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31 Cards in this Set

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What are some meds that should be stopped prior to surgery?
• aspirin (stop 3-5 days before surgery)
• coumadin (stop 7-10 days before surgery)
• insulin & anti-glucose meds
How long before surgery should you stop smoking to see post-operative benefits?
2-4 weeks
What are standard pre-op labs to order?
• CBC
• Platelets
• Chem-7
• UA
• Chest X-ray
• 12 lead EKG
What antibiotics do you use for anaerobic coverage in the bowel?
• Cefoxitin (Mefoxin)
• Metronidazole (Flagyl)
or
• Clindamycin (for allergies to PCN)
What antibiotics do you use for vascular cases pre-operatively?
• Cefazolin (Ancef)
or
• Clindamycin (for PCN allergic)
What is dehiscence?
A rupture or splitting open, as of a surgical wound, or of an organ or structure to discharge its contents
What are the phases of wound healing?
• inflammation (within 24 hrs)
• epithelialization: laying down of granulation tissue (within 48 hrs)
• fibroplasia: laying down of fibrous material (72 hrs)
• contraction (> 5 days)
What is granulation tissue?
• the initial tissue deposited within the forming scar
• lays the matrix for giving the scar its strength (most wounds achieve strength within 1 month)
• can be affected by patient status (HIV status, immunosuppresion)
What are 3 factors that promote wound healing?
• decrease inflammation
• increase blood flow
• decrease wound edema
Which patients are good candidates for hyperbaric medicine?
patients with low tissue oxygenation
What is the difference between primary and secondary intention?
• primary intention: closure of the wound using simple approximation (ex. sutures, surgical staples, etc.)

• secondary intention: wound is allowed to close without suturing; let the wound epithelialize and granulate on their own
What type of dressing is used to treat a wound infected with pseudomonas?
dressing with acetic acid (Dakin's Solution)
What is delayed primary closure?
• performed by leaving sterile surgical dressing intact and wound to heal by secondary intent
• at 4-5 days post-op, perform wound closure
• works well for initially infected/contaminated wounds
What are inhibitors of wound healing?
• anemia
• bacteria and foreign bodies (direct inhibitors of collagen synthesis)
• cancer
• poor nutrition
• radiation
• steroids
• tissue hypoxia
What lab test can be ordered to asssess nutritional status?
albumin or pre-albumin
What are different types of dressings?
• Acetic acid
• Aquacel
• Dakins solution
• VAC dressings
• wet to dry (gauze soaked with normal saline)
What should you not put wet to dry dressing on?
• open bowel
• ligaments and tendons
• open visceral organs (heart, lung, liver)

* will adhere to organ or tendon
What is Aquacel?
• good to put over viseral organs (heart, lung, liver, etc...)
• hydrophillic, non-adherent, gel-based gauze
• will not adhere to wound
What is a VAC dressing?
• vacuum-assisted closure
• gets rid of tissue edema
What are the two causes of burn death?
• immediately after injury
• weeks later due to multisystem organ failure
What happens to the body during the burn response?
• release of vasoactive substances (ex. histamine, prostaglandins, arachidonic acid)
• results in increased vascular permeabilty » leads to edema formation
• intravascular volume decreased (causes decrease blood flow to GI, renal, and skin)
• decreased cardiac output
• diminshed oxygenation of vital organs
What is hemoconcentration?
• an inadequately elevated hematocrit
• ex. hemoglobin - 12; hematocrit - 50
• caused by leaking from capillaries
What is the percent of body surface area of each part of the body (according to the rule of nines)?
• arms: 9% each
• torso (front/back): 18%
• head & neck (front/back): 9%
• leg (front/back): 18%
• genitalia/perineum: 1%
What is the treatment of 1st degree burns?
• pain meds (ex. Dilaudid, Morphine, Versed)
• keep wounds clean and covered to decrease level of pain
What is the treatment for 2nd degree burns?
• remove blisters and apply Silvadene antimicrobial cream
• other options:
- Acticoat: Silvadene in a 4 x 4 gauze (sticks to the wound)
- Pig skin: allows mobility and avoids contractures
- Cadaveric grafts: allows hypermobility and produces very little scarring
What is the treatment for 3rd and 4th degree burns?
• perform excision and escharotomy early
• split thickness skin graft (STSG)
What is the difference between escharotomy and fasciotomy?
• escharotomy is done on burn patients
• fasciotomy is done on non-burn patients
A foley catheter is inserted in a burn patient to measure urine output. What would be considered adequate urine output for an adult and a child?
• adult: 0.5 cc/kg/hr
• child: 1-2 cc/kg/hr
What is the Parkland formula?
• used to estimate the total volume of crystalloid fluid administered to burn patients during the first 24 hours
• 4 cc x kg x %BSA
• give ½ the toal volume in the first 8 hrs, and the remaining amount over the remaining 16 hrs
True/False: Antibiotics can be used for prophylactic/empiric theray for burn patients
• antibiotics are reserved for documented infection
• prophylactic/empiric therapy is usually avoided (unless patient is septic and cultures are pending
• The correct answer is: False
Why are dextrose-based fluids avoided during initial resuscitation of burn patients?
• blood gluocse levels are generally elevaed secondary to inflammatory cascade or stress
• destruction of cells causes release of glucose