Surgical Principles

What is using practices and procedures to prevent contamination from pathogens known as?
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What is using practices and procedures to prevent contamination from pathogens known as?
aseptic/sterile technique
What procedures require sterile technique?
urinary catheter/central line/PICC line placement, LP, donning sterile gloves
What procedures require a clean technique?
injections, peripheral IV, removing catheter, cleaning/dressing abrasion
What should be avoid when handling tissues?
excessive crushing, pulling of tissues
What instruments are preferred to forceps that crush wound edges?
Toothed forceps & skin hooks
What should be done when drilling or cutting bone to avoid damage from heat?
irrigation
What is the key to surgical blood management?
meticulous hemostasis, perfusion to support organs
What is required on surgical/procedural documentation and is often underestimated?
estimated blood loss
What is a cavity, potential or real, remaining after the closure of a wound that is not obliterated by the operative technique permitting the accumulation of blood, pus, serum or air?
dead space
How can dead space be prevented and managed in surgery?
suture placement in all planes, minimal tension, drains/packing, pressure dressings
What is an abnormal collection of blood outside blood vessel?hematomaHow do hematomas impair wound healing?increased tension on wound & decreased tissue perfusionWhat can result when a hematoma acts as a culture medium?deep space infectionWhat can result when a hematoma compresses nearby structures?nerve damageHow should expanding hematomas that form post-operatively be addressed?evacuated surgically in order to regain hemostasis, drains, closed suction drainsWho is at greatest risk for hematoma formation post-operatively?Trauma, anti-coagulated & those w/ bleeding disordersWhat is a collection of pus that can be the indication for or a complication of surgery?abscessWhat is a superficial incisional infection?wound abscessHow are abscesses managed?surgery, IR drain, antibiotics or local wound careWhat is a pocket of clear secretions/blood plasma and inflammatory fluid produced by injured and dying cells?seromaWhat is a seroma produced by?injured and dying cellsWhat is used to remove necrotic and devitalized tissue and debris?debridementWhy is debridement necessary?necrotic tissue acts like a foreign body & delays healing/may prolong inflammatory phaseWhat results from collection of fluid in interstitial spaces d/t damaged vessels and lymph obstruction by fibrin?edemaWhat causes edema post-operatively?damaged vessels & lymph obstruction by fibrinHow should edema be managed postoperatively?IVF, careful tissue handling, steroids, ice/cryocompressionWhat are some conditions that could induce catabolic states that can interfere with wound healing?DM, ESRD, malignancy, infectionWhat are cleavage lines that correspond to the alignment of collagen fibers within the dermis which help minimize scarring?Langer's linesWhen are Langer's lines most helpful?plastics or excisionWhat is the fatty superficial fascia that lies just deep to the subcutaneous tissue?Camper's fasciaWhat is the membranous superficial fascia that lies just deep to the fatty Camper's superficial fascia?Scarpa's fasciaWhat is the deepest layer of the lateral abdominal wall?parietal peritoneumWhat layers of the lateral abdominal wall do the muscle layers lie in between?deep fascia and transversalis fasciaWhat are the layers of the abdomen from superficial to deep?skin, subcutaneous tissue, superficial fascia, deep fascia, muscular layers, transversalis fascia, extraperitoneal fat, parietal peritoneumWhat are the four abdominal muscle layers?transversus abdominis, internal oblique, rectus abdominis, external obliqueWhat layers of tissue are passed through if a laparoscope is inserted centrally along the linea alba?skin, linea alba, transversalis fascia, extraperitoneal fat, peritoneumWhat is absent below the arcuate line?posterior rectus sheathWhat is the demarcation above which the posterior lamella of the internal oblique aponeurosis fuses with the aponeurosis of the transversalis muscle and passes posterior to the rectus muscles?arcuate lineWith a Pfannenstiel incision, what layers of abdominal wall and incised from superficial to deep?skin, superficial fascia, deep fascia, anterior rectus sheath, rectus abdominis muscle, transversalis fascia, extraperitoneal fat/CT, parietal peritoneumWhat is the arcuate line the site of entry of?inferior epigastric artery into the rectus sheathWhat kind of injury is associated with the arcuate line?Spigelian hernia (laterally)Where does the aponeurosis of the internal oblique pass below the arcuate line?anterior to the rectus musclesWhat superficial vessels must be avoided when placing trocars/ports for laparoscopic surgery?Superficial epigastric, Superficial circumflex iliac, 10th & 11th Posterior intercostal & Subcostal arteriesWhat are some deep vessels that must be avoided when placing trocars/ports for laparoscopic surgery?Inferior & Superior epigastric, Deep circumflex iliac, Internal thoracic arteriesWhat are some superficial nerves you must avoid when placing trocars/ports for laparoscopic surgery?Cutaneous branches of intercostal, subcostal, & iliohypogastric nervesWhat can retraction/dissection of tissue produce?pockets known as dead spaceWhat are some deep nerves you must avoid when placing trocars/ports for laparoscopic surgery?Iliohypogastric & Ilioinguinal nerves, Subcostal nerve (T12), 10th & 11th Thoracoabdominal/intercostal nerves (arise from spinal nerves T7-T11)What are the most commonly injured vessels during laparoscopic surgery?epigastric vesselsWhat lies between the superficial and deep fascia in the layers of the extremities?adiposeWhat are some procedures that are executed via natural or artificial opening?Endotracheal intubation, foley catheter placement, EGD, colonoscopyWhat is currently the preferred method of pain management initially?regional blocksAccording to ERAS (Enhanced Recovery After Surgery), how should a patient be managed pre-operatively?carb-loading, less fasting time, warming, selective bowel prepAccording to ERAS (Enhanced Recovery After Surgery), how should a patient be managed intra-operatively?epidural, warming, no NG tubes/drains, MIS surgery, short-acting anestheticsAccording to ERAS (Enhanced Recovery After Surgery), how should a patient be managed post-operatively?analgesia, pre-emptive pain/nausea management, early feeding/mobilization, nutrition supplements