Easy Points : Surgery - Surgical Infection

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orcl777
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252966
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Easy Points : Surgery - Surgical Infection
Updated:
2013-12-13 19:53:47
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Surgical Infection olfu2016
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Surgery
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Surgery: Surgical Infection
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  1. who introduced the first anti septic acid? carbonic acid in wounds
    Joseph Lister
  2. Pioneered the source control principle in managing surgical infection
    Mcburbey
  3. promote wearing of gloves
    William Stewart Halsted
  4. conveniently be defined as infections that require operative treatment or result from operative treatment
    Surgical infections
  5. when do you stop debridement of the wound
    when you see capillary bleeding means viable tissue
  6. Surgical Site Infection (SSI)
    most common surgical infection after surgical procedure
  7. what is substance in the blood serve as a nutrient for bacteria?
    presence of iron
  8. patient underwent anastomoses leak with ananstomoses band, after one week patient develop abdominal distention, fluid coming out in the incision site, xray (+) bowel obstruction, open laparotomy revealed yellow, fibrin formation. identify surgical complication.
    Peritonitis
  9. two main factors that determine risk of infection
    risk of infection -  pathogenecity (number of bacteria/host defense
  10. Determinants of Infection
    • Microbial pathogenicity and number
    • Host defenses (pt)
    • The local environment(wound)
    • Surgical technique(for postoperative infection)
  11. characteristic of organism to cause infection
    virulence
  12. characteristic of the organism  to cause a disease
    pathogenecity
  13. one of the commonly associated metabolic disorder that cause more risk of developing infection
    hyperglycemia/DM
  14. important factor/determinant of preventing overwhelming infection
    nutrition
  15. true or false 
    In the immunocompetent patient whose wound is properly managed, antibiotics are unnecessary and may even be contraindicated.
    true
  16. Local Environmental Factors (wound)
    • Extent of contamination
    • Tissue devitalization
    • Location of wound
    • Continuing contamination
    • Type of tissues injured
  17. factors that determine risk of infection in organism 
    number, virulence, type
  18. factors that determine risk of infection in wound
    • contamination
    • size
    • vascularity
    • devitalization
  19. factors that determine risk of infection in the host
    • Immune competence
    • cell function
    • vascularity 
    • metabolic disorder
    • nutrition
  20. the most important factor in determining risk of infection ?
    host defense
  21. complication of overstimulation of inflammatory cells such as cytokines
    MOF, SIS, MOD
  22. common isolate organism in the skin
    gram positive coccci (staphylococcus and streptococcus)
  23. common isolate organism in the biliary system (as well as almost all segment of GIT)
    bacteriodes (gram-negative anaerobe)
  24. factors that favor bacterial proliferation 
    • ambient temperature
    • low oxygen concentration 
    • presence of iron
    •  
  25. criteria for organism that may infect individual or produce infection
    • pathogenic
    • virulent factor
  26. why is poor nutrition puts individual at risk for increased infection
    source of sugar is from protein, glucose store is easily depleted due to obligate metabolic process being shunted to the brain and heart. cells then malfunction and unable to perform normal metabolic process such as host defense
  27. first line of anatomical barriers
    physical barriers and host microflora
  28. simple technique to facilitate coughing 
    deep breathing technique
  29. simple device to open airways and encourage oxygenation post surgery 
    incentive spirometry 
  30. body's mechanism to prevent dissemination during infection
    • sequestration mechanism ( via development of abscess, ilieus formation ,  bowel distention, omental pathching ) 
  31. which part heal faster upper torso/head and neck or LE wound? 
    torso/Head and Neck - due to good vascular supply 
  32. surgical procedure to prevent recurrent infection in sacral wound due to fecal material 
    diverging colostomy 
  33. osseous vs non-osseous which is one is easier to treat? 
    osseous -> difficult due to poor vascular supply,  can develop osteomyelitis
  34. placed adjacent to bones to promote healing 
    antibiotic beads
  35. what are some surgical guideline techniques
    • handle tissues gently
    • remove devitalized tissue and promote good hemostasis
    • use drains appropriately
    • avoid excessive cautery ( harmonic scalpel)
    • not performing intestinal anastomoses under tension or when there is any question of inadequate blood supply
  36. what is the common practice in performing anastomosis in left side of the colon 
    don't do anastomosis ( feces is already formed, increased contamination). This is being challenged can be performed as long as contamination is contained 
  37. non-operative therapy in treating post surgical infection
    • Chest physiotherapy
    • increasing fluid intake
    • immobilization and elevation
  38. operative therapy in treating post surgical infection
    • Incision and Drainage, debridement
    • Diversion
    • Periotoneal lavage
  39. Procedure of choice for deep, solitary abcess
    CT guided aspiration ( if multiple abscess, open patient ) 
  40. a type of necrotizing infection or gangrene usually affecting the perineum
    Fournier gangrene
  41. utilized if surgical area has a high risk of developing infection
    • delayed primary incision. 
    • Check after five days, if wound is viable and no necrotic tissues, wound edges are approximated.
  42. what is the site of placement of penrose drain? 
    subcutaneous area
  43. active form of closed suction drain, most ideal type of drain, it creates continuous negative pressure 
    Jackson-Pratt (JP drain) 
  44. when to remove drain
    if drainage is less than 20 cc (non-purulent) 
  45. Highest incidence of nosocomial infection
    Pneumonia
  46. form of peritonitis that is caused by single type of organism, usually caused by e-coli, usually associated with excess peritoneal fluid.
    primary peritonitis
  47. associated with patients having problem in the liver, kidney (nephrotic syndrome), patient undergoing peritoneal dialysis.
    primary peritonitis
  48. diagnostic procedure to diagnose primary peritonitis
    paracentesis ( aspiration)
  49. form of peritonitis that is caused by more than one organism
    secondary peritonitis
  50. treatment for primary peritonitis
    non-surgical ( antiobiotic coverage x 2 weeks) 
  51. Usually hematogenous or bacterial source. No break or perforation associated with this type of peritonitis 
    Primary 
  52. classical type of peritonitis found in most surgical patients
    secondary peritonitis
  53. treatment of secondary peritonitis 
    surgical ( concept of source control) 
  54. what type of peritonitis? anastomosis leak
    tertiary peritonitis
  55. happens to patients who are still recuperating with highest mortality 
    tertiary peritonitis
  56. organism involved in Tetanus
    Clostridium tetani 
  57. tetanus prone or non-tetanus prone? traumatic wound
    tetanus prone
  58. tetanus prone or non-tetanus prone? burn injury
    tetanus prone
  59. patient has hx of tetanus immunization but questionable 
    give both active and passive tetanus immunization 
  60. elective, primary closed, and undrained
    non-traumatic, uninfected
    no inflammation  encoutered
    no break in asepsis
    respiratory, alimentary, genitourinary
    oropharyngeal tracts not entered
    Clean wound
  61. alimentary, respiratory or genitourinay tracts entered under controlled conditions and without unusual contamination 
    Clean-contaminated
  62. appendectomy
    Oropharynx entered
    Vagina entered
    genitourinary tract entered in absence of culture-positive urine
    biliary tract entered in absence of infected bile
    minor break in technique
    mechanical drainage
    Clean contaminated
  63. open, fresh traumatic wounds
    gross spillage from gastrointestinal tract
    entrance of genitourinary or biliary tracts in presence of infected urine or bile
    major break in technique
    incisions in which acute nonpurulent inflammation is present
    Contaminated wound

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