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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
Q

Return to ER after I+D if….

A 
Fevers
Chills
↑ pain
Redness
Swelling
Streaking occur
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26
Q

Abscess wound care

A 
Wound check in 24-48 hours
Repack daily (if applicable)
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27
Q

A worsening abscess formation after I+D could lead to

A

Fistula formation

osteomyelitis

28
Q

2 reasons to do arthrocentesis

A

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

29
Q

Contraindications to arthrocentesis

A
  • Cellulitis or broken skin over joint
  • Coagulopathy
  • Infected bursa (for injection)
  • Bacteremia (unless joint is cause)
  • Joint prosthesis→ Refer to orthopedics
30
Q

After inserting a needle during arthrocentesis _______

A

aspirate to insure no blood return, THEN aspirate or inject site, collect fluid

31
Q

Indications for CT guided biopsy

A

Mass→ Lymph node, lung, liver, kidney, bone

Fluid collection

32
Q

Contraindications for CT guided biopsy

A

Mass→ Lymph node, lung, liver, kidney, thyroid, prostate

33
Q

CT vs ultrasound guided biopsy: indications

A

Masses:

Either: lymph, lung, liver, kidney
CT: bone, lung
US: thyroid, prostate

34
Q

Contraindications to CT or ultrasound guided biopsy.

Also contraindications to Arterial lines/ABGs

A

Coagulopathy
Skin infection at site
Uncooperative patient

35
Q

Complications to CT guided biopsy (but not US)

A
  • Allergy to contrast

* Renal failure from contrast

36
Q

Vascular complications of an arterial catheter

A 
Vasospasm
Thromboembolism
Dissection
Pseudoaneurysm
Arteriovenous fistula
formation
37
Q

Indications for a Central Venous Catheter

A
  • 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
Q

Complications from a Central Venous Catheter

A
  • Hemorrhage, hematoma
  • Pneumothorax
  • Hemothorax
  • Arrhythmias
  • Infection
39
Q

After placing a Central Venous Catheter, you have to do a _______

A
  • Follow-up CXR
  • Verify line position
  • Desired position is tip of catheter in the SVC near right atrium
  • Rule-out complication
40
Q

Contraindications to Central Venous Catheters

A
  • Distortion of anatomy/landmarks
  • Coagulopathy
  • Infection over insertion site
  • Pneumothorax or hemothorax on contralateral side
41
Q

Inserting an Internal Jugular Central Venous Catheter

A
  • Insert either anterior or posterior to SCM or between the sternal and clavicular heads of SCM
  • Aim 30° towards xiphoid
42
Q

Inserting a Supraclavicular Central Venous Catheter

A

1 cm above mid-point of clavicle

Direct 30° towards opposite nipple

43
Q

Inserting a Subclavian Central Venous Catheter

A

• 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
Q

A central venous catheter is a ______

A

STERILE procedure:
Sterile gloves, masks, gowns
Aseptic technique critical to avoid infections

45
Q

Hickman catheter

A

may be used for central venous catheters

46
Q

Central venous catheter that has the highest risk of pneumothorax

A

Subclavian

47
Q

Indications for Chest tubes

A 
Pneumothorax
Hemothorax
Recurrent pleural effusion
Empyema
Penetrating chest trauma or flail chest
48
Q

Contraindications for Chest tubes

A

Coagulopathy
Loculated pleural effusion
Previous chest tube insertion, preventing re-insertion

49
Q

Complications from a chest tube include

A

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

50
Q

Chest tube sizing

A 
#16-24 for air
 #34-40 for fluid or blood
51
Q

Patient positioning for chest tube insertion

A

Supine with arm over head

52
Q

Incision is at _______ for chest tube insertion

A

For fluid or air evacuation, positioning is in 4th or 5th ICS in anterior axillary line or MCL.

53
Q

How do you secure a chest tube?

A

Purse string suture

54
Q

Continue suction of a chest tube until

A

minimal drainage or no evidence of air leak

55
Q

When inserting a chest tube, you aim it _____ for air evacuation and ______ for fluid evacuation

A

Fluid evacuation: aim tube inferiorly and posteriorly

Air evacuation: aim tube apically

56
Q

The subcutaneous tunnel for the chest tube is located _____

A

Up and over top of next rib (nerves are below the rib)

57
Q

Is chest tube entry into the pleura painful?

A

Yes

58
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 of leukemia and lymphoma
Bone marrow transplant
59
Q

Contraindications for Bone Marrow Aspiration and Biopsy

A

Bleeding disorders
Skin infection at site
Uncooperative patient

(basically same as everything)

60
Q

Complications from Indications for Bone Marrow Aspiration and Biopsy

A

Bleeding→ At biopsy site or retroperitoneal hemorrhage

Perforation of sternal plate

61
Q

Where may both bone marrow biopsy and aspiration be safely performed on an adult?

A

Iliac crest (anterior or posterior)

also may sternum

62
Q

Patient positioning for Bone Marrow Aspiration and Biopsy

A

lateral decubitus position

63
Q

How do you find the spot for bone marrow biopsy?

A

three finger-widths from the midline and two finger-widths inferior to the iliac crest

64
Q

After bone marrow biopsy….

A

Place pressure on biopsy site for 1 hour following procedure.

65
Q

Once advanced into the periosteum during a bone marrow biopsy….

A

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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