Arthrocentesis

Question 1

what must you avoid when you inject a joint?

Answer 1

articular cartilage

can be very damaging

Question 2

why would you do a joint aspiration?

Answer 2

get out synovial fluid for analysis

• reduce pain and inflammation from effusion
• make them feel better

Question 3

what is the leading cause of septic joint in young ppl?

Answer 3

gonorrhea

Question 4

what are contraindications for injections?

Answer 4

infection
cellulitis
active tumor
recent trauma or skin abrasion
known bacteremia
clotting d/o
unstable joint
weight-bearing tendon

Question 5

which patients need extra concern with this procedure?

Answer 5

DM
Immunocompromised
Infection
osteoporosis
Hx of steroid flare

Question 6

always do what before injecting a joint?

Answer 6

aspirate to check for infection

Question 7

how long should pt wait before leaving after an injection?

Answer 7

30 min to r/o anaphylaxis

Question 8

make sure to document what when doing an injection?

Answer 8

risks and benefits

Question 9

when should you refer an injection?

Answer 9

hand/wrist
deep area (hip/SI)
nerve involvement

Question 10

is a consent required for injecting a joint?

Answer 10

yes

Question 11

how do you determine needle size?

Answer 11

consistency of fluid being injected
!8g (hyaluronic acid/septic arthritis)
22-25g (steroid)
25g (anesthetic)

Question 12

what should you use to numb the area of injection?

Answer 12

ethyl chloride

lidocaine

Question 13

what do you need to have when dealing with ethyl chloride?

Answer 13

everything ready, it wears off quick

Question 14

how deep do you inject the needle?

Answer 14

1 inch

Question 15

where is the neurovascular bundle located on each rib?

Answer 15

underneath the rib

Question 16

what is an empyema?

Answer 16

pus pocket

Question 17

what is chylothorax?

Answer 17

lymph material in the thoracic space

Question 18

what happens in a tension pneumothorax?

Answer 18

trachia is moved away from midline

Question 19

what size CT do you use for pneumothorax?

Answer 19

18-20F

Question 20

what size CT do you use for fluid or blood?

Answer 20

32-40F

Question 21

what is the most important equipment that needs to there before you perform a pneumothorax?

Answer 21

drainage system (pleurovac, glass bottles, heimlich valve)

Question 22

how do you have to tape the chest tube?

Answer 22

occlusively (has to form a vacuum)

Question 23

what do you have to do when you are done inserting chest tube?

Answer 23

chest Xray to see if the lung was reinflated

Question 24

what is the normal amount of pleural fluid?

Answer 24

less than 20 ccs