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Session 8: clinical procedures and surface anatomy of the trunk > Procedures > Flashcards

Procedures Flashcards

1
Q

Describe the process for a cricothyroidotomy (surgical airway)

A
  1. Stab cricothryoid membrane (between thyroid and cricoid cartilage) with scalpel
  2. Keep scalpel in the membrane
  3. Use hook or dilators to dilate the incision
  4. Insert bougie (be mindful that it needs to only go a short way)
  5. Insert endotracheal tube
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2
Q

What are the indications for cricothyroidotomy?

A

PRIMARY INDICATIONS

  • burns of airway (closes airway)
  • difficulty getting to airway (pt trapped under rubble)

SECONDARY INDICATIONS
- failed intubation

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3
Q

What is the difference between cricothryoidotomy and tracheotomy?

A

Tracheotomy is lower, in the anterior wall of trachea.
Longer term solution for airway management
More complicated - large veins and part of thyroid gland overlies

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4
Q

What are the layers of the neck?

A
  • Skin
  • Connective tissue
  • Small blood vessels
  • Cricothyroid membrane
  • Cricovocal membrane (membranes form cricothyroid ligament)
  • Larynx
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5
Q

How is a subclavian vein line inserted?

A
  • Head down position
  • junction between medial 1/3 and middle 1/3 of clavicle
  • 1cm below clavicle
  • in direction of sternal notch
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6
Q

Why do you need a head down position for a subclavian vein line?

A

To avoid giving an air embolus -> death

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7
Q

What are the indications for a subclavian vein line?

A
  • peripherally shut down
  • IVDU
  • need drugs centrally
  • to give blood, fat
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8
Q

What are the steps for the seldinger technique?

A
  1. needle + syringe
  2. guide wire
  3. take off needle
  4. guidewire + scalpel
  5. catheter
  6. remove wire

WATCH A VID

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9
Q

Where can you insert an intraosseous needle?

A
    1. Proximal humerus: head of humerus
    1. Proximal tibia: tibial tuberosity -> medial and 2cm below
      1. Distal femur: medial to lateral femoral condyle
      2. Distal tibia: 3cm proximal to medial malleolus
      3. Pelvis: iliac crest (anterior superior iliac spine)
      4. Sternum
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10
Q

What are the indications for intraosseous insertion?

A

Fast access
If can’t get IV access
Often in children who have arrested
Burns patients

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11
Q

What is the surface landmark for a thoracostomy?

A

4th* or 5th intercostal space mid-axillary line

safe triangle

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12
Q

What are the boundaries of the safe triangle?

A
  • Apex below axilla
  • lateral edge of pectoris major
  • lateral edge/anterior border of latissimus dorsi
  • 5th intercostal space
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13
Q

How do you ventilate with thoracostomy?

A

Positive pressure ventilation - managed with RSI or surgical airway

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14
Q

What are the layers you would pass when doing a thoracostomy?

A 
Skin
Subcutaneous fat
Superficial fascia
External intercostal muscles
Internal intercostal muscles
Innermost intercostal muscles
Parietal pleura
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15
Q

What are the indications for a thoracostomy?

A

Pneumothorax
Haemothorax
Traumatic arrest

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16
Q

Where does the neurovascular bundle lie in relation to the rib? Why is this important?

A

Inferior to the ribs therefore when make an incision, needs to be on the superior surface of a rib

17
Q

Where would you place a chest drain and when would this be appropriate?

A

Same place as thoracostomy: 4/5th ICS MAL

Someone who is spontaneously breathing
Urine bag or bucket of water attached

18
Q

What are the surface landmarks for a needle thoracocentesis? What is the indication?

A

2nd intercostal space, mid-clavicular line

Decompression of tension pneumothorax

19
Q

What are the indications for a thoracotomy? How is it done?

A
  • Penetrating trauma to the chest
  • Cardiac tamponade (take clot out then massage heart if needed)

Join up thoracostomy incisions with ‘swallow’ incision

20
Q

Which structures are often damaged in a thoracotomy?

A

Internal thoracic arteries -> supply anterior chest wall and breasts

Supplies anterior intercostal artery branches for ICS 1-6

21
Q

What are the internal thoracic arteries a branch of?

A

Subclavian artery

22
Q

Describe diagnostic peritoneal lavage

A
  1. make an incision 2cm inferior to umbilicus in midline
  2. Cut through linea albea -> enter peritoneum
  3. Insert catheter - insert saline into peritoneal cavity then move bag to side of patient -> force of gravity forces fluid out: check colour, ?blood, microscopic testing?
23
Q

When would you do diagnostic peritoneal lavage?

A

To determine if there is free floating fluid (most often blood) in the abdominal cavity

24
Q

What are the two different techniques used for DPL?

A

Open (mini - laparotomy)

Closed (seldigner technique)

25
Q

What is the surface landmark for femoral artery?

A

Midway between the anterior superior iliac spine and pubic symphysis = mid-inguinal point

  • seldinger technique
  • or cut down technique (rare) also used in great saphenous vein
26
Q

What is the nerve supply to the costal parietal pleura?

A

Branches of intercostal nerves (pain in the thoracic wall)

27
Q

What is the nerve supply to the diaphragmatic and mediastinal part of the parietal pleura?

A 
Phrenic nerve (C3,4,5)
Pain refers to dermatomes of lateral neck and supraclavicular region of shoulder
28
Q

What are the surface landmarks for the parietal pleura?

A

Superior: 3-4cm above first costal cartilage, does not extend above rib I

MAL: rib 10
MCL: rib 8
Vertebral level: T12

29
Q

What are the surface landmarks for the visceral pleura?

A

MAL: rib 8
MCL: rib 6
Vertebral level: T10

30
Q

What is a flail segment?

A

2 or more ribs broken in 2 or more places

31
Q

What are the surface landmarks for ECG lesds?

A 
V1: 4th ICS R sternal edge
V2: 4th ICS L sternal edge
V3: between V2 + V3
V4: 5th ICS MCL (left)
V5: between V4 + V6, 5th ICS (left)
V6: 5th ICS MAL (left)

RA: red
LA: yellow
RL: green
LL: black

32
Q

Which ECG leads would show an inferior infarct?

A

II, III, aVF

33
Q

Which ECG leads would show a lateral infarct?

A

I, aVL, V5, V6

34
Q

Which ECG leads would show an anterior infarct?

A

V1-V4

35
Q

What is the location for internal jugular vein venepuncture?

A
  • Between 2 heads of sternocleidomastoid

- lateral to common carotid artery

36
Q

Why is the safe triangle safe?

A

Perforation to internal organs is rare

37
Q

What structures might be damaged nearby to the safe triangle?

A

Lung, muscle, neurovascular bundle

38
Q

What is the safe triangle used for?

A

Locating incision for thoracosotomy/thoracotomy/chest drain insertion

39
Q

Where is the incision line for a midline laparotomy?

A

Vertical midline incision from xiphoid process -> umbilicus -> pubic symphysis

Session 8: clinical procedures and surface anatomy of the trunk (1 decks)

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