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Procedures > Final > Flashcards

Final Flashcards

1
Q

Plaster vs. fiberglass splints

A

Plaster is:

  1. Easier to mold but more thermogenic - skin burns
  2. More absorbent - exudates
  3. Longer to harden - 10 min & fully by 8h

Fiberglass

  1. Hardens fully w/in 1-2h
  2. More expensive
  3. Require protective gowns due to resin
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2
Q

Indications of casts

A
  1. Tx of simple nondisplaced Fx
  2. Immobilize closed reduction of joints & Fx
  3. Tx severe sprains & strains
  4. Tx congenital deformities
  5. Manage chronic foot & ankle conditions
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3
Q

Contraindications to casts

A
  1. Before 3-4 days of injury (compartment syndrome)

2. Concealing infection

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4
Q

Complications of casts

A
  1. Cast dermatitis
  2. Pressure sores - ulcers
  3. DVT
  4. Nerve injury
  5. Transient muscle atrophy & joint stiffness
  6. Compartment syndrome
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5
Q

When would you splint the ankle in equines position?

A

Tx achilles tendonitis

Every other time - keep at 90 degrees

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6
Q

Thumb spica splint

A
  1. Scaphoid Fx

2. DeQuervian’s

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7
Q

Ulnar gutter splint

A

Fx of 4th/5th metacarpals/digits

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8
Q

Volar wrist spint

A
  1. Metacarpal Fx
  2. Soft tissue injury
  3. Carpal tunnel
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9
Q

UE sugar-tong splint

A
  1. Distal radial (Colles)

2. Ulnar Fx

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10
Q

Short leg posterior splint

A
  1. Tibia injury
  2. Fibula injury
  3. Jones Fx
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11
Q

Lower leg sugar tong “stirrup” splint

A

Posterior ankle injuries

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12
Q

Indications for arthrocentesis

A
  1. Removal of post traumatic/non-traumatic knee effusion - relief of pain
  2. R/o suspicious Dx
  3. Need for fluid analysis (GS, culture, cell counts, crystal analysis, PCR)
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13
Q

Contraindications for arthrocentesis

A
  1. Burns, infected tissue
  2. Prosthetic joints - needs referral
  3. Hemarthrosis when underlying coagulopathy has not been corrected
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14
Q

Complications for arthrocentesis

A
  1. Bleeding, infection, cartilage damage, fluid reaccumulation
  2. Injury to neurovascular structures
  3. Allergic rxns to meds

For bursal aspiration also:

  1. Development of a chronic sinus tract - especially when bursa connects to the joint
  2. Spreading RA to the bursa
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15
Q

Where is the best site to aspirate a knee?

A

Max extension - lateral approach

Space medially btwn the femoral condyles & behind the patella

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16
Q

Indications for joint ejections

A
  1. Arthropathies
  2. Bursitis
  3. Tendonitis
  4. Plantar fasciitis
  5. RA
  6. Ganglion cysts
  7. Trigger points
  8. Carpal tunnel
  9. Neuromas
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17
Q

Contraindications to joint injections

A
  1. Prosthetics
  2. Tumors
  3. Infections
  4. Neuro conditions
  5. Bleeding issues
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18
Q

What is the most accessible bursa?

A

Olecranon

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19
Q

What is a Hills-Sachs lesion?

A

Posteriolateral humeral head Fx

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20
Q

What is a Bankhart lesion?

A

Fx or tear of the glenoid ligament or bone

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21
Q

Pt presents w/ paresthesias associated with a shoulder dislocation..what should you suspect?

A

Axillary nerve damage

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22
Q

How do you reduce a shoulder dislocation?

A
  1. Stimson technique/Milch maneuver
  2. Kocher maneuver
  3. Hippocratic maneuver

Conscious sedation w/ Fentanyl & Midazolam
Velpeau sling
Old people move at 3wks, young 6 wks
Vigorous motion old people 6 wks, young 3 mo

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23
Q

Stimson technique

A

Shoulder reduction
Pt prone, arm hanging with 5-15lb wt, traction w/ rotation

Doesn’t work w/ adhesive capsulitis

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24
Q

Kocher maneuver

A

Shoulder reduction

Slow external rotation w/ a downward traction

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25
Q

Hippocratic maneuver

A

Shoulder reduction

Longitudinal traction w/ contralateral pulling to reduce humeral head

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26
Q

Which type of finger dislocations might need open reductions?

A

MCP dorsal dislocations

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27
Q

How to reduce PIP dislocations?

A

Digital lidocaine block
Axial traction & flexion
Full extension splint for 6 wks

DIP? Same but splint in flexion for 2-4wks

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28
Q

MC MCP joint dislocation?

A

Thumb

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29
Q

Contraindications to abscess drainage

A
  1. 4 or more
  2. Facial furuncles from nose bridge to corners of the mouth
  3. Perianal abscesses w/ rectal extension
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30
Q

What should you suspect if Pt has abscesses in axilla & groin?

A

Hidradenitis Suppurativa

Multiple recurrences - Need surgery

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31
Q

Tx mastitis

A

Warm compresses, continue breast feeding
abx - Dicloxacillin, Bactrim

Not responding? US to r/o abscess

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32
Q

MC organisms causing abscesses

A

MSSA & MRSA

Tx - I&D + Keflex +/- Bactrim
Allergic? Clindamycin or Doxy

Refractory? Tigecycline

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33
Q

Concerning anatomic locations for draining abscesses

A
  1. Peritonsillar/retropharyngeal
  2. Ant. triangle of neck
  3. Supraclavicular fossa
  4. Deep axillary
  5. AC space
  6. Groin
  7. Popliteal space
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34
Q

When to give abx after draining abscess?

A 
1. >5mm
PLUS
2. Cellulitis
3. Comorbidities
4. FB penetrating wounds/bites
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35
Q

How to prevent ingrown toenail from regrowing?

A

Nail matrix ablation w/ 88% phenol soln.

36
Q

What is DuoDerm & what is it used for?

A

Dressing

Breaks down tissue…good for necrosis

37
Q

What type of dressing keeps a moist wound bed?

A

Xeroform

38
Q

What type of dressing is non-adherent?

A

Telfa

Avoid removing new tissue

39
Q

What types of dressings should you avoid with PVD?

A

Occlusive

40
Q

What is evisceration?

A

Insides come out

41
Q

What is dehiscence?

A

Separation

42
Q

What are alginates & when are they used?

A

ex. AlgiDERM & Algisite
From brown seaweed - absorb 20x their weight

Best for infected wounds w/ heavy exudate

43
Q

What are Biosynthetic dressings & when are they used?

A

Ex. E-Z Derm
Gel/film for partial thickness wounds like burns/abrasions

Barrier protection, moist environment, minimizing protein loss & pain

44
Q

What are collagen dressings & when are they used?

A

Ex. BCG Matrix
Used in non-infected areas, partial & full thickness wounds except 3rd degree burns

Promotes debridement & granulation via extra collagen
Requires another primary dressing to absorb exudate

45
Q

What are foam dressings & when are they used?

A

Ex. Mepilex

Absorbent & protective for skin tears & granulating wounds
Can be primary/secondary dressings

46
Q

What are hydrocolloids & when are they used?

A

Ex. DuoDERM
For necrotic wounds

Not for heavy exudates/infected wounds

47
Q

What are Hydrogel dressings & when are they used?

A 
Ex. Aquacel 
Can be used as filler
Good for moderate exudate to maintain moist bed for granulation 
Allows for autolytic debridemnet 
Conforms to wound
48
Q

What are transparent film dressings & when are they used?

A

Ex. Tegaderm
Secondary dressing
Waterproof & microbial resistant - allows excess moisture to evaporate

49
Q

When should you avoid wound vacs?

A

Negative pressure wound therapy

Exposed vital structures, florid infection, CA, ischemic wounds, fragile wounds. allergies

Mechanism: Inc. blood flow, dec. inflammation/bacterial burden/devitalized tissue

50
Q

Decubitus ulcers

A
  1. Intact skin - blanchable erythema
  2. Partial thickness tissue loss involving epidermis +/- dermis
  3. Full thickness - NOT into underlying fascia
  4. Full thickness w/ extension into underlying structures
51
Q

What is a Majolin ulcer?

A

Aggressive SCC in area of chonic inflammation

52
Q

Shave Bx

A

Removes part of epidermis & upper dermis
Snip, saucerization (deep shave), curettage

ContraindicationsL

  1. Melanoma/dysplastic nevi
  2. Hair/dermal components
  3. Suspected sclerosing BCC
53
Q

Punch Bx

A

Incisional - removes part of lesion
Excisional - removes whole lesion

2-8mm
Heal by secondary intention

54
Q

Which areas are high risk for keloids?

A
  1. Chest
  2. Upper back
  3. Arms
55
Q

How do you stop bleeding after shave Bx?

A

Drysol / cautery

56
Q

Is curettage sent to pathology?

A

NO

57
Q

What size lesions should you excise?

A

> 8 mm
Use ellipse pattern w/ 4:1 length:width ratio

Abx?
Groin, lower extremities, high risk, prosthetic materials, oral lesions

58
Q

When should you avoid electrosurgery?

A

Pts w/ implantable electronic devises

Facial PPE required - respirator or high filtration face mask

59
Q

What type of Bx should you use for facial lesions?

A

Shave

60
Q

What veins are in the antecubital fossa?

A
  1. Median cubital - MC for phlebotomy
  2. Cephalic
  3. Basilic
61
Q

How long can the tourniquet be left on?

A

No more than 2 mins

62
Q

CLSI recommended order of blood draw

A
  1. Blood cultures
  2. Red
  3. Gold
  4. Light blue
  5. Green/Lavender
  6. Gray
63
Q

How often should an IV catheter be changed?

A

q72h

64
Q

When is arterial sampling preferred over venous?

A
  1. Ammonia
  2. CO2
  3. Lactate
65
Q

Contraindications to arterial puncture?

A
  1. No arterial pulse
  2. Abnormal allen test
  3. Arterial disease
  4. Coagulopathy
  5. AV shunt
  6. Cellulitis
  7. Uncooperative Pt
66
Q

Angles for blood punctures

A
  1. Blood - 15-30
  2. IV - 15-30
  3. Arterial - 40-60
  4. Arterial line 30-45
  5. Intradermal - 15
  6. SQ - 45
  7. IM - 90
67
Q

Indications for arterial line

A
  1. BP monitoring

2. Frequent blood gas sampling

68
Q

Allergic to eggs, which vaccines should you avoid?

A

Influenza & yellow fever

69
Q

Allergic to Baker’s yeast, which vaccines to avoid?

A

Hep B

70
Q

Allergic to gelatin, which vaccines to avoid?

A

Varicella

71
Q

Which vaccines should pregnant & IC avoid?

A
  1. MMR
  2. Varicella
  3. Live attenuated flu
  4. Yellow fever
72
Q

Intradermal injections

A

Slow absorption - good for delayed rxns

Volar forearm best - distal to AC space

15 degrees - DONT massage

73
Q

SQ injections

A

Optimal abs. in fatty regions
Better w/ lipophilic & lower volume drugs

Good locations: lower abd, thigh, lower lat back

74
Q

IM injections

A

Best absorption
Highly vascular

Best sites - deltoid, vastus lateralus
Ventrogluteal - risk of sciatic nerve injury

3 deltoid

75
Q

Technique for ventrogluteal injection

A

IM - more risk of sciatic nerve injury

V technique

76
Q

IM injection of flu vaccine, do you need to aspirate first?

A

No - IM vaccines don’t need to aspirate

77
Q

Indications for urinary cath in surgical Pts

A
  1. > 60 min surgery
  2. ICU postop
  3. Procedure involving urinary tract, prostate, colon/rectum or major GYN
  4. Limited mobility postop
78
Q

Contraindications to urinary cath

A
  1. Injury - blood clot at meatus

Relative - urethral stricture, recent urinary tract surgery

79
Q

Length of urethra

A

F - 3.5-5 cm

M - 15-17 cm
3 cuvres - penile, membranous, prostatic

80
Q

What size urinary cath to use in kiddos?

A

Age/2 + 8

Infants <6mo. - feeding tube 5F

81
Q

Urinary cath size w/ BPH?

A

18-20 F

82
Q

Indications for performing anoscopy

A
  1. Rectal bleeding
  2. Anorectal pain
  3. Pruritis
  4. Anal discharge
  5. Mass found on DRE
83
Q

Contraindications for anoscopy

A
  1. Severe rectal pain
  2. Perirectal abscess, acutely thrombosed hemorrhoid, anal fissure
  3. Imperforate anus/severe anal stricture
  4. Recent anorectal surgery
84
Q

Contraindication for endometrial Bx?

A

Pregnancy

85
Q

Indications for endometrial Bx

A
  1. Abnl bleeding
  2. Postmenopausal bleeding
  3. Amenorrhea for 1 yr
  4. Endometrial dating of menstrual cycle
  5. Infertility
  6. Response to hormonal therapy
  7. Atypical glandular cells on Pap
  8. Prior Dx of endometrial hyperplasia
  9. FH
86
Q

Ortolani test

A

Test for presence of posteriorly dislocated hip

Abduct hips until touching table - feel clunk as femur pops back into acetabulum

87
Q

Barlow test

A

Test for ability to sublux or dislocate an intact but unstable hip

Dislocates hip
Bring leg down - pull leg forward & adduct w/ posterior force

Procedures (4 decks)

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