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FALL15 N833 Adv Pedi Probs > OFFICE PROCEDURES > Flashcards

OFFICE PROCEDURES Flashcards

1
Q

Presentation of foreign body in nose

A
  • Witness on first day
  • Delayed: unilateral purulent nasal discharge!
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2
Q

Techniques for removal of foreign body in nose

A
  • Suction: aspirate w/catheter
  • Blow it out: positive pressure
  • Pluck it out: ENT tools or use skin adhesive
  • Rinse it out: nasal irrigation
  • Pull it out: catheter method
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3
Q

Preparing patient for removal of foreign body in nose: suction method

A
  • Tools & support straff ready
  • Pretreat w/vasoconstrictor (shrink swelling)
  • Position in sniffing position! (won’t go to airway)
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4
Q

Positive pressure methods for removal of foreign body in nose

A

Parent’s kiss (plug other side of nose, blow into mouth)

  • Bag valve mask over mouth
  • Beamsley Blaster: tool to use highflow O2 to push out
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5
Q

Pulling: method for removal of foreign body in nose

A
  • Secure child’s head
  • Place balloon catheter in affected nare
  • Insert past the FB and inflate balloon
  • Withdraw balloon slowly, pulling FB out of dilated nare
  • *good if space to get by!
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6
Q

Nasal wash method for removal of foreign body in nose

A
  • Fill blue bulb syringe w/saline
  • Tilt patient’s head forward over basin and make a good seal
  • Instill saline into opposite nare
  • Flush out FB from affected nare alone w/saline
  • *esp good if organic matter – multiple pieces!
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7
Q

What to do after removal of foreign body in nose

A

Take a 2nd look! – second foreign body, trauma or underlying infection

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8
Q

When to refer to ENT for foreign body in nose

A
  • Multiple failed attempts
  • Pts who require sedation
  • Trauma to nose
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9
Q

Risks to foreign body in ear

A
  • Trauma to ear canal or rupture of TM
  • Infection
  • Insects!
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10
Q

When to refer for foreign body in ear

A
  • Object too close to TM
  • Sedation required
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11
Q

How to remove insect from ear

A
  • Anesthetize ear!
  • Instill lidocaine –> drowns insect –> remove
  • Scoop out w/forces, curette, or swab
  • Flush out w/saline (similar to cerumen)
  • Pluck out (skin adhesive)
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12
Q

What to do after removal of foreign body from ear

A
  • Second look! FB, trauma, infection
  • Consider otic antibiotics: Cipro or ofloxacin drops 5-7days
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13
Q

Alarm signs for nail injury

A

Fracture and laceration at fingertip (osteomyelitis)

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14
Q

Presentation of subungual hematoma

A
  • After crushing injury
  • Bluish discoloration beneath nail
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15
Q

Mgmt of subungual hematoma

A
  • Trephination: Drain hematoma if >25% of nail bed (pressure) and 1st 24h of injury.
  • Do not drain if old organized clot
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16
Q

How to drain subungual hematoma

A
  • Cautery or 18 gauge needle
  • Prep w/betadine. Dry completely, hand on hard surface. Apply cautery or needle directly to nail. Stop once through nail. Evacuate by soaking or gentle pressure.
  • No need to anesthetize w/cautery
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17
Q

Presentation and cause of paronychia

A
  • Superficial infection around nail
  • Painful swollen epinychial fold
  • Caused by staph or strep (anaerobes in thumb suckers)
  • (may be caused by ingrown nail)
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18
Q

Tx for paronychia

A
  • Mild: warm soaks
  • Moderate: I&D
  • Severe: I&D, oral antibiotics
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19
Q

How to drain paronychia

A
  • Anesthetize w/digital block
  • Elevate nail fold w/scalpel
  • Release pus
  • Do not directly incise skin!! Needs to come through skin, not ideal
20
Q

Mgmt of ingrown nail

A
  • Need to tx or infection will occur
  • Can ask pt to elevate nail ledge (cotton)
  • Or can resect nail wedge
21
Q

How to assess for eye injury

A
  • Examine external eye, lids, sclera, conjunctiva, pupil, palpate bony landmarks
  • Flip lid to examine for FB
  • Check red reflex, pupillary responses
  • EOMs and acuity
  • Check for corneal abrasion
22
Q

When to refer for eye injury

A
  • Bony fracture palpated, pain on eye mvmt, suspect puncture
  • (always check acuity when sending to optho!)
  • Deep or large abrasion, abrasion in direct line of site
23
Q

Presenting Sx of corneal abrasion

A

Tearing, painful eye, photophobia

24
Q

Causes of corneal abrasion

A
  • Debris, injury from fingernail, contact lens
  • Neuropathy from Bell’s palsy (dry eyes)
25
Q

Assessing for corneal abrasion

A
  • Position supine
  • Anesthetize w/proparicaine
  • Fluoroscein stripor drops
  • Apply to nasal aspect of eye
  • Lights up green w/wood’s lamp
  • Pooling is normal
  • Do not use if suspect globe rupture!
26
Q

Tx for corneal abrasion

A
  • No patching (impedes healing)
  • No numbing!
  • Rx for antibiotic ointment
27
Q

DDx for corneal abrasion

A

Always be alert for HSV!!

28
Q

Factors to assess for in burns

A
  • Method, severity, extent
  • Assess for associated injuries
29
Q

Methods of burn

A
  • Light: intense light, UV
  • Chemical: acids, bases, caustics
  • Thermal: flame, steam, not liquids
  • Electrical: current, lightening
  • Radation: nuclear sources
30
Q

Severity of burns

A
  • 1st degree: red painful skin, like a sunburn, heals in 2-3 days w/no scar
  • Superficial partial thickness: red w/wet painful blisters. Heals 2 wks w/minimal scarring
  • Deep partial thickness: thrombosed vessels give speckled look, more scarring
  • Full thickness: pale charred leathery skin, not as painful w/nerves damaged
31
Q

When to refer to burn center

A

Any full thickness burn! Emergency eval for burn center admission.

32
Q

How to calculate extent of burn

A
  • Calculate BSA involved
  • Adults: rule of 9s
  • Children: Patient’s palms= 1% and add it up
33
Q

What to do in case of burn / triage

A
  • Stop burning – remove clothing
  • Cool skin (avoid direct ice)
  • Keep blisters intact
  • Apply antibiotic ointment
  • Refer as needed
34
Q

Wound care for first degree burns

A

NSAIDs

35
Q

Wound care for 2nd degree burns

A

Clean w/soap/water, debride dead tissue, apply ointment, cover w/gauze

36
Q

Wound care for 3rd degree burns

A

Cover and transfer to hospital

37
Q

Home care instructions for burns

A
  • Change bandage every day
  • Wash w/soap and water
  • Check for infection
  • Re-apply ointment
  • Return for infection or debridement
38
Q

Burns: When to admit to hospital

A
  • 2nd and 3rd degree burns w/ >10% BSA
  • Involves hands/feet, face, circumferential around joints, perineum
  • Associated injuries (inhalation, chemicals)
  • Concerns for abuse/neglect
39
Q

When to use tissue adhesives

A
  • Cyanoacrylate
  • Great for wound closures!
  • NOT for high tension areas (chin, fingers), highly contaminated wounds (bites), densely hairy areas (scalp)
40
Q

How to apply tissue adhesive

A
  • Position to avoid dripping!
  • Clean wound and dry before closure
  • Reduce tension on wound, pull together to approximate
  • 1-2 layers
  • No bandage, no ointment
  • *petroleum to create barrier to eye. Petroleum can also be used to remove if drips!
41
Q

Who gets nursemaid’s elbow?

A

Toddlers! Subluxed radial head

42
Q

Assessment for nursemaid’s elbow

A
  • Examine arm for swelling, crepitus, deformity
  • If not present –> reduce arm
  • Not in pain though may be apprehensive and guard arm
43
Q

Methods to reduce nursemaid’s elbow

A
  • Hyperpronation: position arm slightly extended, grasp elbow with one arm, grasp patient hand w/other, rotate to pronate hand until thumb pointing to floor
  • Supination/flexion: position arm at 90 degree angle, grasp elbow w/non-dominant hand, rotate palm up and flex at elbow
44
Q

Education w/nursemaid’s

A
  • At risk for repeats!
  • Don’t swing by hand!
45
Q

How to use slings and splints

A
  • Immobilize above and below injury (e.g., forearm injury – if you don’t immobilize elbow, can supinate and pronate)
  • Extra padding in pre-verbal kids
  • Leave fingers exposed for assessment of circulation
  • Immobile position should be functional
  • Close f/u!
46
Q

How to make a splint functional

A
  • Upper extremity needs to be elbow flexed, wrist extended, fingers flexed
  • Lower extremity: knee extended, ankle 90 degrees
47
Q

When to refer when requiring sling/splint

A
  • Angulation or deformity
  • Sensory changes or nerve injury (hours after injury)
  • Pain persists after 1 week

FALL15 N833 Adv Pedi Probs (10 decks)

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