Intraoperative Scanning and Ultrasound Therapy

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  1. What are 3 reasons why may need to do intraoperative scanning?
    • 1.) assess reconstruction
    • 2.) CEA
    • 3.) visceral vessels
  2. What are 3 advantages for intraoperative scanning?
    1.) Localize pathologies missed and determine the exact location.

    2.) Assess hemodynamics right away

    3.) Make corrections immediately
  3. What are the steps involving the machine when intraoperative scanning?
    1.) Probe and gel must be inserted in sterile sheath.

    2.) Use at least a 7.5 MHz (use highest frequency) for .5 cm to 2 cm depth

    3.) Machine depth 2-3 cm
  4. True or false.
    Probe must be disinfected with bleach and what?

    Bleach and Cavicide
  5. What is put into the vessel area when intraoperative scanning?
    sterile saline
  6. What are two limitations to intraoperative scanning?
    1.) experience of sonographer

    2.) Availability of machine and the right transducers
  7. What are two types of invasive therapies used for arteries?
    1.) Percutanous Transluminal Angioplasty (PTA)

    2.) Atheroectomy
  8. What is PTA?

    Used for what?

    Percutanous Transluminal Angioplasty

    Used to remove plaque.

    It chews the plaque and is absorbed in the blood stream
  9. What are three pharmacological therapies used with clots?
    1.) Anticoagulant

    2.) Thrombolytic

    3.) Antiplatelet
  10. What do anticoagulants do?
    First line?
    Second line?
    a drug that prevents further clotting

    interferes with fibrin production

    Heparin is given in IV drip or subcutaneous (into belly) or IV Bolus

    Coumadin or Warfin - long term
  11. How long does Coumadin or Warfin take to start working?

    So what should be given right away?
    3-5 days to build up in system

  12. Is Heparin given for acute or chronic thrombus?
    acute thrombus
  13. How does Coumadin or Warfrin work?
    stops the production of vitamin K
  14. What is PT stand for?

    What is it used for?
    Prothrombin time levels

    blood test that shows how heparin is working
  15. What is PTT stand for?

    What is it used for?
    Partial Prothromin time

    blood test that shows how Coumadin is working
  16. What is INR stand for?

    What is it used for?
    International Normalized RAtio

    protocol of limits of PT and PTT
  17. What do thrombolytic used for?
    2 examples?
    Used on? (2)
    Administered how?
    dissolves the thrombus that is already there

    Strepokinase and Urokinase

    • Used on: 1.)  Acute pulmonary emboli
    •              2.)  Graft occlusion

    Administered: IV infuse or insert catheter by thrombus and drip in
  18. What is an risk factor of Thrombolytic?
  19. What do antiplatelets do?

    Two examples?
    sticks down platelets so they don't stick together

    ASA and Plavix
  20. What is popliteal entrapment?

    Usually seen in?

    POPA compressed by head of gastrocnemius muscle and fibers in that area

    young athletes

    unilateral claudication with exercise
  21. Are the symptoms easy to reproduce?
    NO, very difficult
  22. How do you test for popliteal entrapment? (4)
    1.) Do a resting study

    2.) Dorsal flexion of the foot and monitor the PVR waveforms

    3.) Duplex in tibial vessels

    4.) angiogram with dorsal flexion
  23. What is the treatment for popliteal entrapment?
    Surgery- take out some of the muscle
  24. What is compartment syndrome?

    Causes what?

    Which causes what?
    Swelling on one or more specific arteries which causes interstitial pressure becomes greater than transmural pressure (inside a vessel).

    Causes blood flow to become obliterated.

    Tissue becomes ischemic and necrotic
  25. What causes compartment syndrome?
    Trauma to the leg.
  26. What three arteries can compartment syndrome affect?
    Anterior- Dorsalis Pedis A.

    Medial- Post tib. A.

    Posterior- Peroneal A.
  27. What is the 2 testing for compartment syndrome?
    1.) Lower arterial Duplex

    2.) Ankle/Brachial Index
  28. What is the treatment for compartment syndrome?

    Which is?

    Make an incision and open, fluid leaks out.
  29. What are Algorithms?
    flow charts of what causes what
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Intraoperative Scanning and Ultrasound Therapy
Intraoperative scanning
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