Peer 9 - procedures Flashcards
Indications for thoracentesis?
relief of dyspnea associated with large effusion, suspected pleural space infection, new effusion without a clear clinical diagnosis
treatment of unstable tachyarrythmias
synchronized cardioversion
treatment of unstable bradyarrhythmias
transcutaneous/transvenous pacing
most reliable way to confirm ET tube intubation
end tidal capnography
men and postmenopausal women should receive what blood type?
O+
women of child bearing years should receive what blood type transfusion?
O-
indications for NG tube?
stomach herniation, gastric decompression, medication/contrast in intractable vomiting, monitor upper GI bleed
contraindications to NG tube?
alkali injury/corrosive ingestion, basical skull fx or midface injury, coag, esophageal strictures, gastric bypass/lap band surgery
indications for pacing?
AV block or sinus node dysfunction, or other arrhythmias such as torsades that would benefit –> not used in hypothermic patients
tx of subungual hematoma occupying more than 50% of nail plate?
trephination
when do you do nail plate removal instead of trephination?
nail avulsion or disruption of the nail fold
size of ETT for neonates?
2.5 uncuffed if premature, 3.0 uncuffed if not premature
when do you perform perimortem cesarean delivery?
maternal cardiac arrest at greater than 24 weeks’ gestation
mother and neonate survive more likely when delivery is performed in what time span?
less than 5 minutes
how big and where is the incision for perimortem c delivery?
vertically from pubic symphysis to the umbilicus
when do you consider lateral canthotomy?
retrobulbar hemorrhage with intraocular pressure higher than 40 mm Hg
best incision for thrombosed hemorrhoid for minimal complications?
elliptical incision
contraindications to video or fiberoptic laryngoscopy?
airway containing blood or vomit
ester local anesthetics? more likely to produce allergies
Can’t Treat Pain with Esters
Can’t - cocaine
Treat - tetracaine
Pain - Procaine/ chloroprocaine
amide local anesthetics?
two i’s in their name
bupivacaine
lidocaine
prilocaine etc
structure mos tlikely injured if peritonsillar abscess drainage is too far posterior and lateral?q
carotid artery
steps to trouble shoot urinary retention caused by suspected urethral obstruction
- attempt 14 Fr Foley cath
- attempt to pass a coude cath
- consider requesting a urology consultation
- attempt suprapubic tube placement
preferred med for shoulder dislocation with hypotension for procedural sedation?
fentanyl - minimal effect on BP, provides analgesia and sedation –> also reversible agent
best closure technique with greatest tensile strength in a wound located over a joint
sutures
volume of contrast injected into adult bladder in cystourethrogram?
400 ml
in trauma always get ____ before getting cytogram?
retrograde urethrogram
preferred access sites for placing a transvenous pacemaker?
right IJ and left subclavian vein
absolute contraindication to transvenous pacing?
prosthetic tricuspid valve
steps for controlling nosebleeds?
nasal pressure
cautery
nasal packing
- otherwise assume posterior and call ENT
contraindications to NIV
absent or agonal resp effort AMS life threatening epistaxis max/face trauma basical skull fx severe hypotension vomiting
contraindications to IO line insertion?
fx of same bone previous IO attempt on same bone IVC injury osteogenesis imperfecta osteopetrosis overlying cellulitis
contraindications to gastric lavage?
unprotected airway hydrocarbon ingestion corrosive ingestion FB ingestion bleeding diathesis known esophageal strictures history of gastric bypass small children
findings with concern for compartment syndrome?
five Ps
pain with passive extension paresthesias paresis/paralysis pallor pulselessness
first step of g tube dysfunction/clogging?
milking the proximal portion of the tube
conus medullaris ends at which vertebrae in infants?
L2-L3
conus medullaris ends at which vertebrae in adult?
L1-L2
structure of concern when doing a left sided thoracotomy?
phrenic nerve
