1
Q
What issues does informed consent imply that the patient completely understands?
A
- The nature of the treatment
- All material risks for the treatment
- The possibility of risk(s)
- Alternative treatment(s) available and associated risks of those treatments
- Consequences of going untreated
2
Q
What does PARQ mean?
A
- Procedure: a description of the proposed procedure, how it is to be done with as much detail as the patient wants or desires
- Alternative: a description of any and all alternatives (and their risks) to doing the procedure this way (i.e. homeopathy as an alternative to surgery, etc…)
- Risk: a description of any and all possible risks associated with this procedure (i.e. infection, hypopigmentation, etc…)
- Questions: let the patient ask questions about the procedure; write down their questions and the your answer to the questions in the chart
3
Q
How do you use PARQ for “informed consent?”
A
- To explain the alternatives and risks of the procedure
- Chart that you discussed PARQ with the patient
- It’s best to have a written informed consent and an oral PARQ with the patient prior to surgery
4
Q
*What should you include (and not include) in the Procedure Note portion of the MS report?
A
- SOAP note
> Detailed procedure description
> Justifies the procedure (insurance will want) - Pre-operative diagnosis
- Describe skin prep used, record the amounts of anesthesia and bicarbonate mixed and used
- Describe the suture type(s), size(s), location, and number
- List the duration of the procedure and the amount of blood lost
- If using epic: remove any unused procedure’s wording
- Indicate if an oral PARQ was done
- Write a brief description of the actual procedure
> Do NOT include the details already recorded in the upper sections of the form - Include as much detail as possible, especially if the procedure is complicated
- Indicate how well the patient tolerated the procedure
- Some physicians include an “operative report” with more extensive narrative
5
Q
What is a “free margin” on a pathology report?
A
- That means that there were no pathological cells present at the edge of the resected area
- Ideal is “free and clear”
- If it isn’t “free and clear,” then you must go back and cut out the rest of the pathological cells
6
Q
What is “dead space?”
A
- Large open space inside a deep wound (ex. after removing a lipoma)
7
Q
What is undermining?
A
- Using a tool to separate the skin and subcutaneous tissues in order to free the wound edges for better/easier closure
- Can use surgical blade or sharp iris scissors
- Blunt dissection is preferred so as to not damage nerves or blood vessels
- Should undermine each side 1/2 the length of the incision
- If wound edge tension persists, undermine further before sututring
8
Q
Why is undermining important?
A
- It allows the skin to slide over the subcutaneous tissue more easily and stretch enough to close the opening with less tension, resulting in less scarring
9
Q
How do you remove sutures?
A
- Grasp one end of the suture or knot, shift it back and forth to free it up so you can clearly see where to make your cut
- Cut the suture with a scissors or scalpel blade and pull the freed knot across the suture line
- Pulling the suture out in this manner helps reduce wound “stress” and helps avoid dehiscence
10
Q
What are the four reasons for/advantages of using the Subcutaneous Suture (Buried Stitch)?
A
- Provide wound stability
- Close dead space
- Help to evert the edges
- Relieve tension on the wound edges
11
Q
*What type of subcutaneous suture would you typically use?
A
- Upward knot placement for deep wounds
- Buried knot placement for dermal wounds
