procedures

Question 1

TVP

Answer 1

• 7 Fr Cordis (has to match pacer wire size)
• partner: plug connecting cable into pacer box
• test equipment: test wire balloon and keep stopcock open
• wire prep: feed wire through sleeve so it comes out at the side that connects to the Cordis
• insert wire to 20 cm and inflate balloon
• partner: use adaptor pins to connect pacing wire to wire that connects to box (- to -, + to +) and turn on the pacer (HR 80, output 5 mA, sensitivity 0 so it works regardless of intrinsic rate)
• find the spot: advance wire while looking for pacer spike –> LBBB
• confirm mechanical capture: pulse ox waveform should match pacemaker (or can echo)
• partner: turn down output until you lose capture, then turn it up again
• drop balloon, lock stopcock, pull sleeve down onto Cordis/extend it

Question 2

TCP

Answer 2

• AP pads (air is a poor conductor, so get the pads around the heart)
• set HR 80, 80 mA and downtitrate current while looking for capture (pacer spike followed by QRST) –> set final current 5-10 mA above capture current
• confirm mechanical capture: pulse ox waveform should match pacemaker (or can echo)
• comfort: low-dose Fentanyl or ketamine

Question 3

2 situations to use a real chest tube instead of a pigtail, and what size

Answer 3

hemothorax and empyema - 24Fr

Question 4

pericardiocentesis: equipment and technique

Answer 4

equipment: central line needle (or 18g spinal needle), 20-30 cc syringe, prep, drape, gown/gloves, US w/probe

technique:

• always enter above RV and aspirate constantly until you get blood (5-10 cc is enough to help stroke volume)
• never go steeper than 45° (the heart is anterior - you’ll hit liver/stomach)
• SXY: enter parallel to probe and at a 45° angle toward L scapular tip
• PSL: enter in-plane to probe and at a 45° angle toward effusion
• confirm: flush saline under US guidance
• check for PTX

Question 5

tamponade: what to do

Answer 5

IV (good access), O2, monitor good access
EKG
bolus

Question 6

PTA needle aspiration: equipment and technique

Answer 6

equipment: light source, tongue blade, topical and local anesthesia, syringe, 18-gauge needle w/guard exposing 1 cm, suction
technique: go as medial as possible (carotid)

warn pt up to 10% recur

Question 7

inferior alveolar nerve block

Answer 7

ipsilateral mandibular teeth, lower lip, and chin

Question 8

infraorbital nerve block

Answer 8

lower eyelid to upper lip

Question 9

mental nerve block

Answer 9

ipsilateral lower lip and chin

Question 10

supraorbital nerve block

Answer 10

ipsilateral forehead/scalp

Question 11

posterior superior alveolar nerve block

Answer 11

ipsilateral maxillary molars