ch 8 delmar

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  1. hemostasis
    stopping the loss of blood (hemorrhage) arresting blood flow
  2. coagulation
    the formation of a blood clot
  3. phases of the clotting process:
    • platelets adhere to vessel walls
    • platelets release ADP
    • ADP causes more platelets to adhere
    • initial thrombus forms
    • permanent thrombus forms
  4. as soon a vessel is injured....
    vasoconstriction begins: in which the muscular walls of vessel constricts to help slow the flow of blood
  5. hemophilia
    congenital clotting deficiency
  6. acquired bleeding disorders
    liver disease, aplastic anemia
  7. anticoagulant therapy
    • heparin, warfarin sodium (coumadin), aspirin
    • -may be asked to discontinue meds pre-op
  8. methods of hemostasis
    • mechanical: instrument or device
    • thermal: uses heat
    • pharmacological: drugs
  9. clamps
    • used to compress the walls of vessels
    • most common is the hemostat
    • vascular clamps are non-crushing
  10. ligatures
    • free tie
    • tie on a passer
    • stick ties
    • tie on a real
    • when using a monofilament type materical, the tails should be left ~ 1/4" long from the knot
  11. ligating clips
    • used in place of ligatures
    • on small vessels
    • made of: titanium, stainless steel, plastic
    • manual or disposable applicators
    • placed on vessel and crimped
    • often used in pairs: clip, clip, cut
  12. surgical sponges
    • raytecs
    • laparotomy sponges
    • tonsil sponges
    • patties/cottonoids
    • kitner/peanuts
  13. pledgets
    • to control bleeding through needle holes in vessel anastomosis
    • small squares of teflon
    • sewn over the hole
    • exerts outside pressure
  14. bone wax
    • made of beeswax
    • used on the edges of bone
    • seals off oozing blood
    • knead to soften
    • roll into balls
  15. suction
    • used to aspirate
    • connected to disposable tubing
    • must always be available to clear airway
  16. drains
    • passive: penrose, t-tube
    • active: hemovac, jackson pratt, sump(GI), chest tube-water seal
  17. pneumatic tourniquets
    • used on extremities: minimizes blood vessels, makes visualization easier
    • padding required
    • exsanguinate the limb
    • notify surgeon: after 1hr. then every 15min.
    • deflate: after 1 1/2-2 hrs
  18. thermal methods
    • electrosurgical unit (ESU):
    • active electrode
    • generator
    • inactive electrode
    • different types of tips
    • bipolar
    • remove char from tip
    • keep pencil in holster
  19. thermal hemostasis
    • laser: intense, concentrated beam of light
    • argon beam coagulator
  20. harmonic ultrasonic scalpel (thermal)
    • cuts and coagulates
    • advantages:
    • no charring of tissue
    • no smoke plume
    • minimal damage to adjacent tissue
    • no grounding pad required
    • precise cutting
  21. pharmacological
    vitamin K-needed for blood clot
  22. pharmacological agents (absorbable gelatin)
    • foam pad or powder
    • gelfoam-variety of sizes that can be cut
    • may be soaked in thrombin, epinephrine, saline or used dry
  23. pharmacological agents (collagen)
    • avltene-mecrofibrillar collagen powder
    • must use dry instruments and gloves
  24. pharmacological agents ....
    • silver nitrate-stick or solution
    • epinephrine
    • thrombin: topical and hsould NEVER be injected, powder or liquid, descard if not used in several hours
    • bovine origin
  25. blood loss
    • monitored by several means intraoperatively: calibrated suction devices, weighing sponges while wet, drainage collection
    • surg tech should keep a close track of amount of irrigation used: total volume in canister-amount of irrigation used=estimated blood loss (EBL)
  26. blood replacement
    • whole blood
    • blood components: plasma, packed RBC, platelets
    • homologous: donated by another person
    • autologous: donated by the pt and stored, autotransfusion
  27. 4 main blood types/groups
    • A- has A antigen, has anti-B antibodies
    • B-has B antigen, has anti-A antibodies
    • O-has no (zero) antigens, has both anti-A&B antibodies -- universal DONOR
    • AB-has both A&B antigens, has neither antibody -- universal RECIPIENT
  28. Rh factor
    • used for blood matching
    • antigen in the erythrocytes of 85% of ppl
    • individuals with the factor are Rh positive
    • individuals without are Rh negative: if Rh+ blood is given to an Rh- person, hemolysis will occur (antigen/antibody reaction)
    • if Rh- mother has Rh+ fetus (from Rh+ father) causes hemolytic disease of the newborn Rhogam used to prevent build up on antibodies in mother
  29. autotransfusion
    • reinfusion of pt's own blood
    • preferable to homologous blood
    • salvaged intraoperatively with cell saver machine
    • cannot use blood exposed to collagen hemostatic agents, ceratin antibiotics, gastric or enteric contents, infection, or cancer cells
  30. hemolytic transfusion reactions
    • not properly matched blood
    • may be fatal if not treated immediately: stop transfusion, administer appropriate drugs, monitor output
  31. emergency situations
    • react appropriately: anticipate, prepare, stay calm
    • indicators of an emergency
    • first priority is provide pt airway
    • clincal death vs biological death
    • ABC-Ds of CPR:
    • airway
    • breathing
    • circulation
    • definitive treatment
  32. clinical death vs biological death
    • begins the moment heart action and breathing stop; the pt has only 4-6 min. before the cells of the brain begin to deteriorate
    • therefore; it is very important that breathing and circulation be restored within this time frame to prevent biological death from occuring
  33. CPR in adult
    • 1 person: 100/min, 30:2 ratio, 2 hands
    • 2 person: 100/min, 30:2 ratio, 2 hands
  34. CPR in child
    • 1 person: 100/min, 30:2 ratio, 1 or 2 hands
    • 2 person: 100/min, 15:2 ratio, 1 or 2 hands
  35. CPR in infant
    • 1 person: 100/min, 30:2 ratio, 2 fingers
    • 2 person: 100/min, 15:2 ratio, 2 thumbs
  36. 2 ways to open airway
    • head tilt - chin lift
    • jaw thrust if you suspect cervical spine injury
  37. cardiac arrest in the surgical setting
    • STSR role is to protect sterile field
    • may be required to assist
    • roles are well defined by facility policy
    • anesthesia personnel will manage the code
    • circulator will provide support and bring crash cart
  38. malignant hyperthermia
    • life-threatening, acute disorder
    • develops during or after anesthesia:
    • rapid increase in body temp
    • first sign is increase in end-tidal CO2
    • unexplained tachycardia
    • unstable blood pressure
    • muscle rigidity-sustained muscle contraction
    • tachypnea
    • cyanosis
    • hypermetabolism
  39. (previous slide)
    rapid increase in body temp
    • high level of calcium accelerates the cellular metabolism rate
    • evevated temperature is one of the last signs seen
  40. MH crisis
    • usually triggered by anesthetic agents such as gases (-ane) and succinylcholine
    • predispostion cannot be absolutely determined
    • family history of muscle disorders may indicate predisposition
    • may be diagnosed with a muscle biopsy under a local anesthetic
  41. treatment of MH
    • stop administration of triggering anesthetic
    • deepen anesthesia-opioids, barbiturates, propofol
    • follow hospital protocol
    • pact the pt in ice
    • circulate water through nasogastric tube
  42. treatment of MH
    • irrigation of the open cavity with chilled fluids
    • dantrolene sodium (dantrium) drug of choice- then steroids and diuretics
    • administer 100% oxygen- compensate for CO2
    • anticipate stopping surgery- quick closure
  43. DIC
    • disseminated intravascular coagulation
    • blood clots throughout the body followed by hypocoagulation and internal hemorrhage
  44. syncope convusions and seizures
    • syncope- sudden loss of consciousness
    • convulsions- grand mal vs petit mal seizures
    • **protect pt from injury, insert airway, prior to mouth clenching
  45. grand mal seizure
    characterized by loss of consciousness and convulsive body movement
  46. petit mal seizure
    • must shorter in duration and come about quite suddenly and without warning
    • symptoms: vacant facial expression, and a cessation of all motor activity except for slight twitching of the eye lids or face and arms
  47. anaphylactic reactions
    • exaggerated allergic reaction
    • common causes:
    • local anesthetics
    • codeine
    • antibiotics
    • animal derived drugs: insulin
    • contrast media
    • latex
  48. anaphylactic shock (signs)
    • signs:
    • itching--first signs are generally mild inflammatory symptoms**
    • swelling:**
    • difficulty breathing:**
    • hypotension
    • tachycardia
    • diminished urine output
    • death
    • allergies should be ID on chart and on bracelet
  49. anaphylactic shock (treatment)
    • treatment:
    • maintain airway
    • provide oxygen
    • treat for shock
    • epenephrine-first line drug causes bronchodilation, reduces laryngeal spasm, raises blood pressure
    • steroids- anti-inflammatory
    • IV fluids and plasma
    • levophed to raise BP
  50. biological injuries: radiological injuries
    • possibly from a "dirty job"
    • injuries may include blast injuries, thermal/flash burns, and ionizing radiation injuries
    • pts must be decontaminated prior to surgery
  51. chemical injuries
    • intial treatment is removal of clothing
    • decontaminate the wounds with household bleach (1 part bleach to 9 parts water)
    • instruments and equipment will need to be decontaminated in full strength household bleach
  52. biological warfare
    • intentional use of infectious agents, or germs to cause injury
    • annual disaster preparedness drills should be conducted yearly
    • the 2 most likely bioweapons are smallpox and anthrax
  53. autologous
    from oneself
  54. cardiac dysrhythmia
    refers to any type of abnormal heart rhythm
  55. CPR -- cardiopulmonary resuscitation
    act of manually providing chest compressions and ventilations to pts in cardiac arrest
  56. hemolysis
    destruction of erythrocytes
  57. hemostasis
    the arrest of the escape of blood through natural or artifical means
  58. hemostat
    a device or agent used as a coagulant
  59. homologous
    from the same species
  60. Rh factor
    genetically determined blood group antigen that is present on the surface of erythrocytes of some individuals
  61. suction
    act of sucking up air or fluids through a device, such as a tonsil suction tip
  62. when cutting suture for the surgeon who is using monofilament surture, leave a tail of approximately how long??
Card Set
ch 8 delmar
hemostasis and emergency situations
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