10d 10%
42d 50% 120d 70% year or two = 90% never 100%! |
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what about fascia, stomach, and bladder healing?
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fascia is slow: 30% at 40d
stomach fast early, slow late bladder similar except 100% at 3 weeks |
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when is peak tissue reaction to sutures?
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2-5d
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T/F you should use suture material a lot stronger than the pull out strength of the tissue
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FALSE
pointless |
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what kind of suture in GI, genitourinary and biliary tracts?
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synthetic mono absorbable like PDS and maxon
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what kind of suture for fascia?
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nylon, polypropylene, PDS, maxon
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what kind of suture for vessels?
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polypropylene, teflon-coated polyesters and SILK
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what kind of suture for hearts?
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teflon-coated polyesters
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what kind of sutures for tendons?
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steel
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what kind of suture for skin closure?
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braunamid, polypropylene, nylon
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what kind of suture for cornea?
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polypropylene or nylon
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what kind of suture for abdominal wall closure?
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synthetic absorbable
dexon, vicryl, PDS and maxon |
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use for taper vs cutting needles?
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taper = soft easy tissue like fat, muscle and intestine
cutting = dense like skin |
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deeper tissues require a greater/less curve
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greater
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when in doubt, use ________ needle
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taper!
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T/F interrupted sutures harbor more FB
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twue.
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T/F continuous sutures are not air/water tight
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false.
continuous lines ARE air/water tight |
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a too tight simple interrupted will invert or evert?
where commonly used? |
invert
skin, GI, subQ, urinary, vasc, fascia |
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T/F cruciate prevents eversion
when is it used? |
true.
skin and fascia! ez to remove |
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simple continuous is weaker/stronger and secure than SI
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weaker and less secure
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when do you use ford interlocking?
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diaphragm and ruminant skin
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when do you use lembert?
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hollow viscera and fascia
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diff between connell and cushing?
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connell is full thickness
cushing (and lembert....) are partial |
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vertical mattress:
-strength relative to horiz mattress -how can be reinforced -appositional or everting? -use |
stronger than horizontal
with a stent either! skin/fascia/subQ with a lot of tension |
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horiz mattress:
-a few uses -if too tight? |
skin/fascia/subQ/skeletal muscle/inguinal closures
-tissue necrosis if too tight -can appose OR evert depending on tension. |
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how to ligate large vs. small vessels
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small = circumfrential lig
large = transfixation |
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how do you use hemostats to grab small vs large vessels
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small - with TIPS, angled down then rotate up when laying hemostats down
large - perpendicular to tissue, tip UP |
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what kind of knot for hemostatic ligature?
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just a square
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topical epinephrine dose?
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.02 mg/kg
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T/F bone wax is poory absorbed and may act as both a barrier to healing and a harborer of bacteria
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true
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when do you activate the current for monopolar electrocautery? why?
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BEFORE touching tissue because the patient is part of the electrical circuit
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what do more power and less power do with monopolar cautery?
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more power cuts with less heat but does not coagulate
less power coagulates but produces more heat |
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t/f THE PATIENT CAN BE BURNED BY THE CURRENT AS IT EXITS
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true!
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bipolar cautery
-when to activate current -grip -use |
AFTER grasping tissue
light grip hemostasis NOT cutting! only tissue within forceps is affected. used when you don't want collateral heat like neuro/cardiac/ophtho |
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which laser mode is better at hemostasis, continuous or intermittent?
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continuous
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what are 3 advantages and one disadvantage of laser
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less swelling, pain and damage
less hemostasis though |
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check out last 30 or so slides of L6?
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ok.
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what's the minimum database of preop info for a healthy young animal
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PCV, TP, BUN, glucose maybe urine sg
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attitude, pain level and hydration status are S or O
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S!
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abnormal lab findings, oral ulcers and anorexic are S or O
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O!
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how long is food restricted before sx for older than 4 months? why?
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6-12 hrs
so they don't aspirate |
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how long is food restricted for pups under 4 months....why?
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max 4 hrs to prevent hypoglycemia
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water preop?
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sure until premeds
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what reflex should ALWAYS be there?
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palpebral
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what should you suspect post op with high pulse, CRT and pale MMs? what do you do?
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hemorrhage!
electrolytes if PCV over 20 blood if PCV under 20 |
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what should you suspect w/ post op tachypnea?
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pain, hyperthermia, aspiration, pulmonary congestion
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what should urine output be?
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1-2 ml/kg/hr
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what do you do with pink/clear/thin discharge, white cloudy discharge and blood discharge?
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-nothing
-debride maybe abx -PRESSURE |
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t/f abdominal dehiscence after spay is a surgical emergency
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TRUE!
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what does antimicrobial prophylaxis do and not do?
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30 minutes prior to incision and every 90 min after
DOES NOT include post-op abx |
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look at L7 S7 at the classification of sx types
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ok.
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what's the rate of infection in general and with clean wounds
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5% overall
3% with clean wounds |
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T/F post op abx increases risk of infection
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true.
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when should you use abx in a clean surgery?
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>90 minutes or using an implant
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what are the most common bugs in SA sx both orthopedic and soft tissue. the most common abx?
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ortho - staph intermedius
soft tissue - enteric like e.coli and kleb cephalosporins |
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what's the most common cause of antimicrobial failure?
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low or late dose!
also bad pick |
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when do iatrogenic infections usually occur in soft tissue and bone?
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st - 30d
ortho - 1 year |
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1st intention healing.....?
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apposed edges in clean or clean-contaminated wound
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2nd intention healing?
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allowed to heal without edge approximation (increased scar)
the wound is left open to close by granulation/contraction/epithelialization not enough skin to close w/o mucho tension |
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delayed primary aka 3rd intention healing.....?
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delayed closure after debridement usually after granulation tissue present
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what are the 3 phases of wound healing?
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1) inflammation and debridement
2) repair 3) maturation |
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how long does closed wound inflammation last?
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3-4 days
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check out the time frame graphs in L8
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ok
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when do neuts peak during wound healing?
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24-48 hours
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T/F monocytes are essential for wound healing
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TRUE
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what 2 things to macrophages release?
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TNFa and GFs
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what 3 things do platelets release?
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PDG, TGF and EGF
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when should granulation tissue start?
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3-6 days even though debridement still active
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when do fibroblasts appear?
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day 3
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what 2 things stimulate angiogenesis?
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bFGF and VEGF
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when does wound contraction start? how long does it last?
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5-9 days
12-15 day duration |
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when does epithelialization start for closed vs. open wounds?
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closed maybe done in 48 hours
open starts after gran tissue maybe 4-5 day latent period |
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when stimulates mitogenesis in epithelialization? migration?
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KFG does mitogenesis
TGF-b does migration |
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when does migration stop in contact inhibition?
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after cell contact!
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what is the "lag phase" of wound maturation?
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1st 4-6 days there is no wound strength
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when is collagen deposition complete (maturation phase)
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day 21
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T/F scars are stronger than the original tissue
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false. never.
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how does uremia affect wound healing?
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causes deposition of crappy collagen!
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what are the 3 positive factors for wound healing?
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warmth, moisture and oxygen
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2nd intention has more/less granulation than 1st in cats
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LESS
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what's the best way to evaluate a wound for closure/bandaging?
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degree of contamination
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what 2 kinds of wounds can utilize primary wound closure? what's the golden period?
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clean or clean-contaminated
6-8 hours |
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how should you close a contaminated wound? an infected wound?
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contaminated= primary closure over drain or delayed primary closure
infected = open wound management |
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T/F you want to put aseptics on the wound
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no because they inhibit healing
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you want to lavage with hypo/iso/hypertonic fluids?
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iso!
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when should you administer systemic abx relative to debridement?
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asap after wounding but before debriding
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what is en bloc debridement and when should it be used?
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cutting out wound and surrounding tissue.
infected wounds w/o systemic infection on the trunk and proximal limbs |
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what kind of tape NOT used for tape stirrups?
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circumferential. don't do it
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how many layers to a bandage?
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3
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what does triple not do that SSD does?
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get pseudomonas
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which layer:
-absorbs exudate -pads the wound -supports the limb |
2nd layer
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which layer:
-provides pressure to decrease swelling |
3rd
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what is 2ndary closure?
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5 or more days after injury
healthy granulation tissue |
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how long should a drain stay in?
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3-6 days
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