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149 Cards in this Set
- Front
- Back
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Most common material for instruments and inserts:
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high quality stainless steel instruments with tungsten carbide inserts
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Most common material for microsurgical instruments:
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titanium alloy
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Disadvantages of chrome plates carbon steel:
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early deterioration that leads to oxidation and rust formation
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Methods to increase corrosion resistance:
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passivation, polishing
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Define passivation:
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nitric oxide removal or foreign material from stainless steel surface and coating with chromium oxide
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Advantages of disposable blades:
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replacement blades are consistently sharp
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Advantages of reusable scalpel with attached blades:
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blade does not detaches when in heavy connective tissue, joints, or deep tissue planes
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What sterilization method is recommended for reuseable scalpels with attached blades?
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Ethylene oxide
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Examples of high energy scalpels:
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electrosurgical, plasma, water, laser
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MOA of high energy scalpels:
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radiofrequency current produces either incision, coagulation desiccation, fulguration
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Range of frequencies in electrosurgical units:
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1.5-7.5 mHz
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What does the effect produced by electrosurgical units depend on?
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Waveform of the current produced
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Characteristics of properly functioning scissors:
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open & close with a smooth gliding action, tip should meet when closed
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Description of grasping surface of needle holders:
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cross hatched with central longitudinal groove
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Most commonly used needle holders:
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mayo-hegar, olsen-hegar
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Difference between mayo-hegar and olsen-hegar needle holders:
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olsen-hegar has scissor to cut suture
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Advantage of tungsten carbide needle holder inserts:
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facilitate needle grip, improve needle holder durability
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Classes of thumb forceps:
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traumatic (smooth or anatomic) and surgical (serrated or toothed)
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Effect of traumatic thumb forceps:
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smooth tips crush tissue because of forces needed to gain purchase on tissues
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Effect of surgical thumb forceps:
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serrations or teeth allow secure hold on tissue with minimal digital crushing pressure
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Most aggressive surgical thumb forcep:
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rat tooth (or tissue)
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Least traumatic thumb forceps:
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Russian
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Classification of DeBakey and Cooley thumb forceps:
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atraumatic (surgical)
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Use of Debakey thumb forceps:
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vascular, thoracic, intestinal surgery
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Examples of hemostatic forceps:
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halstead mosquito, Kelly, crile, Rochester-pean, Rochester-carmalt, Rochester-oschner
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Difference between Kelly & crile hemostatic forceps:
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transverse grooves are only on distal half on kelly but the entire surface on crile
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Jaw surface Rochester-pean:
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deep transverse grooves entire jaw surface
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Jaw surface Rochester-carmalt:
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longitudinal grooves on jaw with a few horizontal cross striation on tip
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Jaw surface Rochester-oschner:
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transverse groove with 1-to-2 interdigitating teeth at jaw tip
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Caution with Rochester-oschner:
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traumatic, use on tissue to be removed
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Jaw surface doyen-debakey intestinal forceps:
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longitudinal serrations
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Use of allis tissue forceps:
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heavy tissue planes, tissue to be excised
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Pull of allis tissue forceps:
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perpendicular to the orientation of teeth
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Classes of tissue retractors:
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finger held, hand held, self retaining
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Examples of finger held retractors:
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senn, Volkmann, parker
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Examples of hand held retractors:
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army-navy, hohman, Kelly, meyerding, lahey
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Use of hohman retractor:
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blunt projection useful in exposing bone while retracting muscle in orthopedic and reconstructive surgery
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Examples of self retaining retractors:
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gelpi, weitlaner, balfour, finochietto, adson cellebellar, aanes
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Difference between weitlaner & adson cellebellar retractor:
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weitlaner has 2 to 3 or 3 to 4 outwardly pointed blunt or sharp teeth, adson cellebellar has 4 to 4 sharp teeth
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Difference between aanes & finochietto rectractor:
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aanes has interchangeable blades of different depths and finochietto does not
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Examples of suction tubes:
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yankauer, frazier-ferguson, poole
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Difference between burns and volkman curettes:
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burns have a grooved handle, volkman is a double-ended curette with an oval cup on 1 end and either a oval or rounded cup on the other end
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Examples of periosteal elevators:
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Adson, Mcilwraith, Foerner, Freer
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Sharpest periosteal elevator:
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Foerner
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Difference between osteotome & chisel:
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osteotomes are double beveled at cutting tip, chisels are single beveled
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Examples of bone cutting forceps:
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Liston, Ruskin-Liston, Stille-liston
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Maximum sized pin for Jacob chuck:
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0.6mm (1/4”)
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Examples of trephines:
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galt, Michele
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Sizes of galt trephines:
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from 1.25-2.5 cm (1/2-1”)
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Sizes of Michele trephines:
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0.6-3.1 cm (1/4-1 ¼”)
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Cutting surface of galt trephine:
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end of shaft and outside perimeter of shaft
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Cutting surface of Michele trephine:
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end of shaft
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Halsted’s principles:
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strict aseptics during prep & surgery; good hemostasis to improve procedure & decrease infection; avoid dead space formation; minimize tissue trauma with careful handling; maintain blood supply; avoid tension on tissue; adapt corresponding tissue layers
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3 ways to hold scalpel blade handle:
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pencil, fingertip, palm
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indications for pencil grip:
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short, precise incisions
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disadvantages of pencil grip:
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steep angle so decreased contact of cutting edge with skin
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Indications of fingertip grip:
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long, straight, curved or sigmoidal incisions
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Location of scissor cutting:
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tip of instrument
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Advantages of straight scissors:
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most efficient cutting
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Advantages of curved scissors:
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more comfortable for surgeon, better visualization of tip in deeper planes
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3 methods of holding needle holders:
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tripod, palm, thenar
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advantage of palm grip:
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rapid instrument manipulation when precision not essential
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Advantage of tripod grip:
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precision when releasing needle, especially in delicate tissues
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Advantages of electrosurgical incision:
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reduction in blood loss; decreased need of ligatures; reduced operating time
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Undesirable effects of charred electrosurgical instruments:
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higher power needed to incise tissue; current dispersed to a larger area; increased thermal necrosis at edges
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Disadvantages of electrosurgical incisions:
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delayed wound healing, decreased resistance of wound to infection
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Examples of mechanical hemostasis:
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pressure (manual, hemostatic forceps), ligatures, hemostatic or vascular staples, surgical repair, esmarch system
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Vessel diameters occluded with vascular staples:
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up to 7mm
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Disadvantage of vascular staples:
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expensive, failure on larger vessels
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Major holding (suture) layer of vessels:
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tunica adventitia, tunica media
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Pressure for pneumatic tourniquet after placement of esmark tourniquet for distal limb mechanical hemostasis:
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600 mmHg
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Length of time for tourniquet placement for distal limb mechanical hemostasis:
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2 hours
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2 types of thermal coagulative hemostasis:
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obilterative, coaptive
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define obliterative coagulation:
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direct contact between electrode & vessel causes vessel to shrink & lumen to occlude by thrombosis
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Define coaptive coagulation:
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vessel initially occluded with hemostatic forceps, electrode is applied to hemostats conducting energy to the vessel inducing occlusion
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Examples of chemical hemostasis:
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epinephrine, 10% buffered formalin
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Dilutions of epinephrine for chemical hemostasis:
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1:100,000 or 1:20,000
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Dose of buffered formalin for chemical hemostasis:
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0.02 to 0.06 mL/kg in 0.9% saline IV
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Suction pump vacuum pressure:
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80-120 mmHg
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Difference between electrocautery and electrosurgery:
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ES pass current through tissue to cut, coagulate, desiccate, or fulgurate tissue. no electrical current passes through the tissues or patient with electrocautery
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Types of electrosurgical circuits:
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monopolar, bipolar
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Components of a monopolar circuit:
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generator, instrument (electrode), grounding pad
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Describe monopolar circuit:
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generator, when activated, directs current to the active electrode, through the patient’s body to the grounding pad and finally back to the generator to complete the circuit
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Position of electrode for monopolar cutting:
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holding the electrode slightly away from the tissues in cutting mode
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Position of electrode for fulguration coagulation:
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holding the electrode slightly away from the tissues in coagulation mode
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Position of electrode for desiccation coagulation:
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holding the electrode on the tissues in coagulation mode
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Vessel size for monopolar hemostasis:
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less than or 2 mm
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Area of collateral damage from monopolar hemostasis:
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up to 2 cm from site
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How does bipolar differ from monopolar circuit?
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Circuit does not pass through the patient
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Describe bipolar circuit:
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current passes from the generator, to 1 prong of the instrument, through the tissue in the jaws, to the opposite prong, and then back to the generator
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Vessel size for bipolar hemostasis:
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less than or 3 mm
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Area of collateral damage from bipolar hemostasis:
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up to 8mm from site
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Describe ligasure:
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bipolar RF vessel sealing system consisting of a generator and variety of instruments that can be used to grasp, seal, coagulate, and cut soft tissue
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Vessel size for ligasure hemostasis:
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less than or 7mm
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Area of collateral damage from ligasure hemostasis:
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1.5-6mm from site
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Describe harmonic system:
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generator, a hand piece, and an instrument. energy transmitted from generator to hand piece, activates crystals in the transducer, which produce high-frequency ultrasonic mechanical energy delivered to the tip. No electrical current travels through treated tissue or the patient.
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Preferred type of endoscopic light source:
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xenon
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Advantage of xenon light vs halogen:
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xenon light is whiter which results in better color reproduction
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Common size of arthroscopy telescope diameter:
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5mm or less
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Common size of laparoscopy or thoracoscopy telescope diameter:
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10mm
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Lengths of laparoscopes:
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30cm (from human) 57cm (equine)
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Lengths of arthroscopes:
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15 to 25 most common by 4mm diameter 35 cm length available
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Common endoscopic lens angles:
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0, 25, 30 for all and rarely used 70 for arthrocopy
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How is fluid extravasation minimized during arthroscopy?
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Skin incision slightly smaller than joint capsule incision, decrease fluid pressure
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When is gas insufflation required in arthroscopy?
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Insertion of cartilage grafts, injection of gel into subchondral bone cysts
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Minimum and desired insufflator flow rates for abdominal insufflation:
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10-20 L/min
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Flow rates of needles used for abdominal insufflation:
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veress <3L/min; teat cannula 6-7L/min
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Desired patient abdominal pressure with insufflation:
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15 mmHg or less
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Desired patient thoracic pressure +/- insufflation:
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5 mmHg
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Difference between semm laparoscopic forceps and babcock laparoscopic forceps:
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semm are traumatic and only used on tissue to be removed, babcock are autraumatic
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Examples of laparoscopic vessel sealing devices:
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Ligasure, SurgRx enseal
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Define triangulation:
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placement of telescope and instruments through separate portals so that they converge on the operative target
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Effects of trendelenburg postion on cardiopulmonary parameters:
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decreased pH, increased PaCO2, increased MAP, decreased PaO2
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Define arterial embolization:
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catheter directed delivery of particulate material for the purpose of embolizing selected arteries
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Define aortic-iliac thrombosis:
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chronic arterial occlusive disease of caudal aorta and caudal arteries
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Instruments for AI thrombectomy:
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fogarty graft thrombectomy catheter
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Complications of AI thrombectomy:
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post-anesthetic myopathy, AI thrombosis in the contralateral limb
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Components of computer assisted surgery system:
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instruments with LED, vetgate navigation system, orbic 3d c arm fluoroscopy
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satinsky
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A bard parker #3
B bard parker long #3 C narrow #7 D bard parker #4 E 10, 11, 12, 15 D 22 |
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veress needle
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A Semm
B Babcock |
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Fogarty thrombectomy catheter
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