-
hemostasis
stopping the loss of blood (hemorrhage) arresting blood flow
-
coagulation
the formation of a blood clot
-
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
-
as soon a vessel is injured....
vasoconstriction begins: in which the muscular walls of vessel constricts to help slow the flow of blood
-
hemophilia
congenital clotting deficiency
-
acquired bleeding disorders
liver disease, aplastic anemia
-
anticoagulant therapy
- heparin, warfarin sodium (coumadin), aspirin
- -may be asked to discontinue meds pre-op
-
methods of hemostasis
- mechanical: instrument or device
- thermal: uses heat
- pharmacological: drugs
-
clamps
- used to compress the walls of vessels
- most common is the hemostat
- vascular clamps are non-crushing
-
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
-
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
-
surgical sponges
- raytecs
- laparotomy sponges
- tonsil sponges
- patties/cottonoids
- kitner/peanuts
-
pledgets
- to control bleeding through needle holes in vessel anastomosis
- small squares of teflon
- sewn over the hole
- exerts outside pressure
-
bone wax
- made of beeswax
- used on the edges of bone
- seals off oozing blood
- knead to soften
- roll into balls
-
suction
- used to aspirate
- connected to disposable tubing
- must always be available to clear airway
-
drains
- passive: penrose, t-tube
- active: hemovac, jackson pratt, sump(GI), chest tube-water seal
-
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
-
thermal methods
- electrosurgical unit (ESU):
- active electrode
- generator
- inactive electrode
- different types of tips
- bipolar
- remove char from tip
- keep pencil in holster
-
thermal hemostasis
- laser: intense, concentrated beam of light
- argon beam coagulator
-
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
-
pharmacological
vitamin K-needed for blood clot
-
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
-
pharmacological agents (collagen)
- avltene-mecrofibrillar collagen powder
- must use dry instruments and gloves
-
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
-
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)
-
blood replacement
- whole blood
- blood components: plasma, packed RBC, platelets
- homologous: donated by another person
- autologous: donated by the pt and stored, autotransfusion
-
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
-
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
-
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
-
hemolytic transfusion reactions
- not properly matched blood
- may be fatal if not treated immediately: stop transfusion, administer appropriate drugs, monitor output
-
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
-
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
-
CPR in adult
- 1 person: 100/min, 30:2 ratio, 2 hands
- 2 person: 100/min, 30:2 ratio, 2 hands
-
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
-
CPR in infant
- 1 person: 100/min, 30:2 ratio, 2 fingers
- 2 person: 100/min, 15:2 ratio, 2 thumbs
-
2 ways to open airway
- head tilt - chin lift
- jaw thrust if you suspect cervical spine injury
-
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
-
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
-
(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
-
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
-
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
-
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
-
DIC
- disseminated intravascular coagulation
- blood clots throughout the body followed by hypocoagulation and internal hemorrhage
-
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
-
grand mal seizure
characterized by loss of consciousness and convulsive body movement
-
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
-
anaphylactic reactions
- exaggerated allergic reaction
- common causes:
- local anesthetics
- codeine
- antibiotics
- animal derived drugs: insulin
- contrast media
- latex
-
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
-
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
-
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
-
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
-
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
-
-
cardiac dysrhythmia
refers to any type of abnormal heart rhythm
-
CPR -- cardiopulmonary resuscitation
act of manually providing chest compressions and ventilations to pts in cardiac arrest
-
hemolysis
destruction of erythrocytes
-
hemostasis
the arrest of the escape of blood through natural or artifical means
-
hemostat
a device or agent used as a coagulant
-
homologous
from the same species
-
Rh factor
genetically determined blood group antigen that is present on the surface of erythrocytes of some individuals
-
suction
act of sucking up air or fluids through a device, such as a tonsil suction tip
-
when cutting suture for the surgeon who is using monofilament surture, leave a tail of approximately how long??
1/4"
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