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56 Cards in this Set

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Absorbable suture materials - Natural
Collagen, Chitin, Cat gut (3 C's)
Absorbable suture materials - Synthetic (plus brand names)
Polyglycolic acid (Dexon), Polyglactin(Vicryl), Polydiaxanone(PDS)
Nonabsorbable suture materials - Natural
Silk, Linen, Steel (SLS)
Nonabsorbable suture materials - Synthetic (plus brand names)
Polyamdie (Nylon), Polyester(Ti-cron), Polypropylene(Prolene)
Creator of the principle of surgical staplers ?
Aladar Petz (1888-1956)..Hungarian of course
Properties of an ideal suture material
1. Physical (tensile strength, tying capacity, flexibility, smooth, easy to sterilize, etc)
2. Chemical (resistance to bacteria, acids, alkalis, enzymes)
3. Biological (not allergic, not toxic, no carcinogenic effect, no drainage effect, MINIMAL tissue reaction)
*** Low cost
3 disinfection components in scrub solutions
Izopropyl-alcohol, Hydrogen peroxide, Benzalconiumchlorid
3 brand names of scrub solutions
Skinman soft N, skinman Asept, Biotensid
Steam autocloving (details, what you disinfect with it)
120C, 2.5Atm, 15-30min
Use for gowns, isolation towels, instruments
Dry heat disinfection (details, what you disinfect with it)
160C - 2 hours, 180C - 1 hour
Use for instruments
Gas (Ethylene Oxide) disinfection (what you use it for)
Gloves, catheters, tubes
Gamma radiation (what you use it for)
Gloves, suture materials, solutions
Cold sterilization (Glutaldehyde)(what you use it for)
Plastic devices, endoscopic instruments
3 important historical landmarks of disinfection
1. Semmelweis (1847) - handwash with chloride of lime
2. Lister (1867) - handwash with soap+carbolic acid
3. Ahlfeld (1896) - handwash with soap+alcohol
Skin disinfection solutions (of the operative field)
Betadine, Dodesept, Kodan (note Iodine burning or allergy)
Stopping the bleeding definitively
**Closing the vessel lumen :
*Mechanical (suture, torsion),
*Phyiscal (electrocoagulation, laser coagulation, thermocoagulation (NaCl), Ultrasound)
*Chemical (Dicynon)
*Biological (Bioplast)
**Reconstruction of the vessel lumen (vascular surgery)
Treatment of the consequence of bleeding (3 techniques)
1. Intravenous (superficial veins of arms, etc)
2. Central venous (for CVP measurement and Total Parenteral Nutrition)
Types of laparotomies
*Vertical (Midline, Paramedian)
*Transverse (Pfannesteil, transrectal)
*Oblique (subcostal, paracostal, Mcburney)
*Combined
*Laparoscopy
Laparotomy - incisions not cutting muscles
Midline, Paramedian, Pararectal
Laparotomy - incisions dividing muscles
Mcburney, Pfannensteil
Laparotomy - Incisions cutting muscles
Kocher (paracostal), subcostal, inguinal
Midline Laparotomy - tissues
Skin, Subcutaneous fat, Linea Alba, Tranversalis fascia&preperitoneal fat, Parietal peritoneum
Paramedian laparotomy - tissues
Skin, subcutaneous fat, anterior rectus sheath, rectus abdominis, posterior rectus sheath, transversalis fascia&preperitoneal fat, parietal peritoneum
Steps of laparotomy
1. Patient position
2. Orientation
3. Skin preparation
4. Isolation of field
5. Skin incision
6. First isolation line (w/surgical forceps and doynes)
7. Stop the bleeding (Peans, mosquitos)
8. Muscle incision
9. stop bleeding
10. Periotoneum incision (w/surgical forceps or peritoneal clamps, scalpel, peritoneal scissors)
11. Second isolation line (surgical forceps, peritoneal clamps, 2 towel clamps)
12. Expose abdominal cavity (retractors)
13. Orientation in the abdominal cavity
Indications for Conicotomy, Tracheostomy
1. Dyspnea
2. Inspiratory stridor
3. Cyanosis
4. Unconscious
Steps of conicotomy
1. Patient position (pillow under shoulders)
2. Orientation
3. Skin incision (2 fingers under thyroid cartilage
4. Cut cricothyroid membrane
5. Keep hole open
4.
Tracheostomy steps
1. Patient position
2. Skin disinfeciton
3. Isolation, orientation
4. Skin incision
5. Divide muscle (sternohyoid, sternothyroid)
6. Cut pretracheal fascia
7. Cut between 2/3 or 3/4 C ring (T-shape or window)
8. Check before inserting Luer tube, insert luer tube
9. Control
10. Wound closure, fix the tube
Intraoperative complications of tracheostomy
Injury of nerves (vagus, recurrent laryngeal)
Injury of vessels (carotid, jugular)
Injury of esophagus
Fossa route
Postoperative complications of tracheostomy (early, late)
Early - hematoma, bleeding, subcutaneous emphysema
Late - Laryngitis sicca, stricture, errosive bleeding
Priorities of upper airway obstruction
1. Mechanical cleaning, also make sure base of tongue does not obstruct airway
2. Pharyngeal airway. Mask and bag to help the patient breath
3. Endotracheal tube
4. Tracheostomy/Conicotomy
Steps in preparation of a venous cannule
1. Cut the butterfly needle on a straight position and connect the end to a saline filled syringe
2. Take out the air, clamp the tubuel with a rubber pean close to the syringe
3. Check infusion and clamp it with a rubber pean
Mnemonic for Intestinal decatholon
Always Wear Condoms On Audi TT, Wait, Count Sperm
Atraumatic, Wet, Clear, Opening of bowl, Anatomy, Types of sutures, Types of anastamoses, Waterproof, Count, Sure
Adhesions in intestinal surgery can be caused by
1. Serosa problem
2. Traumatic work
3. Bowel wasn't kept wet
4. Not clear work
5. Assistant work
6. Foreign bodies
Decathlon of liver (or spleen, kidney, pancreas)
2 B's, 4 S's, MAC J
Blood supply, Bioplasts
Segments of liver, Suture types, Suture materials, Surgical tissue adhesives, Moving, Atraumatically, CApsule, Juice problem
How many segments does the liver have ? The spleen ?
Liver - 5
Spleen - 2/3
Juice problem in the liver ? kidney ? spleen ? pancreas ?
Liver - bile
Kidney -urine
Spleen - blood
Pancreas - pancreatic juices
Bioplast materials (+brand names)
Fibrin - Sevac
Gelatine - Gelaspon
Oxidized cellulose - Surgicel
Collagen - Avitene
Collagen+Fibrin - Tachocomb
Tissue adhesives materials
GRF (Gelatin resorcin formaldehyde), Cyanoacrylat (histoacryl blue), Fibrin sealant (Tissuco-body temp, Beriplast - room temp)
Decathlon of vascular surgery
TASS NVA OPA
Types of sutures, Anatomy, Sutures, Suture materials, Needles, Vascular clamps, Anastaomses, Operative techniques, Prosthesis, Anticogulants
Which suture materials and needle do you use for vascular surgery ?
Needle- atruamatic round body, 1/2. Double armamentarium
Suture materials - Nonabsorbable, monofilament (4/0-7/0, 11/0 microsurgical)
Types of anastamoses in vascular surgery
End-to-end (physiological, difficult,causes stenosis)
End-to-side (in transplantation)
Side-to-side (in liver cirrhosis, portocaval anastamosis)
Operative techniques in vascular surgery (incision, preparation, clamping, suturing)
Skin incision - parallel or perpendicular
Preparation - hold vessel in hands, clamp both sides of vessel
Clamping smaller branches with bulldogs
Suturing by the Triangular technique (Negative disproportion, isodisproportional, positive disproportion)
Won noble prize for the triangular suturing technique of vascular surgery
Alexis Carrel, 1912
Who invented the cooper scissors ?
Sir Asetly cooper
Invented Peans
Emile Jules Pean
Discovered Lumniczer ?
Lumniczer Sandor
Invented Kocher
Theodor Kocher
Intestinal surgery technique
1. Sceletization - clamp arcuate vessels
2. Put intestinal clamps 3cm from each side of the place to be sutured
3. Make two sutures (?)
4. Close posterior wall
5. Close anterior wall
6. Suture mesentery
Capsules of kidney
Proper capsule, fatty capsule, renal fascia
Segments of kidney
5 : apical, lower, upper, middle, posterior
Moving and holding in kidney
When you hold the kidney the BP drops to 30mmHg, so you need to clamp the hilus before that.
Which layer of the blood vessel holds the sutures ?
Media
What types of sutures do you use in vascular surgerty ?
Everting sutures, intima to intima
Anesthesia was invented by ?
Wells and Morton
First successful open heart surgery was performed by ?
Blalock, 1944
Vascular surgery, famous surgeon ?
Cooper