Signs inflammation has moved to infection: exudate, systemic heat, nausea, general malaise, function loss
preventing contact with all microorganisms before they can enter the body; no microbial life. Autoclaving surgical instruments, using sterile gloves, maintaining sterile field, sterile draping, etc.
Dry heat sterilization
requires higher heat 320 F, and longer exposure 3-4 hours; done in an autoclave, for easily corroding instruments like sharp blades or things that should not get wet.
amount of tension or pull, expressed in pounds that a suture strand can withstand before breaking
applied to the skin or sprayed on with short duration to allow piercing, lancing or injecting for patient comfort; ex: ethyl chloride spray, Emla patch
have eye, must be threaded with suture material, eye is bigger than needle so more traumatic to skin
"not traumatic needles", no eye, minimizing trauma to skin, called "swaged" needles because the suture is pre-attached, usually curved
sterile drape with fenestration/window/hole to put over surgical site to only expose immediate area for procedure
A. sterile saline 0.9% comes in 1. multiple dose vial for injections, 2 larger container for rinsing and irrigating wounds. B. sterile water comes in 1. multiple dose vial for use as diluent for mixing meds, 2. large container for rinsing instruments after chemical disinfection.
minor surgical procedures done in office
suturing, cyst removal, incision and drainage of an abscess, collection of biopsies, vasectomy, arthroscopy, circumcision, teeth extraction, toenail removal, mole removal, needle biopsy, joint fluid aspiration, spinal tap, bone marrow aspiration
cauterizes or seals off ends blood vessels using an instrument with a pencil-point sized source of electricity to burn the tissue
must be sanitized, disinfected, sterilized for next time or disposed of if they were intended for single use.
chromic gut vs. plain gut sutures
made from sheep historically, both are absorbable sutures. Chromic gut is treated with chromic salts and will last longer (up to 60 days)
on the side
an area separate from the sterile field, but should be nearby; can turn your back on it, may have unopened sterile items and all items will at least be clean.
protects wound from injury and contamination; maintains constant pressure minimizing bleeding and swelling; holds wound edges together; absorbs drainage and secretions. Because it is going directly in or on an opening into the body, it must be sterile.
Helps hold dressing in place; improve circulation; support or reduce tension or prevent movement. Must be clean, may be sterile.
destroying transient microorganisms after they leave the body; hand washing, disinfecting surfaces in the exam room when patient leaves, sanitizing stethoscope, etc.
cutting instruments: scalpels and dissecting, bandage, suturing and surgical scissors.
grasping or clamping: hemostatic forceps, tissue forceps, dressing or thumb forceps, sponge forceps, splinter forceps
to examine body cavities.
scopes have lights: coloscope, bronchoscope, anoscope, endoscope.
probes or sounds
Dilators:used to enlarge openings like uterine cervix.
Retractors: pull wound edges back.
Speculums open things wider: nasal and vaginal.
Size of sutures
From largest to smallest 4, 3, 2, 1, 0 "aught", 1-0 or 0 or one-aught, 2-0 or 00 or two-aught, 3-0 or 000 or three-aught, 4-0 or 0000 or four-aught, 5-0 or 00000 or five-aught, 6-0 or 000000 or six-aught, 7-0 or 0000000 or seven-aught. The more zeros, the smaller the gauge.
Size of sutures-uses
overall: smallest possible for face 7-0 ideally,
higher for joints and higher tension areas or deep sutures more like 4-0 (handout)
anesthesia and pt. medical history.
All communication to and from pt. prior to administering anesthesia. Also MUST ask about allergies prior to administering anesthesia.
may be added to anesthesia, will have red labelling. It is a vasoconstrictor and should not be used on Pts with hypertension or on areas that are extremities. It's benefit is less bleeding during procedure.
lock box instruments
lock box is the hinge so it is on many grasping tools such as forceps and needle holders
silk, nylon, Dacron, cotton, stainless steel staples; used on body surface, must be removed
face, eyelid, eyebrow, nose, lip 3-5 days
scalp 6-8 days
chest, abdomen, penis 8-10 days
ear, hand 10-14 days
back, extremities, foot, joints 12-14 days (handout)
minor surgical procedures performed in the medical office
are less complex than major; uses local vs. general anesthesia; is an office procedure vs. hospitalization. could include electrosurgery, laser surgery, microsurgery, or cryosurgery,
surgical short scrub
5-6 minutes (each arm); hands, wrists, forearms, 2" above elbows; hands held up for rinsing; prevents bringing microorganisms from unwashed area; clean nails with brush after pick; use scrub brush for friction; dry with sterile towels; no lotion; sterile gloves for protection and sterility.
Autoclave temperature for sterilization
250-254 F or 121-123 C. Autoclave requires-heat water and pressure: 15psi, 20 minutes minimum
medically aseptic hand wash
2-3 minutes; hands and wrists; hands held down for rinsing; pathogens loosened and carried away from hands and wrists; clean nails with pick; hands together for friction; dry with paper towels; lotion use ok; apply gloves for protection; (removes transient flora)