Diagnostic and therapeutic procedures Flashcards
1
Q
indications for cerumen impaction removal
A
- EAC or TM obscured by cerumen
- hearing loss, tinnitus, vertigo, or otalgia
2
Q
contraindications to cerumen impaction removal
A
- abnormal anatomy
- pervious ear surgery
- suspected TM perforation
3
Q
complications that can occur with cerumen impaction removal
A
- TM perforation
- otitis externa
- vertigo, N/V, tinnitus
- IAC wall abrasions
4
Q
subungual hematoma
A
- bleeding between the nail bed and finger/toenail caused by trauma
5
Q
contraindications to subungual hematoma evacuation
A
- crushed or fractured nail bed
- hematomas > 50% of nail
6
Q
complications with subungual hematoma evacuation
A
infection
7
Q
Indications for a Nasogastric tube
A
- decrompress stomach
- gastric outlet obstruction
- ileus
- small bowel obstruction
- gastric lavage
- medication overdose
- bleeding
- enteral feeding
8
Q
contraindications to a nasogastric tube
A
- basilar skull fx
- significant facial trauma
- nasal obstruction
- esophageal disease
9
Q
sizing for Nasogastric tubes
A
- small number, small tube
10
Q
describe Orogastric tubes
A
- large bore
- designed for gastric lavage
11
Q
describe Feeding tubes
A
- smaller, softer tubes
- designed for being left in place for longer periods of time
12
Q
how can you verify position of NG tube
A
- inject air into tube while listening over stimach with stethoscope
- should hear a “burp” of air
- xray
13
Q
complications from NG tube insertion
A
- trauma to nares
- sinusitis on side of tube
- gastric irritation
- aspriation PNA - feeding tubes
14
Q
contraindictions to incision and drainage of an abscess
A
- abscess with triangle of bridge of nose and corners of mouth
15
Q
why is the anesthetic become weak when administering it around an abscess
A
- acidic nature of pus weakens strength
16
Q
wound check after I&D of abscess
A
- 24-48 hours
- repack daily
17
Q
indications for arthrocentesis
A
- to evaluate synovial fluid
- relieve pain by either removing fluid or injecting lidocaine and/or corticosteroids
18
Q
contraindications to arthrocentesis
A
- cellulitis or broken skin over joint
- coagulopathy
- infected bursa
- joint prosthesis
19
Q
complications with arthrocentesis
A
- bleeding
- infection
- nerve trauma
- cartilage or tendon damage
20
Q
indications for thoracentesis
A
- remove air and/or fluid from chest
- remove pleural fluid for anaylsis
- introduce therapeutic medications
21
Q
contraindications to thoracentesis
A
- coagulopathy
- platelet count < 50,000
- uncontrolled cough or hiccups
22
Q
should needle for thoracentesis be placed above or below rib
A
- above rib to avoid neurovascular bundle
23
Q
complications with thoracentesis
A
- pain
- pneumothorax
- hemothorax
- diaphragm laceration
- re-expansion pulmonary edema
24
Q
in order to avoid re-expansion pulmonary edema when performing a thoracentesis, do NOT
A
- remove > 1 L
- perform bilaterally
25
indications for a Paracentesis
* ascites
* diagnostic
* therapeutic
26
contraindications for Paracentesis
* acute abdomen
* coagulopathy
* distended bladder
* bowel distension
* pregnancy
* infection at site
27
complications with Paracentesis
* bladder, bowel, stomach perforation
* infection
* hematoma
28
lumbar puncture is diagnostic for what conditions
* CNS infections
* multiple sclerosis
* SAH
* tumors
* NPH
29
contraindications for lumbar puncture
* known or suspected intracranial lesions
* focal deficit, papiledema
* local skin infection
* coagulopathy or thrombocytopenia
30
primary target for lumbar puncture is in what spinal process
* L4-L5
* top of iliac crest
31
normal opening pressure seen in lumbar puncture when lying down? when sitting?
* lying: 5-14 mmHg
* sitting: 15-27 mmHg
32
complications with lumbar puncture
* CSF leak with headache
* infection
* nerve root impingement
* herniation
33
contraindications for central venous catheter
* distortion of anatomy
* coagulopathy
* infection over insertion site
* pneumothorax or hemothorax on contralateral side
34
is central venous catheter a sterile procedure
* yes
* wear sterile gloves, masks, gowns
35
where can central venous catheters be placed
* internal jugular
* external jugular
* subclavian
* femoral
* brachial veins
36
which approach for central venous catheter has the highest risk for pneumothorax
* subclavian approach
37
complications of central venous catheter
* hemorrhage, hematoma
* pneumothorax
* hemothorax
* arrhythmias
* infection
38
desired position of central venous catheter seen on CXR is
* tip of catheter in the superior vena cava near right atrium
39
indications for chest tube insertion
* pneumothorax
* hemothorax
* recurrent pleural effusion
* empyema
* penetrating chest trauma of flail chest
40
contraindications for chest tube insertion
* coagulopathy
* loculated pleural effusion
* previous chest tube insertion
41
for fluid or air evacuation, position chest tube where
* 4th or 5th ICS in anterior axillary line or MCL
42
complications with chest tube insertion
* injury to heart, vessels, lung, diaphragm
* pneumothorax
* hemorrhage
* localized infection
43
indications for bone marrow aspiration and biopsy
* unexplained anemia, leukopenia, thrombocytopenia
* abn peripheral smear
* unexplained splenomegaly
* fever of unknown origin
44
contraindications for bone marrow aspiration and biopsy
* bleeding disorders
* skin infection at site
45
what is the only site at whcih both aspiration and biopsy for bone marrow aspiration and biopsy may be safely performed in the adult
* iliac crest
46
complications with bone marrow aspiration and biopsy
* bleeding
* at biopsy site or retroperitoneal hemorrhage
* infection
* pain
* perforation of sternal plate
47
after bone marrow aspiration and biopsy, place pressure on biopsy site for
* 1 hour
