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ED/Surgery > Common ED Procedures > Flashcards

Common ED Procedures Flashcards

1
Q

What are some important things to include in procedural note?

A 
Indications
Permission
Physician who performed and ordered
Describe procedure
Complications
Estimated blood loss
Specimens/Findings
Disposition after ("tolerated well")
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2
Q

Antibiotics for any abscess or cellulitis

A

Keflex

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3
Q

How to do procedure to treat paronychia?

A

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

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4
Q

How to drain painful subungual hematoma?

A

middle: drill into by twisting and pushing down with 18-gauge
distal: 11-blade scalpel under nail bed
Electrocautery tool with repeated quick motions

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5
Q

abx for post-toenail removal

A

Neosporin or Vaseline with gauze

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6
Q

Before digital block, you should clean skin with _______.

A

Betadine

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7
Q

How to treat epistaxis?

A
  1. Blow nose, then Afrin, then 10min pressure
  2. Cautery with silver nitrate or electrocautery; suction to see where bleed is
  3. If can’t find bleeding source Nasal Packing with Tampon (Muricell) or Balloon (Rhino-rocket)
  4. Refractory Bleeds: Surgicel and Gelfoam with prothrombin

Posterior bleeds:
Storz T-3100 or foley catheter 10-14F

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8
Q

How to remove nasal foreign bodies?

A

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)

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9
Q

How to remove ear foreign bodies?

A

Rough - Alligator forceps
Smooth - Suction tipped catheter
Refractory - Glue on swab, Right angle hook

Bug - liquid or viscous Lidocaine

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10
Q

How to remove eye foreign bodies?

A

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

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11
Q

When should object in eye not be removed?

A

if object penetrating

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12
Q

How to remove fish hook?

A

String-pull technique: tie string to bend in hook and depress shaft, then quick tug

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13
Q

Ring removal

A

Lubrication
String technique - String under ring and then wrap from base to tip of finger
Ring Cutter - Cut out section
Vise Grip - Repeated tightening

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14
Q

Indication for joint aspiration

A
  • any suspicion of infectious arthritis = red, warm, swollen joint
  • removal of large joint effusion
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15
Q

Joint aspiration/injection procedure

A

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

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16
Q

Indications of lumbar puncture

A

ANY suspicion of:

  • meningitis = HA, Fever, Nuchal rigidity
  • subarachnoid hemorrhage = worst HA ever, “Thunderclap”, LOC, N/V
17
Q

Location of lumbar puncture

A

L3/L4 interspace

18
Q

Tube thoracostomy landmark

A

4th or 5th intercostal space, midaxillary line

19
Q

Indications of tube thoracostomy

A

hemo-/pneumothorax

20
Q

How to do cricothyrotomy?

A

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

21
Q

Indications of cricothyrotomy

A

last resort airway in cases where orotracheal and nasotracheal intubation are impossible or contraindicated

22
Q

Where is needle decompression inserted to treat tension pneumothorax?

A

2nd or 3rd intercostal space, mid-clavicular line

23
Q

What is considered the definitive airway?

A

ET tube

24
Q

Indications for double sugar tong splint

A

distal forearm and elbow fractures; limits flex/extension and pro/supination

25
Q

Indications for thumb spica splint

A 
scaphoid fracture (seen or suspected)
De Quervain tenosynovitis
26
Q

Indications for Jones Compression Dressing

A

short term immobilization of soft tissue and ligamentous injuries to knee or calf

27
Q

Contraindications to biopsy

A

Infection
Inflammation
Traumatized, crushed, scratched, or significantly modified areas
Coagulopathy

28
Q

When is punch biopsy indicated?

A

Rashes with unclear biopsy
Removal of subcutaneous growths
Nevi of uncertain malignant potential

29
Q

Methods for partial thickness biopsy

A

Curettage

Shave

30
Q

When should you NOT do shave biopsy?

A

if melanoma suspected

31
Q

Excisional biopsy technique

A

Use sterile technique
Field block anesthesia
Draw elliptical shape
Scalpel 15 deg away from lesion

ED/Surgery (16 decks)

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