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24 Cards in this Set
- Front
- Back
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What are 3 ways to preoperatively evaluate the efficiency of hemostasis in your patient?
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1) Platelets
2) Mucosal bleeding test 3) ACT |
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**How much blood can be lost before need replacement?
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70-80 mL/ kg of BW
-Loss of 20% to 50% BV may require replacement |
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What are 5 ways you can stop bleeding at the surgical site?
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1) Pressure (1st thing!!!)
2) Cautery +/- instrumentation 3) Ligation 4) Surgical staples 5) Primary repair of larger vessels |
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Why is it important to blot and not wipe the surgical site?
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Wiping removes venous clots and causes tissue trauma
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What is electrocoagulation? ****When do you use electrocoagulation?
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Electricity causes heating in tissues
**Use in vessels <1.0-2.0 mm |
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What is electrocautery?
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Something heated first then applied
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Where does the current flow with monopolar electrocoagulation?
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Flow of current from active electrode through patient to ground plate
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What allows maximal tissue heating with monopolar electrocoagulation?
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Active electrode has small contact area with a high current density
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What prevents the ground plate from burning the patient?
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Patient ground plate has large contact area and reduces current density and results in minimal tissue heating
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What are 6 complications of monopolar electrocoagulation?
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1) Thermal necrosis at wound site
2) Thermal necrosis from inappropriate patient grounding 3) Excessive use of electrocautery increases risk for surgical wound infection 4) Charring-irrigation of the wound 5) Smoke evacuation 6) Time is trauma- judicious use is appropriate |
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What is bipolar cautery? Where does the current flow?
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Active and ground electrodes on forceps, current passes from one tip, through tissue, to the other tip
-Handswitch or foot switch |
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Is monopolary or bipolar more precise?
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Bipolar cautery
-Neurological or cosmetic surgery |
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What size of vessels should be ligated?
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Vessels greater than 1 to 2 mm
-Usually absorbable type |
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Does finer or thicker suture material have better holding power?
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Finer: 0, 2/0, 3/0
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What should you do when ligating a larger artery?
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Double ligatures
-transfixation in some situations |
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What are 5 knot types?
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1) simple
2) square 3) Surgeon's 4) Half hitch 5) Granny |
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What is a transfixation ligation?
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Where suture into the tissue or vessel itself
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Why don't staples cause irritation?
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The staples are an inert substance
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How can you try to ensure staple security with large vessels?
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Double application
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What are 4 hemostatic agents?
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1) Bone wax- beeswax; applied to bone surface
2) Surgical- oxidized cellulose; clotting substrate, should be removed 3) Gelfoam- gelatin sponges; swell and expand--> pressure 4) Hemcon bandage |
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How do Chitosan-based wound bandages work?
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Positively charged chitosan acetate in bandage adheres to tissues and agglutinates RBCs
-Labeled for external use |
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When should use packing in a wound? What can be used for pressure & packing?
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Deep bleeders
Roll gauze, laparatomy pads |
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What are the 3 types of units used for electrosurgery?
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Monopolar
Bipolar Grounding |
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What type of suture do you want to use for primary repair (reattaching the circuit together), which is reserved for larger vessels?
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5/0 to 7/0
Nonabsorbable usually Monofilament |
