Common ED Procedures Flashcards
What are some important things to include in procedural note?
Indications
Permission
Physician who performed and ordered
Describe procedure
Complications
Estimated blood loss
Specimens/Findings
Disposition after ("tolerated well")Antibiotics for any abscess or cellulitis
Keflex
How to do procedure to treat paronychia?
Use 18-guage needle or 11- blade scalpel to elevate nail fold and then inserted at the point of maximum fluctuance and irrigate with NS
remove a longitudinal portion of the nail If the lesion extends beneath it
How to drain painful subungual hematoma?
middle: drill into by twisting and pushing down with 18-gauge
distal: 11-blade scalpel under nail bed
Electrocautery tool with repeated quick motions
abx for post-toenail removal
Neosporin or Vaseline with gauze
Before digital block, you should clean skin with _______.
Betadine
How to treat epistaxis?
- Blow nose, then Afrin, then 10min pressure
- Cautery with silver nitrate or electrocautery; suction to see where bleed is
- If can’t find bleeding source Nasal Packing with Tampon (Muricell) or Balloon (Rhino-rocket)
- Refractory Bleeds: Surgicel and Gelfoam with prothrombin
Posterior bleeds:
Storz T-3100 or foley catheter 10-14F
How to remove nasal foreign bodies?
Mothers kiss (+60%): positive pressure from mouth to mouth and blockage of unaffected nostril
Rough - Alligator forceps Smooth - Suction tipped catheter
Refractory - glue on swab, Fogarty catheter, Right angle hook (paperclip or needle)
How to remove ear foreign bodies?
Rough - Alligator forceps
Smooth - Suction tipped catheter
Refractory - Glue on swab, Right angle hook
Bug - liquid or viscous Lidocaine
How to remove eye foreign bodies?
Prep with anesthetic drops (Proparacaine)
Irrigate with NS to wash out and moist Q-tip
Embedded: bent 20-gauge needle to scrape
Alger brush for rust ring
When should object in eye not be removed?
if object penetrating
How to remove fish hook?
String-pull technique: tie string to bend in hook and depress shaft, then quick tug
Ring removal
Lubrication
String technique - String under ring and then wrap from base to tip of finger
Ring Cutter - Cut out section
Vise Grip - Repeated tightening
Indication for joint aspiration
- any suspicion of infectious arthritis = red, warm, swollen joint
- removal of large joint effusion
Joint aspiration/injection procedure
Aspirate while Inserting 18-gauge needle
Aspirate as much material as possible
Leave needle in place and replace syringe with one prefilled with medication if desired (usually Kenalog)
Apply dressing
Indications of lumbar puncture
ANY suspicion of:
- meningitis = HA, Fever, Nuchal rigidity
- subarachnoid hemorrhage = worst HA ever, “Thunderclap”, LOC, N/V
Location of lumbar puncture
L3/L4 interspace
Tube thoracostomy landmark
4th or 5th intercostal space, midaxillary line
Indications of tube thoracostomy
hemo-/pneumothorax
How to do cricothyrotomy?
Make 1” vertical incision into skin
Perform blunt dissection down to cricothyroid membrane
Make 1” horizontal incision through cricothyroid membrane
Place bougie into hole and advance beyond carina
Inserts ETT tube over bougie
Indications of cricothyrotomy
last resort airway in cases where orotracheal and nasotracheal intubation are impossible or contraindicated
Where is needle decompression inserted to treat tension pneumothorax?
2nd or 3rd intercostal space, mid-clavicular line
What is considered the definitive airway?
ET tube
Indications for double sugar tong splint
distal forearm and elbow fractures; limits flex/extension and pro/supination
Indications for thumb spica splint
scaphoid fracture (seen or suspected) De Quervain tenosynovitis
Indications for Jones Compression Dressing
short term immobilization of soft tissue and ligamentous injuries to knee or calf
Contraindications to biopsy
Infection
Inflammation
Traumatized, crushed, scratched, or significantly modified areas
Coagulopathy
When is punch biopsy indicated?
Rashes with unclear biopsy
Removal of subcutaneous growths
Nevi of uncertain malignant potential
Methods for partial thickness biopsy
Curettage
Shave
When should you NOT do shave biopsy?
if melanoma suspected
Excisional biopsy technique
Use sterile technique
Field block anesthesia
Draw elliptical shape
Scalpel 15 deg away from lesion
