Procedures

Question 1

Biers block

Answer 1

ECG, BP, Sats 
Cuff check 5 mins
IV access x2
Elevate arm 3min
Inflate cuff 100mmHg over sBP
— max 300 (red=distal)
Absent radial pulse?
Inject 3mg/kg prilocaine 
Remove cannula (~5min)
Inflate distal cuff (~8min)
Reduce and POP
Check XR
Cuff on; 20-45min
Monitor; 5,10,15,30 mins

Question 2

Indications

Finger thoracostomy

Answer 2

1) Tension PNX
2) Haemothorax
3) Unexplained hypotension/ hypoxia in chest wall injury
4) Cardiac arrest secondary to trauma
(Bilateral decompression)
?Traumatic PNX in I+V patient esp air transfer

Question 3

Equipment

Surgical chest drain

Answer 3

Sterile gloves 
Gown 
2% chlorhexadine 
Gauze 
Large Scalpel (size 22)
Spencer Wells forceps (8”)
Chest drain 28-32Fr
Underwater seal
Suture 2-0 silk
Tegaderm, gauze

Question 4

Procedure

Thoracostomy

Answer 4

Oxygen
Sats, BP, ECG +\- CO2
Ketamine 0.5mg/kg
\+\- midazolam 1-2mg
Position, clean 
4/5th IC space 
Lidocaine 3mg/kg
3-4cm incision 
Blunt dissect (vertical 1st)
Finger sweep

Question 5

Procedure

Insertion chest drain

Answer 5

Thoracostomy 
28/24/20Fr patient 
Spencer Wells 
Finger guide tube 
Clamp or bend end of tube 
Connect underwater seal
Swing/bubble? 
Secure: 2-0 silk
Y cut gauze 
Tegaderm x2 +1
CXR

Question 6

Procedure

Landmark Fascia iliaca block

Answer 6

Confirm XR and side 
INR<1.5, Plt>100
Sats, ECG, BP
Lateral 1/3 ASIS to PT
— 1cm inferior 
Pulse (2cm medial) 
Clean skin
2 pops
- fascia Lata then iliaca 
Inject LA 
Monitor pain and obs;
- 5,10,15,30 mins

Question 7

Procedure

US guided fascia iliaca

Answer 7

Check XR and side 
Linear or curvilinear on nerve setting
Scan transverse over inguinal crease 
Femoral artery 
Scan Lateral to identify
- iliacus, fascia iliaca and lata 
In plane approach
Inject under fascia iliaca

Question 8

Procedure

US femoral nerve block

Answer 8

Check XR and side 
Linear or curvilinear on nerve setting
Scan transverse over inguinal crease 
Femoral artery 
Lateral is femoral nerve 
In plane approach 10ml around nerve

Question 9

Procedure

POP

Answer 9

Stockinette
Padding (webril)
8-4 layer POP
Fold webril over POP
Broad gauze bandage 
Hold position for ~5min 
Neuro vascular status

Question 10

Procedure

Sedation (stable pt)

Answer 10

Anaesthetics Hx
Cannula
SPEEDBOMB
Sats, BP, ECG, CO2

(Fentanyl 0.5-2mg/kg)
Propofol
>75y: 0.5mg/kg
Adult: 1mg/kg

Advice leaflet

Question 11

Procedure

Sedation (unstable)

Answer 11

Anaesthetics Hx
Cannula
Oxygen
Sats, BP, ECG, CO2

Ketamine
IV 0.5-1mg/kg
IM 2-4mg/kg

Advice leaflet; emergence, hypersal

Question 12

Procedure

FAST scan

Answer 12

RUQ
- coronal plane, mid axilla
- 11/12 rib 
- Morrison’s pouch 
LUQ
- slightly superior 
- splenorenal pouch
Suprapubic
- transverse and long
Cardiac
- subxiphoid, transverse

Question 13

Procedure

AAA scan

Answer 13

Transverse x3
Less than 3 cm
Longitudinal

Question 14

Procedure

Ketamine sedation Child

Answer 14

Hx and Exam
Anaesthetic Hx
- previous, last ate, reflux
Airway exam 
- LEMON
Consent
Checklist, (+speedbomb)
Environment; dark/quiet
Ketamine; 
- 1mg/kg +\- 0.5mg per kg
- max 2mg/kg (RSI dose)

Question 15

Consent form

Ketamine sedation

Answer 15

Failure procedure
Emergence phenomena
Respiratory depression
(Inc Aspiration, intubation)
Allergy

Question 16

Process

Seldinger chest drain

Answer 16

Consent, Position
Clean, Drape
Landmark
1% lidocaine (3mg/kg)
Introducer needle - aspirate 
Wire, Scalpel
Dilator 1-2x
Intercostal drain
Connect to bucket
Tie and secure in place 
CXR

Question 17

Aspiration primary spontaneous PNX

Answer 17

Clean
1% lidocaine
2nd intercostal space midclavicular line
16G IV canula (Grey)
Aspirate up to 2.5L or until +++coughing
Via 50ml syringe and 3way tap

Alternative
Safe triangle 4/5th intercostal space