1
one time usage, in and out
what is sim's positioning of the patient during surgery?
semi-prone
4 types of hemostasis?
1. free vessel-hand tie and hemostat
2. ligature
3. figure 8 stick
4. utilize knot tying techniques
4 techniques for removing foreign body from ear
1. irrigation (simplest method if TM is not perforated)
2. if perforated, refer to ENT
3. direct instumentation - avoid pushing further into canal
4. suction
indications for wound closure: (5)
1. decrease time required to heal
2. reduce likelihood of infectino
3. decrease the amount of scar tissue
4. reduce the likelihood of infection
5. cosmetic appearance
when is coude catherization indicated
it has bend in distal tip that allows catheter to follow anterior surface of male urethra
-this helps get around the curve and to the prostate
-this can be used if unsuccessful due to stricture or obstruction
what are 9 different positions for surgery?
1. supine/dorsal recumbent
2. trendelenburg- feet above head
3. reverse trendelenburg- feet below head
4. fowler's/sitting
5. dorsal lithotomy
6. sim's (semi-prone)
7. prone
8. lateral kidney
9. lateral chest/posterolateral thoracotomy
6 ways to control bleeding
1. manual (pressure is simplest and most direct method)
2. clips
3. coagulation
4. ligature (square knot hand tie)
5. suturing
6. vascular stapler
11 causes of epistaxis
1. local trauma (most common) (nose picking)
2. facial trauma
3. foreign bodies
4. nasal or sinus infections
5. prolonged inhalation of dry air (even O2)
6. deviated nasal septum
7. latrogenic causes include nasogastric and nasotracheal intubation
8. topical nasal drugs (antihistamines and corticosteroids)
9. local irritation or URI- in children
10. hypertension - rarely
11. dry climates and cold weather (due to dehumidification of nasal mucosa by heating systems)
6 potential complications of wound closure
1. infection
2. scarring/keloid
3. loss of function
4. loss of cosmesis
5. wound dehiscence
6. tetanus
when is foley catheterization indicated?
designed to remain in place
-has inflatable balloon at tip
-inflated with sterile water
-5 or 30 mL types
-5 mL types uses 10 mL of sterile water to inflate
indications for local anesthesia (6)
1. minor surgical procedures
2. laceration repair
3. I & D of abscesses
4. removal of lesions
5. biopsies
6. nail removal
how to irrigate a wound
60 mL syringe and 21 guage blunt irrigation needle
-minimally 250-500 ml of sterile saline
10 questions to ask in history of epistaxis
1. duration
2. severity
3. side of initial bleeding
4. previous history
10. htn
11. hepatic or other diseases
12. family history
13. easy bruising
9. prolonged bleeding after minor surgery
10. medications: aspirin, NSAIDs, warfarin, heparin
syringe material for arterial puncture
3-5 mL glass heparinized syringe
21-25 gauge 1/2 to 5/8 inch needle
2 complications of short term and long term use and how can you avoid them?
long term: infection and trauma
-avoid kinks, wash hands, wear gloves, empty bag often
6 factors that affect wound healing?
what are the 3 things you should explore when preparing a wound for closure
-explore wond through entire range of motion
-explore in a bloodless field
-evaluate for tendon/vascular injury and FB (debridement if need-cutting away dead tissue)
CLOSURE IN LAYERS IS REQUIRED
4 ways to identify source of bleed from epistaxis
1. blow nose- stops fibrinolysis and removes clots
2. application of a vasoconstrictor - reduce hemorrhage and pinpoint precise bleeding site
3. local anesthetic- reduces pain with examination
4. nasal speculum - shows anterior bleeding sources
material for blood culture
20 ml syringe
21 gauge needle or vacuum tube adapter and needle
what is sitting position of patient during surgery called?
what is the strength of wound at 2 weeks, one month, and after 10 weeks
10%, 40%, and 80%
5 ways to remove foreign body in nose
1. direct instrumentation: forceps, hemostats, hooked probes
2. positive pressure below (best to do and starting point)
3. balloon catheter -foley
4. glue
5. suction
1. fail to visualize an anterior source
2. hemorrhage from both nares
3. visualization of blood draining in the posterior pharynx
what angle do we get arterial puncture
40-60 degrees