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Surgery Mid-term > Lecture 2 > Flashcards

Lecture 2 Flashcards

1
Q

What are Halsted’s principles?

A
  1. Asepsis
  2. Gentle tissue handling
  3. Hemostasis
  4. Preserve blood supply
  5. Reduce dead space
  6. Avoid tension
  7. Anatomic dissection
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2
Q

Why is hemorrhage bad in surgery?

A
  1. Impaired visibility of the surgical field–> risk of iatrogenic injury, increased surgical time, poorer accuracy
  2. Increase risk of dead space, edema, infection
  3. Delays healing
  4. May lead to cardiovascular shock and death
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3
Q

What is the normal blood volume for dog/ cat?

A

Dog: 90ml/kg
Cat: 60 ml/ kg

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4
Q

When do we start to worry about blood loss?

A

40% severe shock, death
25% tachycardia, decrease BP
15% adequate compensation

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5
Q

What are the steps in clot formation

A

Vasoconstriction
Primary hemostasis
Secondary hemostasis
Mature thrombus

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6
Q

What is the main role of primary hemostasis

A

Formation of platelet plug ->

Endothelial cells of chemotactic platelets produce von willebrand factor

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7
Q

What is the role of secondary hemostasis

A

Formation of fibrin

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8
Q

What tests are in a coagulation profile

A

PTT test - intrinsic pathway

PT test - extrinsic pathway

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9
Q

Name a drug that interferes with clotting

A
  • Acetylsalicylic acid
  • warfarin toxicity - prevents formation of vit K formation which is needed for stimulation of factors 2,7,9,10
  • Adequan
  • Heparin
  • NSAIDs
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10
Q

What are some acquired conditions that affect clot formation?

A
  • Liver dz- decreased prod of clotting factors
  • DIC - excessive thrombus formation, exhausts coag factors
  • Biliary duct obstruction
  • neoplasia
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11
Q

What hereditary condition affects clot formation

A

Von willebrands disease - Dobermans
Hemophilia A&B - sex linked/ male dogs
Thrombopathia - Bassett hounds

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12
Q

Problems with primary hemostasis results in ____________?

A

Petechia

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13
Q

Problems with secondary hemostasis results in _____________?

A

Ecchymosis

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14
Q

When hemorrhage occurs _________ is the first step. If it keeps bleeding it is a ______________?

A

Pressure

Big vessel

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15
Q

When do you use pressure pads to stop bleeding

A

For small vessels < 1mm when normal hemostasis is intact

–> require adequate pressure and time!! (1-5 min)

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16
Q

How are hemostatic forceps used to stop bleeding

A

Designed to crush –> provides mechanical seal and injury from crushing vessel releases factors to promote hemostasis

only used for small/low pressure vessels when sufficient clamping time is provided

17
Q

Vascular ligation

A

Used for vessels greater than 2mm diameter

Can use suture or metallic clips

18
Q

What is the most secure form of hemostasis

A

Vascular ligation

19
Q

major disadvantage of vascular ligation

A

introduction of foreign material in the would and increased application time

20
Q

T/F the smallest appropriate suture should be used to ligate vessels

A

true

21
Q

What provides security without excessive bulk

A

square knots

22
Q

what is one advantage and one disadvantage of surgeon’s knot

A

advantage- increased suture friction

disadvantage- increased bulk

23
Q

__________ may be intentionally tied as an initial knot for ligatures in body cavities and _________ is tied over it

A

granny knot

square knot

24
Q

what utilizes a double loop arrangement and is used to ligate vascular pedicles

A

Modified Miller’s

25
Q

what is used in combination with standard ligatures to provide increased security when ligating vessels

A

Transfixation type ligation

26
Q

Advantages/disadvantages of ligating clips compared to vascular ligation

A

increased speed of application and improved effectiveness in less accessible locations

persist in wound as foreign body and may get dislodged

27
Q

What can be used to Atraumatically occlude blood vessels?

A

vascular forceps

28
Q

Slowly absorbable topical that provides physical matrix for clotting and barrier to hemorrhage

A

Gelfoam

29
Q

surgical gauze interacts with protein and platelets to promote clotting and acts as mechanical barrier

A

Surgicel

30
Q

non absorbable/ plugs bleeding edges of cut bone

A

bone wax

31
Q

used to cause vasoconstriction but used cautiously as can cause arrhythmias

A

epinephrine/ norepinephrine

32
Q

types of electrosurgical instruments

A

Electrocautery = thermal cautery

High frequency electrocoagulation

33
Q

advantages/ disadvantages of electrocautery

A

functions in a bloody field, inexpensive

extensive tissue destruction, only effective on small vessels

Surgery Mid-term (5 decks)

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