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X Emergency Med Exam 3 > Diagnostic and Therapeutic Procedures > Flashcards

Diagnostic and Therapeutic Procedures Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Indications for cerumen impaction removal

A

EAC or TM obscured by cerumen

Hearing loss, tinnitis, vertigo or otalgia

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2
Q

Contraindication for cerumen impaction removal

A

Uncooperative pt
Distorted/abnormal anatomy
Previous ear surgery
Suspected TM perf

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3
Q

Equipment needed for cerumen impaction removal

A 
Ear curette
Syringe
Lukewarm tap water
Towels
Ear basin
Debrox
Suction
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4
Q

Procedure for cerumen impaction removal

A

Sit on table
Visualize canal and cerumen with otoscope
Place posterior traction on ear
Use curette or sunction

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5
Q

What to use if can’t get cerumen out with straight pulling?

A

Irrigation (fill syringe with lukewarm tap water, tilt head to side being irrigated into basin, direct water towards occiput)

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6
Q

Complications of cerumen impaction removal

A

TM perf/drainage
Otitis externa
Vertigo, n/v, tinnitus
IAC wall abrasions/bleeding

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7
Q

Subungual hematoma

A

Bleeding between nail bed and finger/toenail caused by trauma

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8
Q

Indications for subungual hematoma evacuation

A

Visible, painful hematoma

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9
Q

Contraindications for subungual hematoma evacuation

A

Crushed or fractured nail bed

Hematomas involving >50% of nail (laceration of nail bed)

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10
Q

Equipment for subungual hematoma evacuation

A

Bunsen burner
Metal paper clip
Forceps or hemostat
Cautery unit

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11
Q

Options for subungual hematoma evacuation

A

Paperclip

Cautery

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12
Q

Complications of subungual hematoma evacuation

A

Infection

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13
Q

Indications for NG tube

A 
Decompress stomach (gastric outlet obstruction, ileus)
Small bowel obstruction
Gastric lavage (med overdose, bleeding)
Enteral feeding
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14
Q

Contraindications for NG tube

A 
Basilar skull fracture
Facial trauma (significant)
Nasal obstruction
Esophageal disease (Strictures, diverticuli, recent surgery)
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15
Q

Sizes of NG tubes

A

Smaller the number the smaller the tube

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16
Q

Orogastric tube

A

Large bore, designed for gastric lavage in a more critically ill pt

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17
Q

Feeding tube

A

Smaller, softer tube
Designed to being left for longer periods in time
Tend to clog (IV meds if possible)

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18
Q

How to measure length of NG tube

A

Tip of nose to ear and ear to xyphoid

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19
Q

How to help NG tube pass into esophagus

A

Have pt flex neck forward (when pt can feel in back of throat, have them swallow)

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20
Q

How to verify placement of NG tube

A

Inject air into tube while listening over stomach with stethoscope
Should hear burp of air

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21
Q

What to do once NG tube is in place

A

Secure with tape to nose

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22
Q

Complications of NG tube

A 
Pt discomfort
Trauma to nares at insertion/bleeding
Sinusitis on side of tube
Gastric irritation
Aspiration pneumonia (feeding tubes)
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23
Q

How to decrease risk of aspiration pneumonia with NG tube

A

Keep HOB elevated

Monitor pt and start feedings slowly

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24
Q

Contraindications of I&D

A

Furuncle or abscess with triangle of bridge of nose and corners of mouth
(in the triangle)

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25
Q

Complications of I&D

A

Pain
Recurrence
Scar
Worsening infection (fistula formation, osteomyelitis)

26
Q

Indications for arthrocentesis

A

Evaluate synovial fluid

Relieve pain by either removing fluid or injecting lidocaine and/or corticosteroids

27
Q

Contraindications for arthrocentesis

A 
Cellulitis or broken skin over joint
Coagulopathy
Infected bursa (for injection)
Bacteremia (unless joint is cause)
Joint prosthesis
28
Q

Complications of arthrocentesis

A 
Bleeding
Infection
Nerve trauma
Adverse drug rxn
Cartilage or tendon damage
29
Q

Indications for CT guided biopsy

A

Mass (lymph node, lung, liver, kidney, bone)

Fluid collection

30
Q

Contraindications for CT guided biopsy

A

Coagulopathy
Skin infection at site
Uncooperative patient

31
Q

Complications of GT guided biopsy

A 
Allergy to contrast
Renal failure from contrast
Pain
Bleeding
Others based on site (pneumo or hemothorax)
32
Q

Indications for US guided biopsy

A

Mass (lymph node, liver, kidney, thyroid, prostate, NOT lung)
Fluid collection

33
Q

Contraindications of US guided biopsy

A

Coagulopathy
Skin infection at site
Uncooperative pt

34
Q

Complications of US guided biopsy

A

Pain
Bleeding
Others bases on site (pneumo or hemothorax)

35
Q

What should you not use arterial line insertion?

A

Not for med administration

36
Q

Indications for arterial line insertion

A

Invasive arterial blood monitoring

Recurrent ABGs

37
Q

Contraindications for arterial line insertion

A

Coagulopathy
Skin infection at site
Uncooperative pt

38
Q

Complications of arterial line insertion

A 
Pain
Swelling
Bleeding
Damage to adjacent structures
Infection
Vascular complications (vasospasm, thromboembolism, dissection, pseudoaneurysm, arteriovenous fistula)
39
Q

How to collect arterial blood gas

A

Usually from radial (can be brachial or femoral)

Collected with anticoagulant, placed on ice and taken to lab)

40
Q

Indication for central venous catheters (central line)

A 
Hemodynamic/CV pressure monitoring
Med administration
TPN
Lack of peripheral sites
Emergent need for vascular access
Hemodialysis
To avoid repetitive blood draws
Administer abx in home setting
41
Q

Contraindications of central venous catheter

A

Distortion of anatomy/landmarks
Coagulopathy
Infection over insertion site
Pneumo or hemothorax on CONTRALATERAL side

42
Q

Is a central venous catheter sterile?

A

YES

43
Q

Where can you put a central venous catheter?

A

Internal or external jugular, subclavian, femoral or brachial veins

44
Q

How to insert central venous catheter into internal jugular?

A

Anterior or posterior to SCM or between sternal and clavicular heads of SCM
Aim 30 degrees to xyphoid

45
Q

How to insert central venous catheter into supraclavicular?

A

1 cm above mid point of clavicle

Direct 30 degrees to opposite nipple

46
Q

Subclavian approach for central venous catheter

A

There are good landmarks

2 cm below mid point of clavicle (direct needle to manubrium and maintain 15 degree angle)

47
Q

High risk of what with subclavian approach to central venous catheter approach

A

Pneumothorax

48
Q

Complication of central venous catheter

A

Hemorrhage, hematoma
Pneumo or hemothorax
Arrhythmias
Infection

49
Q

What to do for follow up with central venous catheter?

A

CXR- to verify line position (want to see tip of catheter in SVC near right atrium)

50
Q

Indications for chest tube insertion

A

Pneumo or hemothorax
Recurrent pleural effusion
Empyema
Penetrating chest trauma or flail chest

51
Q

Contraindications for chest tube insertion

A

Coagulopathy
Loculated pleural effusion
Previous chest tube insertion (preventing re-insertion)

52
Q

Types of chest tubes

A 
#16-24 for air
#34-40 for fluid or blood
53
Q

Where is the positioning for fluid or air evacuation?

A

4th or 5th ICS in anterior axillary line or MCL

54
Q

Complications of chest tube insertion

A

Injury to heart, vessels, lung, diaphragm
Pneumothorax
Hemorrhage
Localized infection

55
Q

Indications for bone marrow aspiration and biopsy

A 
Unexplained anemia, leukopenia, thrombocytopenia
Abnormal peripheral smear
Unexplained splenomegaly
Fever of unknown origin
Dx and staging leukemia and lymphoma
Bone marrow transplant
56
Q

Contraindications of bone marrow aspiration and biopsy

A

Bleeding disorders
Skin infection at site
Uncooperative pt

57
Q

What is the only site to perform both bone marrow aspiration and biopsy in adults?

A

Iliac crest (options are posterior superior iliac crest, anterior iliac crest or sternum)

58
Q

How to palpate anatomical landmarks for iliac crest

A

Three finger widths from the midline and 2 finger widths inferior to iliac crest

59
Q

Aspiration and biopsy needles

A

They are different-do aspiration first and then biopsy from cortical bone

60
Q

Complications of bone marrow aspiration and biopsy

A

Bleeding (at biopsy site or retroperitoneal hemorrhage)
Infection
Pain
Perforation of sternal plate
*pressure at biopsy site for 1 hr after procedure

X Emergency Med Exam 3 (5 decks)

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