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69 Cards in this Set

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What 3 hurdles must modern surgery overcome? What is the "4th hurdle"?
1. Bleeding (hemostasis)
2. Infection (asepsis)
3. Pain (analgesia/anesthesia)
4. Minimization of surgical procedure
Who must provide consent before beginning a veterinary surgical procedure? What is this consent called?
Vet consent + owner consent = informed consent
What does ACVS stand for?
American College of Veterinary Surgeons
What are physical sterilizing agents discussed in class? Chemical?
Physical (dry heat, pressurized steam, gamma radiation)
Chemical (Ethylene Oxide, Glutaraldehyde)
What concentration of chlorhexidine or iodine should be used in wound care? On serosa?
Wound (<0.05% chlorhex; <1% iodine)
NEVER used on serosa!
What are the three types of autoclaves? Which can be used to "flash" instruments?
Gravity displacement
Steam pulsing
Prevacuum autoclaves (fastest; can use for flashing)
What is the safe autoclave standard for temp/time?
13min @ 120C
What must be kept in mind when using cold sterilization?
Gluteraldehyde-soaked instruments must be flushed well with sterile saline!
T or F:
The surgeon and surgical tools are the primary sources of infection in a surgical procedure.
False!
It is contamination from the patient!
How far from the projected surgical incision site should be clipped?
at least 10cm
When is the rough scrub considered complete?
When the EtOH scrub comes off CLEAN!
What is the recommended contact time used for detergent in the sterile scrub?
5min
How much skin around the incision site should be exposed when draping?
2 - 5 cm
How many microbes/minute do people shed?
1K to 10K microbes/minute
What microbes are harbored in human hair?
S. aureus, E. coli, Strept.
Use of masks can reduce microbe levels by what level?
NO REDUCTION IN BACTERIAL COUNT!! Does decrease aerosol contamination
What are Halstead's Principles of proper surgical technique (there are 7)?
Gentle tissue handling
Preservation of vascular supply
Removal of necrotic tissue
Accurate hemostasis
Anatomic tissue approximation w/o tension
Obliteration of dead space
Strict aeseptic technique
What measures can be used to increase the shelf life of autoclaved instruments?
Double wrapping
Heat sealing
Plastic cover
What is the total blood volume for adult small animals? For young animals?
Adults - 8% BW (70-80ml/kg)
Young - 10%
Why is it important to count sponges?
Don't wanna leave any behind!
What size vessels are ligation candidates? What suture material sizes are good for ligation?
Vessels > 1 or 2mm
Use 0, 2/0, or 3/0 suture
T or F:
A Penrose Drain should never drain via the drain lumen.
True! Penrose drains drain via the outside circumference
What are indications for drain use?
Eliminate dead space
Evacuate existing fluids
Evacuate anticipated fluid/gas collections
Choose passive or active drain...
...uses natural pressure gradients.
passive
Choose passive or active drain...
...often has a one-way valve (or condom) affixed to one end.
passive
Choose passive or active drain...
...uses negative pressure.
active
Choose passive or active drain...
...reduces chance of infection.
active
Choose passive or active drain...
...more difficult to maintain.
active
Choose passive or active drain...
...often used in deep areas or cavities.
active
When should most drains be removed?
2-5 days
Which of the following are useful in maintaining drain patency?
a) preiodic retrograde flushing
b) initial flushing with heparin
c) special antibiotic or heparinized coatings
b) initial flushing with heparin
c) special antibiotic or heparinized coatings

RETROGRADE FLUSHING IS CONTRAINDICATED
What pressure should be used in lavaging wounds?
10-15psi (use 19ga needle w/35cc syringe)
Which solution should be used in wound lavage?
a) hypotonic
b) isotonic
c) hypertonic
b) isotonic
Choose electrocautery, monopolar, or bipolar electrosurgery...
...direct heat coagulates proteins causing hemostasis.
Elecrocautery
Choose electrocautery, monopolar, or bipolar electrosurgery...
...uses a grounding plate
monopolar electrosurgery
Choose electrocautery, monopolar, or bipolar electrosurgery...
...heat is generated by tissue's resistance to electrical current.
Monopolar and bipolar electrosurgery
What are dangers of monopolar electrosurgery systems?
Burns due to direct coupling of instruments or reduced grounding pad contact
Choose electrocautery, monopolar, or bipolar electrosurgery...
...no grounding plate necessary.
electrocautery and bipolar electrosurgery
What are the 5 types of staple/ligature devices?
Disposable skin stapler
Surgiclip/Ligaclip
LDS (ligating & dividing stapler)
TA (thoraco-abdominal stapler)
GIA (gastro-intestinal-anastomotic stapler)
When should staples be removed?
10-14d
What type of staple/ligature device would be used in...
...gastric vessel ligations?
LDS (ligating & dividing stapler)
What type of staple/ligature device would be used in...
...small animal deep incisions?
Surgiclip/Ligaclip
What type of staple/ligature device would be used in...
...partial gastrecomies, partial splenectomies, or intestinal anastomoses?
TA (thoraco-abdominal stapler)
What type of staple/ligature device would be used in...
...side-to-side intestinal anastomoses?
GIA (Gastro-intestinal-anastomotic stapler)
In general...how far should sutures be placed from the wound edge? How far from each other?
5mm from wound edge; 5mm from each other
What are the 3 main types of suture patterns? What is the major characteristic of each?
Simple - single pass on each side then tied
Mattress - 2 passes on each side, then tied
Continuous - multiple passages, tied on each end
Choose interrupted or continuous suture...
...provides a better seal.
continuous
Choose interrupted or continuous suture...
...provides adjustable tension.
interrupted
Choose interrupted or continuous suture...
...loss of knot can be disasterous!
continuous
Which of the following are applications of the simple continuous suture pattern?
a) Subcutaneous
b) Bowel
c) Fascia
d) Bladder
e) Pleura
All of em!
What are applications for the cruxiate suture pattern?
Skin closure
Bodywall closure
When are inverting suture patterns used? What are the major suture patterns for inversion?
Intestinal surgery;
Lembert, Halsted, Cushing, Connell
Which appositional suture patterns are commonly used on skin? Which of these are ONLY used in skin?
Simple interrupted
Simple continuous
Cruxiate (only in skin)
Interrupted or continuous Intradermal (only in skin)
Ford interlocking (skin or diaphragm)
What are the 6 inverting suture patterns discussed in class? Which one is unique in penetrating the bowel lumen?
Lembert
Halsted
Connell (penetrates lumen)
Pursestring
Cushing
Parker-Kerr
Which type of appositional suture is NOT used on skin?
Gambee
Choose Lembert, Halsted, Cushing, or Connell type suture pattern...
...is an appositional pattern.
ALL OF THEM
Choose Lembert, Halsted, Cushing, or Connell type suture pattern...
...a horizontal mattress in Lembert fashion.
Halsted
Choose Lembert, Halsted, Cushing, or Connell type suture pattern...
...can be a interrupted or continuous pattern.
Lembert
Choose Lembert, Halsted, Cushing, or Connell type suture pattern...
...provides less inversion than the Lembert.
Cushing
Which appositional suture pattern is used for stump closure?
Purse-string
What are the suture patterns used to close a large gap?
Mattress (horizontal, vertical)
Near/far/far/near
What is the fate of absorbable sutures?
breakdown, phagocytosis, metabolism, excretion
Choose monofilament or multifilament suture...
...less prone to wicking and infection.
monofilament
Choose monofilament or multifilament suture...
...has more tissue drag.
Braided
What are the three main types of absorbable synthetic monofilaments? What is the trade name for each?
Polyglyconate (Maxon)
Polyglecaprone 25 (Monocryl)
Polydioxanone (PDS)
What are the two main types of absorbable synthetic multifilaments? What is the trade name for each?
Polyglycolic acid (Dexon)
Polyglactin 910 (Vicryl)
Choose Maxon, Monocryl, or PDS...
...takes 28-56 days to lose 50% of tensile strength.
PDS
Choose Maxon, Monocryl, or PDS...
...takes 7 days to lose 50% of tensile strength.
Monocryl
Which suture material is highly reactive? What is the use for this material?
Silk - good for opthamology, ligatures, and plastic surgery