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Unit 3 Emerg/Surg > L14: Diagnostic and Therapeutic Procedures > Flashcards

L14: Diagnostic and Therapeutic Procedures Flashcards

1
Q

What might someone with cerumen impaction complain of?

A

Hearing loss
Tinnitus
Vertigo
Otalgia

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2
Q

Contraindications to cerumen impaction removal

A
  • Uncooperative patient
  • Distorted/abnormal anatomy
  • Previous ear surgery
  • Suspected TM perforation
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3
Q

Place ______ on ear when performing cerumen impaction

A

posterior traction

then use your curette or suction to get it out

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4
Q

After removing cerumen _______

A

irrigate with lukewarm water

pt tips head to side

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5
Q

Complications from cerumen impaction removal

A

TM perforation/damage
Otitis externa
Vertigo, N/V, tinnitus
IAC wall abrasions/bleeding

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6
Q

bleeding between nail bed and finger/toenail caused by trauma

A

Subungual Hematoma

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7
Q

Contraindications to Subungual Hematoma Evacuation

A
  • Crushed or fractured nail bed
  • Hematomas involving >50% of nail
  • +/- laceration of nail bed
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8
Q

How do you do a Subungual Hematoma Evacuation?

A

Light a paperclip on fire using a bunsen burner, place on nail. Cauterize (with cautery unit, not with fire paperclip)

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9
Q

Indications for NG tube

A 
Decompress stomach
• Gastric outlet
obstruction
• Ileus
Small bowel obstruction
Gastric lavage
• Medication overdose
• Bleeding
Enteral feeding
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10
Q

How does an NG tube drain the stomach?

A

Gravity or wall suction

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11
Q

Contraindications to an NG tube

A 
• Basilar skull fracture
• Facial trauma (significant)
• Nasal obstruction
• Esophageal disease→ Strictures, diverticuli,
recent surgery
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12
Q

How are NG tube sized?

A

“French”
Smaller number, smaller tube

Peds get 3-8
Adults 10-18

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13
Q

Tube: Large bore, designed for gastric lavage

A

Orogastric

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14
Q

Orogastric tube sizing

A 
Pediatric = 24-28 Fr.
Adult = 36-40 Fr.
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15
Q

smaller, softer tubes, left in place for longer periods of time.

A

feeding tubes

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16
Q

What’s the problem with feeding tubes?

A

Tendency to clog; convert medications to elixir or IV if possible; flush tube after medications given

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17
Q

How do you estimate the length of NG tube needed?

A

Tip of nose to ear

ear to xiphoid

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18
Q

Positioning for NG tube insertion

A

Pt seated, flex neck forward until tube passes into esophagus

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19
Q

Once the pt can feel the NG tube in the back of their throat….

A

ask them to swallow the tube

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20
Q

NG tube placement is confirmed by

A

Injecting air into tube while listening over stomach with stethoscope→ hear a “burp”
Xray (esp feeding tubes)

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21
Q

NG tubes can cause….

A

Sinusitis on side of tube

Aspiration pneumonia – feeding tubes

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22
Q

Prevent aspiration pneumonia from a feeding tube by:

A

Keep HOB elevated
Monitor patient; start feedings slow; advance as
tolerated

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23
Q

I+D contraindications

A

Furuncle or abscess with triangle of bridge of nose and corners of mouth

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24
Q

I+D of abscess procedure

A 
• Clean abscess with betadine.
• Administer lidocaine around abscess (weak b/c of acidic nature of pus)
• Make incision over abscess.
• Obtain culture (if needed).
• Express pus.
• Use hemostat to break up any
loculations.
• If large, pack with iodoform gauze.
• Antibiotics
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25
Return to ER after I+D if....
``` Fevers Chills ↑ pain Redness Swelling Streaking occur ```
26
Abscess wound care
``` Wound check in 24-48 hours Repack daily (if applicable) ```
27
A worsening abscess formation after I+D could lead to
Fistula formation | osteomyelitis
28
2 reasons to do arthrocentesis
• Evaluate synovial fluid • Relieve pain by either removing fluid or injecting lidocaine and/or corticosteroids
29
Contraindications to arthrocentesis
* Cellulitis or broken skin over joint * Coagulopathy * Infected bursa (for injection) * Bacteremia (unless joint is cause) * Joint prosthesis→ Refer to orthopedics
30
After inserting a needle during arthrocentesis _______
aspirate to insure no blood return, THEN aspirate or inject site, collect fluid
31
Indications for CT guided biopsy
Mass→ Lymph node, lung, liver, kidney, bone | Fluid collection
32
Contraindications for CT guided biopsy
Mass→ Lymph node, lung, liver, kidney, thyroid, prostate
33
CT vs ultrasound guided biopsy: indications
Masses: Either: lymph, lung, liver, kidney CT: bone, lung US: thyroid, prostate
34
Contraindications to CT or ultrasound guided biopsy. | Also contraindications to Arterial lines/ABGs
Coagulopathy Skin infection at site Uncooperative patient
35
Complications to CT guided biopsy (but not US)
* Allergy to contrast | * Renal failure from contrast
36
Vascular complications of an arterial catheter
``` Vasospasm Thromboembolism Dissection Pseudoaneurysm Arteriovenous fistula formation ```
37
Indications for a Central Venous Catheter
* Hemodynamic/CV pressure monitoring * Medication administration (pressors, chemo) * Total parenteral nutrition (TPN) * Lack of peripheral sites * Emergent need for vascular access * Hemodialysis * To avoid repetitive blood draws * Abx administration in home setting
38
Complications from a Central Venous Catheter
* Hemorrhage, hematoma * Pneumothorax * Hemothorax * Arrhythmias * Infection
39
After placing a Central Venous Catheter, you have to do a _______
* Follow-up CXR * Verify line position * Desired position is tip of catheter in the SVC near right atrium * Rule-out complication
40
Contraindications to Central Venous Catheters
* Distortion of anatomy/landmarks * Coagulopathy * Infection over insertion site * Pneumothorax or hemothorax on contralateral side
41
Inserting an Internal Jugular Central Venous Catheter
* Insert either anterior or posterior to SCM or between the sternal and clavicular heads of SCM * Aim 30° towards xiphoid
42
Inserting a Supraclavicular Central Venous Catheter
1 cm above mid-point of clavicle | Direct 30° towards opposite nipple
43
Inserting a Subclavian Central Venous Catheter
• Good landmarks, more comfortable for patient • Higher risk of pneumothorax • ~ 2 cm below mid-point of clavicle; direct needle to manubrium while maintaining a shallow angle of 15° • “Walk” under clavicle to find venous access
44
A central venous catheter is a ______
STERILE procedure: Sterile gloves, masks, gowns Aseptic technique critical to avoid infections
45
Hickman catheter
may be used for central venous catheters
46
Central venous catheter that has the highest risk of pneumothorax
Subclavian
47
Indications for Chest tubes
``` Pneumothorax Hemothorax Recurrent pleural effusion Empyema Penetrating chest trauma or flail chest ```
48
Contraindications for Chest tubes
Coagulopathy Loculated pleural effusion Previous chest tube insertion, preventing re-insertion
49
Complications from a chest tube include
Injury to heart, vessels, lung, diaphragm Pneumothorax Hemorrhage Localized infection
50
Chest tube sizing
``` #16-24 for air #34-40 for fluid or blood ```
51
Patient positioning for chest tube insertion
Supine with arm over head
52
Incision is at _______ for chest tube insertion
For fluid or air evacuation, positioning is in 4th or 5th ICS in anterior axillary line or MCL.
53
How do you secure a chest tube?
Purse string suture
54
Continue suction of a chest tube until
minimal drainage or no evidence of air leak
55
When inserting a chest tube, you aim it _____ for air evacuation and ______ for fluid evacuation
Fluid evacuation: aim tube inferiorly and posteriorly | Air evacuation: aim tube apically
56
The subcutaneous tunnel for the chest tube is located _____
Up and over top of next rib (nerves are below the rib)
57
Is chest tube entry into the pleura painful?
Yes
58
Indications for Bone Marrow Aspiration and Biopsy
``` Unexplained anemia, leukopenia, thrombocytopenia Abnormal peripheral smear Unexplained splenomegaly Fever of unknown origin Dx and staging of leukemia and lymphoma Bone marrow transplant ```
59
Contraindications for Bone Marrow Aspiration and Biopsy
Bleeding disorders Skin infection at site Uncooperative patient (basically same as everything)
60
Complications from Indications for Bone Marrow Aspiration and Biopsy
Bleeding→ At biopsy site or retroperitoneal hemorrhage Perforation of sternal plate
61
Where may both bone marrow biopsy and aspiration be safely performed on an adult?
Iliac crest (anterior or posterior) | also may sternum
62
Patient positioning for Bone Marrow Aspiration and Biopsy
lateral decubitus position
63
How do you find the spot for bone marrow biopsy?
three finger-widths from the midline and two finger-widths inferior to the iliac crest
64
After bone marrow biopsy....
Place pressure on biopsy site for 1 hour following procedure.
65
Once advanced into the periosteum during a bone marrow biopsy....
Point needle in the direction of the anterior superior iliac spine, and twist needle. A “give" is felt when the needle enters the marrow cavity. Aspirate

Unit 3 Emerg/Surg (5 decks)

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