Surface anatomy and clinical procedures Flashcards
What structure is penetrated when performing a surgical airway?
Cricothyroid membrane
When are surgical cricothyroidotomies indicated?
Failure to intubate-
“Can’t breathe, can’t ventilate” scenarios
Briefly describe how a cricothyroidotomy is performed
Horizontal stab on the palpated cricothyroid membrane. Use scapel to slightly increase the width of the incision. Use hook or dilator to widen the opening. Place the bougie into the opening and pass it down until hold up at the carina is achieved. Pass a six 6mm endotracheal tube over the bougie and then bougie is removed. If circumstances allow for it, local anaesthetic may be infiltrated down the front of each SCM. This process follows the seldinger technique
Describe two situations where you would perform a primary surgical airway rather than intubation
Burns patients
Patients with airway obstruction
What is the difference between a surgical airway and a tracheostomy ?
Tracheostomy is permanent
Tracheostomies are more distal than surgical airways- usually placed between the second and third tracheal rings
Describe three indications for the insertion of a pre-hospital subclavian catheter
1) If peripheral IV access isn’t possible, for example in patients who are severely hypovolaemic or in IVDU patients.
2) To administer vasoactive/inotropic drugs
3) If a patient is rapidly haemorrhaging and needs to receive a blood transfusion imminently.
Where should a subclavian catheter be inserted?
- Junction between the medial 1/3 and distal 2/3 of the clavicle .
- 1 cm below the clavicle
- Needle inserted almost parallel to the skins surface in the direction of the sternal notch
What is a major adverse event of SC catheter insertion? How can this be avoided?
Air embolus
To avoid, want to avoid upright position. Insert catheter whilst patient is flat with head down (air rises so less likely to enter vein)
What is the name of the technique used to insert a SC vein catheter?
Seldinger technique
List the sites that can be used for IO access
*Head of the humerus- feel for the greater tubercle (this is the surgical neck) and then feel 1 cm above this.
Distal femur- 3 cm above lateral condyle
*Proximal tibia- 1-2 cm medial to the tibial tuberosity
Distal tibia- 3 cm proximal to the medial malleolus
Sternum- specialised device needed
ASIS
What are the indications for IO access?
When vascular access is likely to be difficult or delay treatment in emergency situations . Often used in burns patients and with children
What structures form ‘the safe triangle’?
Superior- Base of the axilla
Medial- Pectoralis major
Inferior- 5th intercostal space
Lateral- Latissimus dorsi
What is the site for a thoracostomy?
In the safe triangle
4th/5th IC space, anterior to the mid-axillary line.
Go above rib to avoid NVB
Why would you not attach a urine bag to a chest drain in a patient who is being ventilated?
Closed circuit can result in a tension pneumothorax but can attach a bad to collect air if someone is spontaneously breathing
What layers are penetrated when a chest drain is inserted?
Skin, subcutaneous fascia, external IC muscle, internal IC muscle, innermost IC muscle, endothoracic fascia, parietal pleura
List some indications to perform a thoracostomy?
Tension and non tension pneumothorax, haemothorax, traumatic arrest, low output state with unknown cause
Where is a needle thoracotomy placed?
Mid clavicular line, 2nd intercostal space. Insert superior to the third rib to avoid damage to the NVB
