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31 Cards in this Set
- Front
- Back
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What are some meds that should be stopped prior to surgery?
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• aspirin (stop 3-5 days before surgery)
• coumadin (stop 7-10 days before surgery) • insulin & anti-glucose meds |
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How long before surgery should you stop smoking to see post-operative benefits?
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2-4 weeks
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What are standard pre-op labs to order?
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• CBC
• Platelets • Chem-7 • UA • Chest X-ray • 12 lead EKG |
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What antibiotics do you use for anaerobic coverage in the bowel?
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• Cefoxitin (Mefoxin)
• Metronidazole (Flagyl) or • Clindamycin (for allergies to PCN) |
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What antibiotics do you use for vascular cases pre-operatively?
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• Cefazolin (Ancef)
or • Clindamycin (for PCN allergic) |
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What is dehiscence?
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A rupture or splitting open, as of a surgical wound, or of an organ or structure to discharge its contents
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What are the phases of wound healing?
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• inflammation (within 24 hrs)
• epithelialization: laying down of granulation tissue (within 48 hrs) • fibroplasia: laying down of fibrous material (72 hrs) • contraction (> 5 days) |
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What is granulation tissue?
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• 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) |
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What are 3 factors that promote wound healing?
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• decrease inflammation
• increase blood flow • decrease wound edema |
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Which patients are good candidates for hyperbaric medicine?
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patients with low tissue oxygenation
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What is the difference between primary and secondary intention?
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• 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 |
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What type of dressing is used to treat a wound infected with pseudomonas?
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dressing with acetic acid (Dakin's Solution)
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What is delayed primary closure?
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• 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 |
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What are inhibitors of wound healing?
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• anemia
• bacteria and foreign bodies (direct inhibitors of collagen synthesis) • cancer • poor nutrition • radiation • steroids • tissue hypoxia |
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What lab test can be ordered to asssess nutritional status?
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albumin or pre-albumin
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What are different types of dressings?
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• Acetic acid
• Aquacel • Dakins solution • VAC dressings • wet to dry (gauze soaked with normal saline) |
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What should you not put wet to dry dressing on?
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• open bowel
• ligaments and tendons • open visceral organs (heart, lung, liver) * will adhere to organ or tendon |
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What is Aquacel?
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• good to put over viseral organs (heart, lung, liver, etc...)
• hydrophillic, non-adherent, gel-based gauze • will not adhere to wound |
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What is a VAC dressing?
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• vacuum-assisted closure
• gets rid of tissue edema |
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What are the two causes of burn death?
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• immediately after injury
• weeks later due to multisystem organ failure |
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What happens to the body during the burn response?
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• 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 |
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What is hemoconcentration?
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• an inadequately elevated hematocrit
• ex. hemoglobin - 12; hematocrit - 50 • caused by leaking from capillaries |
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What is the percent of body surface area of each part of the body (according to the rule of nines)?
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• arms: 9% each
• torso (front/back): 18% • head & neck (front/back): 9% • leg (front/back): 18% • genitalia/perineum: 1% |
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What is the treatment of 1st degree burns?
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• pain meds (ex. Dilaudid, Morphine, Versed)
• keep wounds clean and covered to decrease level of pain |
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What is the treatment for 2nd degree burns?
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• 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 |
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What is the treatment for 3rd and 4th degree burns?
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• perform excision and escharotomy early
• split thickness skin graft (STSG) |
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What is the difference between escharotomy and fasciotomy?
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• escharotomy is done on burn patients
• fasciotomy is done on non-burn patients |
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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?
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• adult: 0.5 cc/kg/hr
• child: 1-2 cc/kg/hr |
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What is the Parkland formula?
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• 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 |
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True/False: Antibiotics can be used for prophylactic/empiric theray for burn patients
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• 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 |
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Why are dextrose-based fluids avoided during initial resuscitation of burn patients?
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• blood gluocse levels are generally elevaed secondary to inflammatory cascade or stress
• destruction of cells causes release of glucose |
