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Flashcards in Total Surgical Care Deck (70)
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1

Systemic Risk Factors for Infection

DM
Corticosteroid use
Obesity
Age
Malnutrition
Second surgery
Co-morbidities

2

Local Risk Factors for Infection

Foreign body
Electrocautery
Wound drains
Injection with epinephrine
Hair removal
Previous radiation
Prolonged operation

3

Most Commonly Given Antibiotic

Cefazolin (Ancef, Kefzol)

4

Antibiotics to Cover Gram-Negative & Anaerobic Pathogens

Cefotetan
Cefoxitin
Cefizoxime
+/- metronidazole (Flagyl)

5

Cardiac Complications & Diabetes

Men 2x the risk
Women 4x the risk
Hypotension from neuropathy

6

Gastroparesis & Diabetes

Aspiration risk

7

Infection & Diabetes

Reduced blood flow decreases healing

8

Risk Factors for Venous Thromboembolism Disease (VTE)

Extent of surgery or trauma
Duration of hospital stay
Previous VTE
Immobility
Central line placement
Ortho procedures
Age
Obese patients

9

Appropriate Prevention of VTE in Very Low Risk Patients

Early & frequent ambulation

10

Appropriate Prevention of VTE in Low Risk Patients

Mechanical methods when contraindication to medicinal prophylaxis

11

Appropriate Prevention of VTE in Moderate Risk Patients

Pharmacologic

12

Appropriate Prevention of VTE in Very High Risk Patients

Combination

13

Medications Given for VTE Prophylaxis

Low molecular weight heparin
Low dose unfractionated heparin (UFH)
Warfarin
Aspirin

14

Mechanical Methods of VTE Prophylaxis

Intermittent pneumatic compression (IPC)
Graduated compression stockings (GCS)
Venous foot pump (VFP)

15

Define Surgical Site Infection

Infection related to an operation that occurs at or near the surgical incision within 30 days of the procedure or 90 days of an implant

16

Impact of Surgical Site Infections

Increase in mortality
Increase cost to patient & hospital

17

Risk Factors for Surgical Site Infections

Surgical technique
Prolonged surgery time
Instrument sterilization
Pre-op preparation
Thermoregulation & glycemic control
Medical condition of the patient
Surgical environment

18

Surgical Environment Risk Factors

Personnel traffic
Excessive use of electrosurgical cautery units
Prosthesis or foreign body
Need for blood transfusion

19

Presentation of a Surgical Site Infection

Localized erythema
Induration
Warmth
Pain at incision site

20

Treatment of Surgical Site Infections

Prophylactic antibiotics
Infected wounds
Antibiotics: broad spectrum, culture & gram stain
Surgical technique

21

Surgical Technique Treatment of Surgical Site Infections

Limit electrocautery
Closure of subQ tissue
Skin closure
Delayed closure & heal by secondary intention
Limit hypothermia

22

Define Hematoma & Seroma

Collection of blood or serum under the incision

23

Presentation of a Hematoma or Seroma

Few days post-op
Pain
May have sebum like fluids
Fever
Erythematous
Edematous

24

Treatment of Hematoma or Seroma

Percutaneous drains
Wound exploration: pack & heal by secondary intention

25

Prevention of Hematoma's and Seroma's

Closure of dead space
Meticulous hemostasis
Placement of drains (controversial)

26

Risk Factors for Fascial Dehiscence

Age
Males
COPD
Ascites

27

Define Fascial Dehiscence

Abdominal wall tension overcoming tissue or suture strength

28

Main Cause of Fascial Dehiscence

Failure of the sutures to remain anchored, knot failure, large stitch intervals

29

Presentation of Fascial Dehiscence

Profuse serosanguinous drainage
Popping sensation with abdominal bulge

30

Treatment of Fascial Dehiscence

Closure in the operating room