Reading material Flashcards
What is the order in which the blood tubes should be filled?
- Blood culture
- Tube withOUT additives (red tubes)
- Tubes WITH additives
What are red tubes used for?
Chemistries, amylase, Igs
What are blue tops used for?
PT
PTT
INR
What are green tops used for?
Ammonia
CPK isozymes
What are purple top tubes used for?
CBC
ABO types
What are gray top tubes used for?
Ethanol
What are pink top tubes used for?
Cross matching
Which colored tube does not have any additives?
Red
True or false: you should not draw blood on the side of the body that a mastectomy was performed
True
True or false: when drawing blood on the side of an arm with an IV in place, you should draw above the IV site
False– I don’t know why though
What should you never do after cleaning a venipuncture site?
touch it
True or false: you should gently invert or shake the tubes of blood in a blood draw
False– NEVER shake. But the inverting bit is a good idea
What are the landmarks that should be palpated before doing a cricoidotomy?
Thyroid and cricoid cartilage (between them in the cricothyroid ligament)
What direction should the needle face when performing a needle cricoidotomy? When should you stop advancing the needle?
45 degrees inferiorly
Stop when air is aspirated into the syringe
How long can adequate ventilation be achieved with a needle cricothyroidotomy?
30-45 minutes
What is the age cutoff (lower bound) for surgical cricothyroidotomy?
12 yo
Central line placement for the IJV is on what side of the body? Subclavian?
IJV = right side Subclavian = left side
What are the landmarks used for placing a central line into the subclavian? How should the hands be placed? How should the needle be inserted?
Thumb on the sternal notch
Index finger on the intersection between the clavicle and the first rib. Insert needle lateral to the thumb, and beneath the clavicle.
What are the landmarks used for central line placement in the IJV?
Between the two heads of the SCM
What way should the tip of the J wire be inserted in an IJV central line?
Toward the heart
What must be monitored with a IJV central line placement? Why?
EKG for arrhythmias
What is the minimal amount of blood that can be seen on a CXR for a hemothorax?
300-500 ml
What should you do if draining more than 1500 ml of blood from a chest tube?
Get to OR for thoracotomy to control bleeding
What are the ribs that are used for landmarks for a chest tube placement with a pneumothorax? Where?
3 4 or 5 intercostal space along the anterior axillary line
Which intercostal spaces are used for chest tube placement with a hemothorax?
3 4 or 5 along the posterior or midaxillary line
What is the position the pt should be placed in for a chest tube placement?
arm over head
What is the area relative to the rib where you should place the chest tube?
On top of the lower rib in the intercostal space to prevent hitting the intercostal arteries/nerves that lie below the ribs
What is the tool used to make the puncture for a chest tube?
Hemostat (after making an incision with a scalpel)
Which way should a chest tube be inserted toward for a hemothorax? Pneumothorax?
Hemo = down Pneumo = up
Widening of the mediastinum following a chest tube placement may indicate what?
Thoracic aorta dissection
What is tidaling with chest tube placement?
Movement of the ball in the pleurivac
True or false: except for checking for leaks, a chest tube should never be clamped off
True
What should be done with a pneumo and hemothorax concurrently?
Chtes tubes place anterior and posterolaterally
What indicated that a chest tube was successful?
No more tidaling
What is a laproscopic surgery?
Small tools + CO2 inflated peritoneum
What are the spaces that an LP should be performed at?
L4-L5
Which way should the needle be driven in a LP?
toward the naval
What is the only position in which you are able to get an opening pressure with a LP?
Lateral recumbent
Why should you never introduce negative pressure with a LP?
will cause hemorrhage
What are the first three tubes that are used in the collection of CSF (in order)?
- cell count and differential
- Gram stain cultures
- Glucose, protein,
What happens if you get a bloody tap?
May have hit the venous plexus, which will stop after you draw more
Name the mallampati score: clear visualization of the faucial pillar, soft palate, and uvula
I
Name the mallampati score: The uvula is masked by the tongue, but o/w clear visualization of the facial pillars and soft palate
II
Name the mallampati score: Only the soft palate is visualized
III
Name the mallampati score: Only the hard palate is visualized
IV
Why should you not rock the laryngoscope?
Will break teeth
Is it every okay to let go of the ET tube?
No
Each time the patient is moved with a ETT in, what is the chance that it will dislodge?
10-15%
What is the Selleck manuver?
Applying pressure to the cricoid cartilage during an intubation
Should you try to intubate through a glottis that is closed d/t a laryngeal spasm?
Never
What are the four regions assessed during a FAST exam?
- Pericardial (Pericardial effusion)
- RUQ (spleen)
- LUQ (kidneys)
- Pelvic (pouch of douglas)
Hyperechoic appears what color on the screen? Hypoechoic?
Hyper = white Hypo = black
What does red flow indicate? Blue?
Red = toward you Blue = away from you
What is the size of the urinary catheter that should be used for adults? What if they have gross hematuria?
16-18 french
22-24 for patients with gross hematuria
What is the only absolute contraindication for urinary catheterization?
Trauma to the urethra (e.g. pelvic fracture)
When are triple lumen catheters used?
For patients with clots or obstruction
What way should the penis be held when doing a cath?
Perpendicular to the body
What should you do prior to inflating the foley cath balloon?
Check for urine return
Name two relative contraindications for urethral catheterization (3 are given)
Urethral stricture
Recent urethral/bladder surgery
Combative patient
Name two contraindications to performing an LP.
Cardiorespiratory compromise Cerebral herniation Focal neurological signs Bleeding diathesis Previous lumbar surgery
What gauge needle is usually used for an LP?
20-22
What should you do first if there is no flow from an LP?
Rotate the needle 90 degrees, since a nerve rootlet may be obstructing the flow
What should you do if there is blood in an LP needle?
get a new needle and enter a new interspace, since you do not want it to clog
Over what mmH2O is concerning in a spinal tap
20
Why should you never aspirate a LP?
May cause a herniation
What is the size of the triple lumen catheter that should be used for central lines? What about for fluid resuscitation?
7 french
11.5 if resuscitation
What are the contraindications to tracheal intubation?
Trauma Burns Tumor Edema Infection
What does gauge measure? What does a high gauge needle mean?
Measures the diameter of a needle.
Larger gauge means smaller needle size
What does bore size indicate?
size of the lumen (inside diameter)
What are the three layers of a vessel, and what is the important part of each?
Outer layer = tunica adventitia (supporting vasculature)
Middle layer = tunica media (muscular layer)
Inner layer = tunica intima (elastic layer)
How often should peripheral IV catheters be changed?
every 72 hours
When is it appropriate to give D5W to a patient IV?
Never– will raise glucose levels too fast, and cause osmotic diuresis
What type of fluids do you want to use when replacing volume: hypotonic, isotonic, or hypertonic
isotonic
What are the electrolyte concentrations in NS? pH?
154 Na and Cl
pH is 4-5
What are the electrolyte concentrations in LR? pH?
130 Na
110 Cl
4 K
100 H2O
7ish pH
What are the electrolyte concentrations in D5W? D10W?
D5 = 50 gm glucose D10 = 100 gm glucose
both have 1000 ml of water
What are the electrolyte concentrations in 3% NS?
513 Na
513 Cl
What is the rule for choosing an IV rate per hour?
4 ml/kg for first 10 kg
2 ml/kg for next 10 kg
1 ml/kg for each kg thereafter
What is the angle of the injection that should be done with SQ administration of a drug? IM?
SQ = 45 degrees IM = 90 degrees
What are the sites of injection of IM meds?
Anterior/posterior forearms, tricep area, chest, or shoulder blade area
What is the preferred site of injection for heparin?
Lower abdominal fat pad, beneath the umbilicus
Under what age should the dorsogluteal muscle not be used?
3 years of age
When injecting into the gluteal area, how do you ensure that you are in the correct area?
Place hand so that the 2nd finger is on the ASIS, and spread your fingers. Inject between the space formed by digits 2 and 3.
What is meant by the “Z” track injection?
Pulling the skin back when injecting, thus creating a non-linear path for blood to flow out when the needle is removed and the skin released
What are the indications for an NG tube? Contraindications?
Acute gastric dilatation/distention
Gastric outlet obstruction
Ileus
Contraindications:
- recent esophageal surgery
- absence of gag reflex
- facial or nasal trauma
True or false: esophageal varices are a contraindication to placing an NG tube
False
What are the indications for a needle cricothyroidotomy?
Complete airway obstruction
Trauma to the face
What are the two complications of a needle or surgical cricothyroidotomy?
Asphyxia
Aspiration
What are the two contraindications to a surgical cricothyroidotomy?
Children under 12
There is a less radical means of establishing an airway
What are the indications for a central line placement?
TPN
Long term infusion of drugs
What are the contraindications for a central line placement?
Morbidly obese
Infection over insertion site
Pneumo/hemothorax on the ipsilateral side
What are the two pre-procedure bits prior to doing a central line placement?
Consent and timeout
What is the position the patient should be placed in for a central line placement?
Trendelenburg
What gauge needle should be used when performing a subclavian or IJV central line placement?
18
In what order should the scalpel, dilator, J wire, 18 gauge needle, and catheter be introduced in a central line placement?
Needle/catheter J wire scalpel dilator Central catheter
What should you do after placing a central line?
Check all ports for blood return
What size tube should be used for pneumothorax in a child/adult? Hemo?
Pneumo: 22ish or 11ish
Hemo: 22 ish or 15ish
True or false: when suturing, you should always select the smallest diameter suture that can adequately hold the tissue edges together.
true
What size of suture should be used for regular skin closures?
3-0, 4-0, or 5-0
What size of suture should be used for skin closure on the face?
5-0 or 6-0
What size of suture should be used on abdominal fascia closure?
2 or 0
What are the two types of points to a suture needle?
taper point
Cutting point
What is a #10 blade used for? #11? #12? #15? #20?
#10 - large incisions #11 - stabs #12 - ENT/GYN #15 - small incision #20 -Digit amputations
What is the universal size for catheters?
16 french
When do indwelling catheters need to be changed?
Every 72 hours
What should you note in the medical record for a urine cath placement? (6)
Indication Size/type Fluid injected Urine output Your name Complications
What drug needs to be in the syringe when doing an ABG?
heparin
What are the pertinent findings in an ABG? (6)
pH PaCO2 PaO2 HCO3 O2 BE
Are you oxygenating the patient, or ventilating them when performing a cricothyrotomy?
Oxygenating them
In a needle cricothyroidotomy, what type of needle should be used?
12 or #14
In a needle cricothyroidotomy, how many seconds do you oxygenate the patient by the tubing?
Occlude 1 second and release for 4
How long can chest tubes stay in?
24-48 hours
How can you check for air leaks in a chest tube?
Look at water seal chamber and if bubbles present = air leak
When do you see tidaling with a chest tube placement?
When pleuravac is taken off suction; fluid in chamber should move with respiration and ventilation
When should you obtain x-rays with a chest tube placement?
Beforehand, after insertion, serial during stay, and after pull out
What is the purpose of undermining tissue?
Undermining = separation of superficial tissues (epidermis/dermis) from deeper tissues (SC tissue) in order to achieve better tissue approximation during suturing
What is the most common cause of post-op fever? treatment?
Atelectasis
Spirometry
What are the 5 W’s of post surgical infection?
Wind (atelectasis) Water (UTIs) Walking (DVTs) Wounds (duh) Wonder drugs (rxn)
What is the daily requirement for K?
40-100 mEq
