Week 10 (exam 3) Flashcards
What are some considerations for foreign bodies in ears
lift up on auricle to open canal better
What is the approach for removal of a foreign body in ears
best to use alligator forceps
flushing
dermaond (caution!)
lidocaine gel for bugs
refer to ENT
What are the methods of removal for ears
ear curette (lighted) for mechanical debridement
softening agents/mineral oils/hydrogen peroxide
irrigations
What do you do for a tympanic rupture
give antibiotics
- oral and topical
What are the most common objects used as softening agents for home for prevention
debrox and colace
Visual acuity is scored as a fraction, what do the first and second numbers mean?
first number: represents the testing distance between the chart and the patient
second number: represents the smallest row of letters that the patient’s eye can read
What are the indications for using a fluorescien stain/woods lamp for eyes
r/o foreign in the eye
r/o corneal abrasions, ulcers, or other minor trauma
r/o viral etiology for patient symptoms
fluorescein binds to damaged corneal epithelium and fluoresces green under a BLANK to light through a BLANK
wood’s lamp
cobalt-blue filter
What are the indications in non-ophthalmology for using a slit lamp for eyes
any acute condition that requires magnification to inspect the naterior segment of the eye
to facilitate ocular foreign body removal
What is another way to identify and remove other foreign bodies that may be present
evert the lid
Define lid eversion
use q-tip to “roll” eyelid and invert it to look for foreign bodies stuck to inside of upper lid
What can you use for foreign body removal in eyes
fine needle tip, eye spud, or eye burr
What can we used to anesthetize the cornea with a local anesthetic
proparacaine/tetricaine
What do you do if the foreign body is tightly adherent to o embedded in the cornea
STOP and send to opthalmalagy
What do you do first after anestehsia for foreign body removal in eyes
irrigate with normal saline first
What should be removed by an ophthalmologist
Full-thickness corneal foreign bodies
When a metallic foreign body is present for more than a few hours a what develops
rust ring develops around the metal
The presence of a BLANK evident in the anterior chamber on slit lamp examination suggests BLANK
gross hyphema or a microhyphema
globe perforation
Once the metallic foreign bod is removed what happens to the rust ring
rust ring area softens overnight and can be more easily removed in the office the next day
If a patient has a history of metal foreign bodies in the eye what do you want to do before an MRI
a skull x-ray
What are the causes of anterior epistaxis
anticoagulants, clotting disorders, trauma, dry air, recent colds, allergies, bad luck
What plexus is the target vasculature anteriorly
kesselbach’s plexus
Posterior epistaxis is usually seen in the BLANk
elderly with other comobordities
What pleuxus is often the origin of posterior epistaxis
woodruff plexus (splenopalatine artery)
What are the treatments for posterior epistaxis
balloon placement, arterial ligation, angiographic arterial embolization
What is the procedure for epistaxis treatment
- try to visualize the source of bleeding
- apply pressure to the anterior cartilage of the nose
- afrin nasal spray 2x/each nostril
- use a nasal tampon, foley catheter or other tampnade device (merocele)
- cautery
- rhino rocket or nasal packing
- if all this fails, call ENT
What are the methods for foreign body removal in the nose
mother’s kiss
alligator forceps
balloon catheters
ENT
What are the indications for oropharyngeal (mouth insert)
those at risk for airway obstruction by tongue or upper airway muscles
What are the indications for nasopharyngeal (conduit through nasopharyngeal pathway)
when opa is difficult or dangerous - can be conscious or unconscious
What are the indications for suctioning
secretion, blood, vomit obstructing airway
What are the complications for oropharyngeal (mouth insert)
may induce vomiting
if wrong size, may obstruct airway more
What are the complications for nasopharyngeal (conduit through nasopharyngeal pathway)
epistaxis, turbinate fracture, intracranial placement throigh a basilar skull fracture, retropharyngeal dissection or laceration
What are the complications for suctioning
hypoxia and tachycardia
- monitor vitals when doing this
What are the contraindications for oropharyngeal (mouth insert)
severe airway edema or trauma
NOT on anyone who is conscious/semiconscious or has gag reflex
What are the contraindications for nasopharyngeal (conduit through nasopharyngeal pathway)
severe airway edema or trauma
facial fractures
What are the contraindications for suctioning
severe airway edema or trauma
no more than 10 seconds at a time
What are the 2 airway devices
endotracheal tube intubation
laryngeal mask intubation
Define endotracheal tube intubation
tube constructed of polyvinyl chloride that is place between the vocal cords through the trachea
Define laryngeal mask intubation
keeps airway open during anesthesia or while they are unconscious
- supraglottic airway device
Name the different mallampati scores
class 1: complete visualization of the soft palate
- easy to intubate
class 2: complete visualization of the uvula
class 3: visualization of only the base of the uvula
class 4: soft palate is not visible at all
- hard to intubate
What is the size of the tube for adults
6.5-8 cm tube that is secured at the 21-23 cm at the lip
What do you give first and then second for intubation procedure
sedative first, then the paralytic
What are the common sedatives for the intubation procedure
etomidate, ketamine, and proprofol
What are the common paralytics for the intubation procedure
succinylcholine and rocuronium
How do you know if you are in the right spot for intubation
- you see the tube pass through the cords
- bilateral breath sounds and chest rise
- no gastric sounds
- end tidal calorimetry (checks for CO2)
- yellow means yes - pulse ox improves
- chest x-ray ALWAYS
- carina area
