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Rosh Review > Procedures & Skills > Flashcards

Procedures & Skills Flashcards

1
Q

What is most commonly responsible for causing misdiagnosis of pericardial effusion?

A

Anterior cardiac fat pad

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2
Q

What factors are likely to result in an underestimation of ocular pressure?

A
  • Ocular pressure > 30 mm Hg
  • Prior refractive surgery (thin cornea)
  • Corneal edema (thick, but soft cornea)
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3
Q

What factors are likely to result in an over estimation of ocular pressure?

A
  • Supine patients
  • Breath holding
  • Off-center measurement
  • Excessively depressing cornea with sensor
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4
Q

Side effect of benzocaine

A

methemoglobinemia

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5
Q

Equipment needed to perform needle cricothyrotomy

A

5mL syringe, 3.0 ETT adapter, 16G over-the-needle catheter

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6
Q

Four measures to reduce risk of developing post-LP headache?

A
  • Ensuring needle bevel parallel to dural fibers
  • Replacing stylet prior to removing needle
  • Small-diameter needles (22 gauge)
  • Atraumatic needles (Quincke or Whitacre)
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7
Q

Absolute contraindications to LP

A
  • Plt < 20,000
  • Coagulopathies
  • INR >/= 1.5
    (Can give platelets or clotting factors, reverse anticoagulation)
  • Lumbar trauma vertebrae
  • Infection at puncture site
  • Heparin administration in 24 hrs prior
  • Spinal or CNS lesion causing increased ICP
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8
Q

Maneuvers for reduction of nursemaid’s elbow (radial head subluxation)

A
  1. Supination technique
    - Hold elbow at 90 degrees with pressure at radial head
    - Firmly supinate child’s wrist and flex elbow directing wrist toward ipsilateral shoulder
  2. Hyperpronation
    - Hold elbow at 90 degrees
    - Firmly pronate wrist
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9
Q

Best transport solution for avulsed tooth

A

Hank’s solution - isotonic solutions with glucose and sodium bicarb (Milk is good alternative)

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10
Q

ED care of tooth avulsion

A
  • Temporary replantation
  • Tooth should be gently rinsed (not wiped)
  • Tooth should be handled by the crown
  • Dental socket carefully rinsed and suctioned
  • Tooth replanted gently and splinted with periodontal dressing material
  • Arrange dental follow-up for following day
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11
Q

Proper procedure for PTA aspiration/I&D

A
  • Premedicate with opioid + intramucosal anesthetic
  • Finger sweep to assess for fluctuance
  • Needle sheath should be used to control puncture depth
  • Aspiration undertaken in the soft palate at the point of maximal abscess fluctuance
  • Medial and superior aspiration are safer to avoid carotid artery (2.5 cm posterolateral to tonsil)
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12
Q

Contraindications for PTA needle aspiration

A
  • Severe trismus
  • Non-cooperative patient
  • Recurrent PTA (indication for tonsillectomy)
  • Evidence of deep neck tissue extension
  • Airway obstruction
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13
Q

At which location is the pediatric airway the narrowest?

A

Cricoid

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14
Q

Ways pediatric airway differs from adult airway

A
  • Proportionally smaller larynx that is more anterior and cephalad
  • Epiglottis is longer and narrower
  • Head, occiput, tongue proportionally larger
  • Neck is shorter
  • Adenoids larger
  • Risk of mainstem higher due to short trachea and bronchus
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15
Q

ETT depth equation

A

3 x tracheal tube size

OR age/2 + 12

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16
Q

Common adverse effects of massive transfusion

A
  • Thrombocytopenia
  • Hypocalcemia
  • Hypomagnesemia
  • Hypothermia
  • Metabolic acidosis
  • DIC
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17
Q

What four clinical variables are used to calculate the Assessment of Blood Consumption score to predict the need for massive transfusion?

A
  • Penetrating mechanism of injury
  • Positive FAST
  • SBP <90
  • HR >120
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18
Q

Differentiating between traumatic LP and SAH

A

Presence of xanthochromia is pathognomonic for SAH

Rate of clearance of RBCs from tube 1 to tube 4 was used, but no longer accurate

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19
Q

Contraindications for Tissue Adhesives

A
  • Wounds under tension
  • Complex stellate lesions
  • Wounds over joints
  • Wounds on mucosal surfaces
  • Wounds in hairy areas
  • Wounds requiring high level of precision
  • Bite wounds
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20
Q

Tissue adhesives are equivalent to what type of sutures?

A

5-0 Nylon

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21
Q

How long do tissue adhesives typically remain on the wound?

A

5-10 days

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22
Q

What vein is most preferable to access during a peripheral venous cutdown in children?

A

Saphenous vein - distal at the medial ankle where it crosses 1cm anteriorly to the medial malleolus

23
Q

After what period of time does the incidence of infection rise dramatically following insertion of a peripheral catheter?

A

After about 48 hours

24
Q

If saphenous nerve damaged during cutdown, what type of deficit will be felt?

A

Small area along medial aspect of foot with sensory loss

25
Q

What is a marker of a successful procedure after performing lateral canthotomy and cantholysis?

A
  • Resolution of a previously detected afferent pupillary defect (pupil exhibits consensual, but not ipsilateral pupillary response to a light stimulus)
  • Improved visual acuity
  • Decrease in IOP to <40 mm Hg
26
Q

Primary indications for lateral canthotomy

A
  • Decreased visual acuity
  • IOP > 40 mm Hg
  • Proptosis
27
Q

Secondary indications for lateral canthotomy and cantholysis

A
  • Afferent pupillary defect
  • Cherry red macula
  • Ophthalmoplegia
  • Nerve head pallor
  • Eye pain
28
Q

Contraindication to lateral canthotomy

A

Suspected globe rupture

29
Q

DOPES mnemonic for hypoxia in ventilated patients

A

D-displacement -> verify tube with end-tidal CO2
O-obstruction -> suction
P-PTX -> CXR/US
E-equipment -> disconnect ventilator, administer breaths through BVM
S-stacked breaths -> disconnect ventilator

30
Q

Testicular detorsion technique

A

Medial to lateral rotation of 360 degrees or more

31
Q

In which space should a thoracentesis be performed?

A

Greater than or equal to 1 intercostal space below the top of the effusion in the midscapular or posterior axillary line

No needle insertion below 8th intercostal space

32
Q

Fascia Iliaca Block procedure step by step

A
  1. Patient in supine position
  2. A line drown b/n ASIS and pubic tubercle and divided into thirds
  3. At border b/n lateral and medial thirds, perpendicular line 2cm in length drawn caudally
  4. Blunt needle inserted and directed cephalad - target is area just beneath fascia iliaca
  5. Local anesthetic injected when operator appreciates two distinct “pops”
33
Q

Indications for fascia iliaca block

A

Proximal femur fracture

34
Q

Between which two muscles does the fascia iliaca block occur?

A

Iliacus and sartorius muscles

35
Q

Where is the accurate location to make incisions for escharotomy?

A

Bilateral anterior axillary lines from the clavicles to the lower costal margin through the eschar down to the subcutaneous fat and extend proximally and distally beyond the borders of the eschar. Two incisions should then be connected by one or more transverse incisions

36
Q

What agents can be used to emulsify or dissolve adherent tar from skin?

A

Topical antibiotic creams (not ointments) with polyoethylene sorbitan

37
Q

Indications for nail trephination in subungual hematoma

A
  • Less than 48 hours old
  • Not spontaneously draining
  • Blood trapped under nail with intact nail folds
  • Painful

Post-procedure care: keep clean and dry for 2 days

38
Q

How should a paracentesis be performed in second- and third-trimester pregnant patients?

A

Open supraumbilical or US-guided approach

39
Q

How many weeks are required for maturation of the cystostomy tract after a new suprapubic catheter is placed, limiting replacement of an accidentally removed catheter?

A

Six weeks

40
Q

Inaccurate diagnostic studies from IO

A
  • WBC
  • Potassium
  • Ionized Ca
  • AST, ALT
  • Blood oxygenation
41
Q

Absolute contraindications to IO

A
  • Fractured bone or previously penetrated

- Vascular interruption

42
Q

Why should patients with posterior nasal packs be admitted to a monitored bed?

A

Posterior packing can cause vagal stimulation with resulting bradycardia and bronchoconstriction

43
Q

Dental fractures that expose dentin, what should be applied over the site?

A

Calcium hydroxide

44
Q

Drugs that can be delivered via ETT (adults)

A 
NAVEL
Naloxone
Atropine
Vasopressin
Epinephrine
Lidocaine
45
Q

Drugs that can be delivered via ETT (peds)

A 
LANE
Lidocaine
Atropine
Naloxone
Epinephrine
46
Q

Where is incision made for venous cutdown of greater saphenous vein in ankle?

A

Anterior and superior to medial malleolus

47
Q

What nerve runs with the saphenous vein, and if transected, what are the effects?

A

Saphenous nerve; sensory loss in a small area along medial aspect of the foot

48
Q

Indications for ED Thoracotomy

A

Penetrating traumatic cardiac arrest:

  • Cardiac arrest at any point with initial vital signs in the field
  • BP <50 mm Hg systolic after fluid resuscitation
  • Cardiac arrest in the ED

Blunt trauma:
- Cardiac arrest in the ED

Other:
- Suspect air embolism

49
Q

Which nerve is at risk of being severed during an ED thoracotomy?

A

Phrenic nerve

50
Q

Accurate studies from IO line

A
  • Hgb
  • pH, pCO2, serum bicarb
  • Cl, BUN, Cr, glucose
  • Serum drug levels
  • Cultures
51
Q

Inaccurate studies from IO line

A
  • WBC
  • Potassium
  • Ionized Ca
  • AST, ALT
  • Blood oxygenation
52
Q

Signs that confirm accurate placement of IO line

A
  • Aspiration of bone marrow
  • Fluid infuses without extrav
  • Needle stands alone without support
53
Q

Which medication may take 20-30 seconds longer to take effect when delivered through IO line than through peripheral IV?

A

Succinylcholine

Rosh Review (22 decks)

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