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CHIR 2 - Coggle Diagram

- - - - incision elliptique et verticale.
        The collected fluid will start to spur out
        
        The space where the blood accumulated is eliminated.
        
        bandaging the ear against the head.
        
        elizabeth colar
        
        Lateral recuberency
        absorbable + non-absorbable monofilament suture, buttons (keeps pressure), sponge
        wound dehiscence, wound infection, recurrence of othematoma, vicious scar
  - - - Grade 1 : Not audible to mild stertor
        Grade 2 Mild to moderate stertor
        Grade 3 Moderate to severe, Dyspnea, cyanosis
        
        RHINOPLASTY SURGERY - 4
        " - ventral wedge resection
        
        grasp edges of nostrils using Brown-Adson forceps
        
        incision around forceps using a 11 blade, ~1-3 mm deep in alar fold (7.3)
        
        incision : vertical, 2nd : >40 degree
        the plug will be grasped with thumb forceps and the base is excised with Metzenbaum scissors and remove
        
        aligning ventral margin of nostrils at muco-cutaneous junction + 3-4 simple interrupted sutures using rapidly resorbable 4 0 suture materials (7.4)
        
        sternal recumbency
        Nasal wound dehiscence if patient frequently licks or rubs his nose
        nonabsorbable suture monofilament, Vicryl + Brown-Adson forceps
        
        Soft palate resection = Staphylectomy - 6
        
        Visualization of the area to excise, btw tip of epiglottis + caudal edge of tonsils
        
        Stay suture at soft palace halfway + on right + left edges of soft palate, in the area to be excised
        - Haemostatic forceps on the stay sutures + maintain lateral traction
        
        Sectioning along 1/3, up to half the thickness of soft palate using Metzenbaum curved scissors
        
        Continuous simple suture (4/0 resorbable monofilament thread) of palate edges, apposing oropharyngeal mucosa with nasopharyngeal mucosa
        
        Continue incising + suturing until the entire excess portion is removed
        
        endotracheal intubation - Sternal
        
        Hemorrhage (especially with scissor/scalpel methods)
        
        Postoperative swelling → can lead to airway obstruction
  - - - Rostral hemimandibulectomy (unilateral rostral)
        Lateral mucosa incision 1 cm around body
        Dissection around maxilla
        Rostral osteotomy eccentric
        Oscilating bone saw osteorome
        Closure monofilament
    - - Partial maxillectomy removes portions of maxilla, incisive bone, palatine bonne ± portions of the zygomatic and lacrimal bones o
        Premaxillectomy: unilateral or bilateral with removal of incisive bone and perhaps rostral maxilla o Central maxillectomy: maxilla and portions of hard palate resected o
        Caudal maxillectomy: maxilla, hard palate, zygomatic and lacrimal bones removed o Hemimaxillectomy: removal of entire maxilla on 1 side extending dorsally to ventral orbit o Orbitectomy: removal of orbit ± caudal maxilla and vertical mandibular ramus
  - - - Skin incision from the caudal angle of the mandible to the dorso-lateral aspect of the larynx, extending 1–2 cm caudal to the larynx.
        Retraction of the sternocephalic muscle palpation of the dorsal margin of the thyroid cartilage.
        Incision of the thyropharyngeal muscle to expose
        cricoid, and arytenoid cartilages.
        Placement of a stay suture through the lamina of the thyroid cartilage to rotate the larynx and improve visualization of the arytenoid cartilage (non-absorbable suture).
        Placement of a non-absorbable prosthetic suture between the muscular process of the arytenoid cartilage and the cricoid cartilage to permanently abduct the arytenoid cartilage tie-back).
        
        Lateral recumbency
        oedema, infections, wound dehiscence
        absorbable + non-absorbable monofilament suture,
  - - - stay sutures (e.g. 2-0 or 3-0 non-absorbable monofilament), absorbable sutures for tracheal rings (e.g., 3-0 or 4-0 PDS
        Dorsal or lateral recuberency
  - - - Incision centred over the palpable bulla
        
        Expose the larger ventromedial compartment, which contains the cochlear (round) window
        
        Identify the sympathetic nerve fibers
        
        Once the outer bulla has been opened, the inner septum in the lateral half of the outer bulla is perforated with a Steinmann pin or burr
        
        The polyp’s attachments to the bulla wall are removed gently, often by traction with a haemostat, and the extracted tissue is saved for culture and histology
        
        The bulla is flushed gently with warm, sterile saline.
        
        Dorsal recumbency
        Inner ear damage, nystagmus, circling, head tilt and ataxia,
        Steinmann Pin
  - - - - Traction-avulsion of the mass w direct endoscopic visualization
        
        Retract the soft palate rostrally using a spay hook or stay sutures. It is rarely indicated to incise the soft palate on the midline to gain access to the nasopharynx
        
        Grasp the polyp using toothed grasping forceps or a small towel clamp (e.g., 3.5 inch [9 cm] Backhaus towel clamp). Expect mild bleeding, but excessive hemorrhage is uncommon.
        
        dorsal or sternal recumbency
        Recurrence, temporary Horner syndrome and vestibular signs > dysphagia, aspi pneumonia, hemorrhagy, permanent nerve injury
- - - - exploratory laparotomy
        anastamosis
  - - - Lapataromy (XP)
        
        Incision of the Periton
        
        Elevate the kidney
        
        LIGATURE A THEN V avoid fistula
        
        Ligature Ureter
        
        DORSAL
  - - - Ventromedial Laparatomy
        
        Exploration and exposure of the stomach, Isolate and elevation with laparatomy pad
        
        2 stay suture of the stomach wall, prevent contamination of the cavity
        
        Incision of the stomach wall is performed (between big and small curvature)
        
        Foreign body is extracted (while holding the stomach wall in tension)
        
        Aspiration of the stomach voncontent
        
        Lavage of the stomach wall and closure with schmieden pattern (end of septic part)
        
        Change of gown, gloves, kit 2nd closure with lembert pattern
        
        Lavage then closure of the abdominal wall with
        
        skin suture with simple interupted pattern
        
        DORSAL
        2 general surgery kits (bc surgery w septic + aseptic parts), Balfour retractor, surgical vacuum, warm sterile saline solution for lavage, absorbable + non-absorbable monofilament suture
    - - Incision Left lateral cervical area -
        Identificaiton of the eosophagous
        
        Isolation by elevation of the esofagous, laparatomy pad
        
        Incision of the eosophagous (along) where foreign body Pean intestinal clamps at a distance from the foreign body
        
        FB extraced, then flushed, then closure (schmieden, suture pattern) (end of septic part) - change of gloves, gown, kit (aseptic part) - 2nd closure WITH LEMBERT PATTERN - Closure of the abdominal wall X,
        then skin suture (simple interupted)
        
        DORSAL
        2 general surgery kits (bc surgery w septic + aseptic parts), Balfour retractor, surgical vacuum, warm sterile saline solution for lavage, absorbable + non-absorbable monofilament suture pean clamp
  - - - Lapataromy (Xipho - P)
        
        Inspection
        
        Isolation, elebation of laparactomic pd
        
        Inspection (neoplams)
        
        Double legature Splenic hilium A V's
        
        Preservation Gastric A V
        
        Preservation Pancreatic A V
        
        Double legature Splenic A V + incise
        
        Homeostasis lavage
        
        Closure and suture
        
        DORSAL
  - - - Explorative Laparatomy
        suction to remove liquid and help id site of active bleeding
        exam all organs and tissues. kidney a nephrectomy might be needed. Use of clotting agents (platelet gels or commercial products) may help control liver bleeding, partial hepatectomy as last resort
        
        Skin incision on the midline.
        Incise the subcutaneous tissue to expose the linea alba.
        Identify and incise the linea alba carefully (avoid damaging underlying organs).
        Balfour retractor to maintain exposure. Perform procedure → explore/remove/correct.
        Lavage if indicated. Closure (3 layers)
        : Linea alba (crucial layer, strong suture) : strong abs monofilament (PDS II) in 0/0 to 3/0
        Subcutaneous tissue : soft abs monofilament (monocryl 3/0 or 4/0)
        Skin : same as subcut if burried, non abs nylon 2/0 to 4/0 if external
  - - - dorsal recumbency
- - - - Lateral recumbency
  - - - constrictive pericarditis (nondistensible, thickened and fibrotic pericardium) / when
        pericardial effusion empty a lot of time by pericardiocentes
        LATER POSITION
        LATERAL THORACOTMY
        T Incision of the Pericardium - base of the Heart to Apex (along cardiac base) 1cm to Phrenic Nerve Exension of the circumferential incision (around the cave vein)
        
        Electroscalpel is recommended for Hemostsis Elevation of the heart an retraction of the pericardium
        Dividing the Pericardophrenic ligament
        Placing a drainage tube Closure of the Thoracic cavity
  - - - Thoracentesis
        sternal recumbency.
        For air upper one-third of the thorax,
        For fluid (effusion) the lower one-third .
        7 9
        Pre-assembly: Always connect the butterfly needle, three-way stopcock, and syringe before insertion. This prevents air entry and reduces the risk pneumothorax. Needle :
        Cats and small dogs: 21- gauge butterfly needle with extension tubing
        Medium to large dogs: 14–16 gauge over-the-needle catheter
        Insertion technique: Introduce the needle perpendicular to the thoracic wall. Once the pleural space is entered, angle the needle downwards at >45° to follow the thoracic wall and minimize the risk of lung puncture. insert just cranial to the rib to avoid the intercostal vessels and nerve located caudally.
        Feel the give
        Aspiration: Advance slowly while applying gentle
        negative pressure.use the stopcock
        
        Chest tube
        Site selection Pneumothorax:
        dorsal third of the 10 11 - 7 98 intercostal space
        Pleural effusion: ventral third of the 6th–8th intercostal space
        Make a small stab incision in the skin
        Advance the introducer needle or catheter cranial to the rib into the pleural space
        Confirm placement by free aspiration of air or fluid
        
        Pass a guidewire through the introducer Withdraw the introducer while keeping the wire in place
        Tract dilation and tube insertion
        Advance the chest tube over the guidewire until all fenestrations are within the thoracic cavity
        Remove the wire and aspirate the tube to confirm patency
        Fixation and closure
        Secure the tube with a purse-string suture at the skin incision
        bBandage
        
        Pneumo : Lobectomy
        Pyothorax : Antibiotic, lavage, lobectomy
        Chyo - TDL and Pericardiectomy