Deck 1

Question 1

Contraindications for Plebotomy

Answer 1

Cellulitis
Trauma 
Burns
Radical Mastectomy on that side
AV Fistula
Hematoma
That arm already has an IV

Question 2

Phlebotomy vs Venipuncture

Answer 2

Plebotomy is the process of making an incision in a vein with a needle. The procedure itself is known as Venipuncture.

Question 3

Complications of Venipuncture

Answer 3

Cellulits
Plebitis
Thrombosis
Laceration of nearby Artery
Hemorrhage or Hematoma
Syncope (at the sight/thought of blood)

Question 4

Phlebitis

Answer 4

Infection of a vein

Question 5

Blue Cap Contains/Used For/Fill Vial?

Answer 5

Blue Cap:

Contains Citrate
Used for Coag Studies: PT/PTT/INR/D-Dimer/Fibrinogen
FILL the vial

Question 6

Blue CAP

Answer 6

COAGULATION STUDIES! Fill The Vial

Question 7

Red Cap Contains/Used For/Fill Vial?

SST: Serum Separator Vial

Answer 7

Bacteriology/Viral Testing
BMP, CMP Fill the Vial

For: Vitamin D, Insulin, C-Peptide, Se, Zn, Androgens

Question 8

Gold Top

SST: Serum Separator Vial

Answer 8

FOR: IRON STUDIES!! Aldosterone, B12, Ferritin, Folate, Downs Syndrome Screening, Blood Chemistries not requiring other tubes ( Zn and Se go in a Red Top…)

Question 9

Green Cap (Heparins)

Answer 9

Hemoglobins: Carboxy Hb, Meth Hb, Cytogenics

Question 10

Purple Top (EDTA)

Answer 10

Full Blood Count (CBC)
A1c
Malaria + Sickle Cell
Electrophoresis

Question 11

These tests require a purple cap tube and each one requires its own vial and blood needs to be sent to the lab asap:

Answer 11

Tacrolimus
ESR
Lead Testing
Chromosomes
Renin and a bunch more.

Question 12

Tacrolimus

Answer 12

Immunosuppressant.

Blood levels are used to guide minimum dose needed to suppress immune function so as to minimize side effects.

Question 13

Pink Cap

Answer 13

Cross Match

This Tube must have FOUR patient IDENTIFIERS and be SIGED

Question 14

Grey Cap

Answer 14

Blood Glucose
Lactate
Ethanol

Question 15

Blood stops flowing during venipuncture

Answer 15

Vein Collapsed.

Withdraw catheter and get another vein

Question 16

Can you perform venipuncture on an artery?

Answer 16

Never

You can get arterial gases and arterial testing but these require different equipment.

Question 17

Catheterization Indications

Answer 17

Output measurement (always with IV therapy)

To obtain a sterile urine sample (instead of a clean catch - this would not necessarily be a Foley, could use a strait cath for this)

Imaging of the urinary tract (running in dye/isotopes to be followed by Xray/CT)

Bladder Irrigation (w/saline or meds ex: Amphotericin B irrigation for fungal UTI)

Intermittent decompression of Neurogenic Bladder (again, unless bed-ridden, this will be a strait cath, possibly even self inserted)

Tidiness in managing bed ridden patients (I should think this somewhat controversial as it is not an insignificant infection risk with pseudomonas and

Question 18

Common Nosicomial Catheterization Caused UTI pathogens

Answer 18

Usually it’s E.Coli or Enterobacteria - as anywhere but

Nosicomial Bugs are notoriously resistant to antibiotics and several can form biofilms on the tubing and in the bag. Also, many nosocomial UTIs occur when urine is alkinized from drugs or dietary changes.

Proteus Mirabilis
Candida Albicans (esp ICU pts)

Question 19

Pros + Cons of Plaster Splints

Answer 19

*Easier to mold than fiberglass, but messier
Mess cleans up with water though, not
solvent
*Plaster curing is an exothermic process and\
could potentially cause Pt a burn if COLD
water were not used to hydrate plaster
*Plaster is heavier than fiberglass and will soft-
en if it gets wet but
*Plaster will ‘wick’ underlying moisture off a
wound, which keeps things nice and
dry beneath, whereas fiberglass will
incubate bugs in moisture.

So…. Mix plaster with COLD water and keep i DRY!

Question 20

Merits of Fiberglass

Answer 20

Its light weight, hard and the cast itself is waterproof, though the pad beneath is not so moisture will get trapped between skin and cast, no real way around that.

It cures quickly, as soon as it’s exposed to air, so you have to work fast

Its a resin + you need to wear gloves while applying and protect pts skin from the uncured fiberglass

Question 21

Indications for Casting + Splinting

Answer 21

To immobilize simple NON-DISPLACED fractures, soft tissue ligament sprains, dislocations + strains

Straighten congenital abnormalities like club foot

Manage ankle ulcers + charcot foot

Question 22

Casting Contraindications + Complications

Answer 22

Don’t cast early, let swelling ebb then cast 4+ days out.

Don’t cast over infection or wounds - you might get away with a casting window but think that through carefully

No Matter what you do, Cast Dermatitis may result from no air flow. Blow COOL AIR under the cast with a hair dryer. NO BABY PWD or itching beneath the cast with a knitting needle - you might scratch and cause infection!

Prevent compartment syndrome by

1) not casting until swelling is done
2) Bi-Valving the cast to allow for expansion

DVT from lack of movement - get Pt up and around and contracting that calf muscle inside his cast to prevent clot formation.

Pressure Sores + Nerve Damage: You must PAD bony prominences well and ensure that you mold the cast with your palms + not your finger-tips as tips make indentations that might press down on the skin and/or nerves

head of fibula - perineal nerve is a common site of nerve pressure damage.

Question 23

Hematoma Block?

Answer 23

When fracture ends are displaced blood vessels are broken and bleeding between the broken bones occurs - this is the hematoma

To anesthetize that area (usually the wrist: radius or ulna) 7-8 ccs of LIDOCAINE is injected directly into the hematoma from various directions.

Then the fracture is reduced: pulled out and repositioned. This would obviously be very painful without the anesthesia.

Question 24

Sugar Tong Splint For? Describe:

Answer 24

For DISPLACED Colles Wrist Fracture : Distal Radius fracture with posterior radial displacement. Also called Dinner Fork Fracture.

Also for fractures of the ulnar and or radial shafts

Splint extends from just proximal of the Metacarpal joints on the dorsal hand, around the medial aspect of the elbow and back to the
palm opposite the metacarpals.

Fingers need to be able to bend at the metacarpals. Thumb has FULL range of motion

Question 25

Thumb Spica Splint For? Describe:

Answer 25

Thumb spika is for Scaphoid Fractures (Usually a Fall on Extended Hand) or for Game-Keeper's Thumb (thumb pulled backwards stretching all its ligaments). It immobilizes the thumb but leaves the pinky side of the hand and all 4 fingers with full range of motion

Question 26

Alumi-form Splints For? Describe:

Answer 26

Alumiforms are for fractures of the metacarpals or first finger bones (proximal phalanges) They are bendable aluminum on one side adhered to a pad that faces the digit.

Question 27

STAX Splints For? Describe

Answer 27

Are for Mallet Finger (dorsal finger extensor ligament stretched/ruptured so ventral flexor ligament pulls tip of finger down @ DIP). The ligament may even avulse a bit of bone off the distal end of the intermediate philange) They support the DIP from beneath, stretching the ventral ligament and allowing immobilization of the dorsal ligament in a fully extended position for healing. These really have to stay in place a long time. Don't take it off at all. They're plastic so just leave them on through all activities for a FULL * WEEKS thereafter reducing splinted time gradually.

Question 28

Grey Top

Answer 28

Blood Glucose Ethanol Lactate (Hb A1C goes in the Purple EDTA tube with the CBC)

Question 29

VENIPUNCTURE PROCEDURE

Answer 29

o WASH HANDS o IDENTIFY yourself to Pt and confirm Pt is here for blood draw. Inquire about vasovagal syncope and LATEX ALLERGY. o TOURNIQUET: Three Fingers about the cubital Fossa, tied so you can untie it with one hand in a single motion while needle is in the pt’s vein. Tie the tourniquet and “feel” for a vein, looking for “bounce”. Note where you see bounce and then o ALCOHOL PADS: clean that area with the alcohol pad. Mark the direction of the vein with one side of the alcohol pad. Let alcohol dry on the skin while you finish preparations. LET tourniquet go. o BUTTERFLY NEEDLE: + HUB Attatch HUB to tubing on the butterfly needle if not pre-attached. o BLOOD COLLECTION VIAL: Attach Blood Vial loosely inside HUB – Don’t break seal just set it there such that it will be easy to manipulate with one hand. o GLOVES: NOW GLOVE UP and o RE-TYE The Tourniquet o Grasp the Butterfly Needle by its wings and follow your alcohol pad side into the vein, as close to the skin a possible, a 10-20 degree angle. o ADVANCE NEEDLE until you see flash in the butterfly chamber then o PRESS BLOOD COLLECTION VIAL ONTO THE HUB initiating suction and Fill the vial. o RELEASE TOURNIQUET when last vial is ½ full, remove last vial (full) from the HUB o COVER INSERTION with a sterile gauze, folded and withdraw the needle, simultaneously activating safety feature. o BANDAGE gauze and have pt bend elbow to stem bleeding o TELL PT TO hold pressure and elevate until coagulated o Discard needle and HUB into sharps/Biohazard

Question 30

INDICATION FOR VENIPUNCTURE

Answer 30

Venous Blood Sampling

Question 31

Naso-Gastric Tube Indications

Answer 31

-Oral Nutrition in pts w/functional GI -Oral Meds -Gastric Lavage/Removal of Contents -Blood -Toxins -Air (relieve pressure on obstructed bowel) -To Relieve Vomiting -To Warm/Cool Pt with Gastric Saline Lavage -Stomach Decompression during Surgury to prevent aspiration of contents

Question 32

NGT Contraindications

Answer 32

``` Facial/Skull Fracture Esophageal Stricture or Atresia Caustic toxin ingestion/burn Comatose w/an Airway Penetrating Cervical Wounds Recent Oropharyngeal Surgery Hx of Gastrectomy or Bariatric Surgery ```

Question 33

NGT Complications

Answer 33

Nose Bleed/Epistaxis Placement into Trachea/lung Intracranial Damage (if inserted into pt w/skull fracture) Long Term Complications include: -Sinusitis -Esophageal/Gastric Erosion from contact

Question 34

NGT INSERTION PROCEDURE

Answer 34

1) Obtain Consent after advising of risks + benefits 2) Gather Supplies: a. NG Tube (14-16F for normal Adult) b. Lidocaine Lube + Swabs (2) c. Evacuation syringe d. Emesis Basin e. Chuck Pad f. Vasoconstrictive Nasal Spray g. Tape h. Gloves, Mask/Shield, Gown i. Stethoscope 3) Wash Hands 4) Open Tube + Measure from tip of nose to Xyphoid Process, mark w/tape 5) Tear Off another piece of tape and attach somewhere within reach, bisect tape like pair of pants. This is for holding the tube to the nose, later 6) Attach Syringe to distal end of NG Tube 7) Don Gloves, Mask, Gown and drape Pt with the Chuck 8) Open Lidocaine Lube, insert 2 swabs + swab each nostril with one swab, allowing time for lidocaine to take effect. Discard Swabs 9) Ask Pt to blow out each nostril separately and choose nostril that is more patent for NGT placement 10) Insert 2” of NGT into lidocaine lube 11) Sit Pt up Straight 12) Have glass of water with straw ready 13) Advance NG Tube into Nare at 90 degree angle 5-6” until visible in pharynx 14) Have pt take up water and tilt chin to chest 15) Have pt swallow sips of water as you advance the tube 16) If pt coughs -stop, take more sips and advance when you can. If coughing doesn’t stop, you are in the trachea – remove + start over with a new tube. 17) Once you have advanced to the tape mark, hold tube to nose with one hand and tape it to the nose with the other. 18) Assess Pt condition and comfort 19) Evacuate stomach contents into tube and take note of color/consistency. If no contents, express air from syringe into tube while listening over stomach with stethoscope for gurgling. If none, you may be in the lung. There ought to be coughing though. 20) Remove Syringe + Close Tube 21) Secure tube to Pt’s gown to prevent pulling and attach the business end to wall suction 22) Order an X Ray and write orders 23) Don’t turn on suction until you confirm placement in the stomach with the X-ray.

Question 35

Components of NGT Procedure Note

Answer 35

Note why NGT is ordered/indicated Consent obtained after risks/benefits described + Allergy inquiry BSI Size + Length of Tube used Nare Placement Describe Pt tolerance of tube advancement Color/Quality of aspirated stomach contents in syringe Describe checking for correct placement Describe Pts Rxn to procedure post procedure

Question 36

Injection Massage?

Answer 36

DO massage Sub Q and IM Do Not massage Intradermal (PPD)

Question 37

NG Tube Warnings

Answer 37

Don't Irrigate Tube Start Suction Put Meds/Food down tube UNTIL you confirm placement with an XRAY

Question 38

NG Tube size for children

Answer 38

3-8 French

Question 39

Adult Esophagus Legth +Diameter?

Answer 39

20cm long 3cm in diameter

Question 40

NGT with and AIRWAY in place?

Answer 40

You can do it - place airway first. May need to deflate ET Tube cuff to get NG tube into the esophagus though.

Question 41

Describe indications for performing urinary bladder catheterization.

Answer 41

``` Acute or chronic urinary retention Urethral or prostatic obstruction Monitoring urine output Collection of sterile urine specimen To act as a traction device for the purpose of hemostasis after prostate surgery ```

Question 42

Describe contraindications for performing urinary bladder catheterization.

Answer 42

- Trauma with suspected urethral injury - Blood @ meatus in pelvic trauma pt - Penile, scrotal, or perineal hematoma - Acute prostatitis or urethritis

Question 43

Identify and describe common complications asst with performing urinary bladder catheterization.

Answer 43

``` Urinary tract inflammation or infection Transient hematuria Urinary structural trauma Bladder perforation Urethral stricture Recurring bladder spasms Periurethral abscess Patient-caused trauma Confused pt ```

Question 44

Describe the essential anatomy and physiology asst w/ the performance of urinary bladder catheterization.

Answer 44

Locate: Glans (circumsized or with foreskin)/Uretal meatus Labia Majora/Minora/Uretal Meatus

Question 45

Identify the materials necessary for performing urinary bladder catheterization and their proper use.

Answer 45

Sterile Catheter Kit: ``` Catheter 14-18 F attached to Foley Bag Swabs + Iodine Lube Sterile water filled syringe 2 drapes sterile gloves ```

Question 46

Catheter Sizing 3F = | Normal Adult Catheter Size

Answer 46

1mm diameter catheter Normal is 14-18 for Adult Male and Female. Go up a size if the catheter is leaking Normal Adult Female is

Question 47

Types of Catheters

Answer 47

Straight = Robsin Rubber Foley - w/bag Latex and/or Silicone Coude - bent tip, can be a foley or a straight tip helps guide it through the prostate in males.

Question 48

Cath Procedure Male

Answer 48

Explain catheter indication to patient and obtain consent after risk/benefit assessment shared. Inquire of latex, seafood and iodine allergy Clean Table for Gloves Position Pt Supine w/legs spread in a wide V Open sterile cath kit using sterile technique at one side of base of V. Remove sterile drape and place between pt's legs beneath scrotum Don Gloves Attach water syringe to catheter and place back in box Open Swabs or iodine/cotton balls Open Lube and squirt into tray in box Drape pt with hole-drape, situating penis through the hole Grasp foreskin with non-dominant hand and retract behind glans, holding tightly. Swab penis 360 degrees with each betadine swab. Lube end of catheter Raise penis up to 90 degrees from body, straight and insert catheter until urine is visible (in males, this may be all the way to the Y-Joint for the syringe), insert 1-2 inches more if you have it and Inflate catheter with sterile water Tug gently to ensure its in place Inquire of pt as to comfort attach catheter to pts thigh and then bag to pt's bed rail below pt level to gravity drain.

Question 49

What to do before and after splinting or casting?

Answer 49

FACTS: F - Function. Assess ROM & Strength A - Arterial Blood Assess Pulses above and below where cast will sit C- Cap Refill on digits distal to cast site T - Temp of limb distal + proximal to cast site S - Sensation Check all Dermatomes distal to cast site

Question 50

Volar Wrist Splint For? Describe:

Answer 50

For Non-Displaced Colles' Fracture or Fracture of Radial/Ulnar shafts. The volar wrist splint immobilizes the wrist and hand up to the Metacarpal joints. Fingers and thumb are free to move. It permits pronation and supination, extension and flexion of the elbow. Wash Hands & Glove Check FACTS on Pts affected arm Measure 4" WEBRIL padding from palmar crease to 2 finger widths from cubital fossa. Then tear off 4 lengths of Webril to that measurement. Make two piles of 2 layers each. Measure out 10 lengths of 3" PLASTER just slightly shorter than the WEBRIL. Stack it up and wet it. Spread 10X thick wet plaster sheets on top of 2 layers of Webril. Top with the other 2 Webril layers and flatten. Turn edges of webril in to cover plaster edges. Place Webril encased Plaster on ventral side of affected forearm from palmar crease to 2 finger lengths below cubital fossa and mold it a bit into the palm Beginning at wrist, wrap the plaster/webril form to the forearm with Kerlix conforming bandage. Not tight. Make Thumb holes and mold as you go but not with your finger tips, with your thenar eminence. Use one whole roll of Kerlix Keep molding until plaster hardens Check FACTS on digits distal to splint Ensure Pt is comfortable with the splint Set up Ortho referral for reduction and casting You can do the velar splint with readymade OrthoGlass that comes in a roll in the box and you cut off a length. This has fiberglass already fused to it's padding. You wet the whole thing, then roll it up over a towel to blot, then place on the pt's ventral forearm and kerlix in place.

Question 51

Sprain Splinting

Answer 51

leave on 4 weeks but for sprains you can remove to wash etc...Return for check up 1 week after splinting.

Question 52

Ulnar Gutter Splint

Answer 52

For Boxer Fracture of 4th or 5th MCP This splint only immobilizes the ring + pinky fingers. Use 3" plaster or OrthoGlass and bend it along the ulnar nerve path from tip of ring finger to 2 -3 fingers from anticubital fossa. FACTS your digits distal to splint location Glove Prepare either the Ortho Glass or the Plaster with Webril, form it over + under 4th + 5th fingers then Kerlix it in place beginning at wrist, going around the thumb and other fingers and then down to the elbow and back. Keep 4th + 5th digits at a 30-40 degree flexion. Other fingers will be unhampered. Assess Pt comfort and do Post Splint FACTS Make appt with Ortho

Question 53

Describe the anatomy of the skin and underlying structures affecting the manner in which injections are administered I

Answer 53

``` Epidermis Superficial Dermis Deep dermis (where nerve endings, capillaries and glands lie) Subcutaneous tissue (fat) Muscle ```

Question 54

identify the most common types of injections, including subcutaneous, intradermal, and intramuscular

Answer 54

Intradermal is injected into the epidermis/superficial dermis to form the PPD wheal. Go in at a 15* angle staying as shallow as possible, bevel up. SubQ needs to get into the subcutaneous fat for slow leaching into the blood (fat isn't well vascularized) Pinch an Inch (belly or back of arm) and go in at a 45* angle with a 5/8 to 1" long needle. On the belly, if you pinch more than an inch, you can go strait in at 90* IntraMuscular needs to go into a thick muscle that can handle the high volumes of medicine being injected (Deltoid, Vastus Lateralis or Gluteus Medius/Mimimus = VentroGluteal) Locate the spot (not so easy) and go in at a 90* angle

Question 55

Recognize the importance of equipment preparation and proper technique when administering injections

Answer 55

gg

Question 56

Identify safe injection practices to limit infection, contamination, and harm

Answer 56

gg

Question 57

Preferred Injection Site for Infants

Answer 57

Vastus Lateralis Lateral Third of the thigh, divide area from knee to hip into thirds and inject into the middle third at 90* angle

Question 58

Sub Q meds

Answer 58

Insulin, HEPARIN lmwt, Vaccines small quantities released over time Thin needles - 25-29 gauge 0.5- 5/8" long needle

Question 59

IM meds

Answer 59

ABX (rocephin, penicillin, Gamma Globulins) Large Volume meds that need to be disbursed well but over time. 1-4 ml can go in IM only 2ml at the deltoid though or in children or elderly anywhere Larger bore needles: 18-22 gauge Longer needles: 5/8 to 1 1/2" Hold the needle like a dart for IM. STAB then inject over 10 seconds then leave the needle in for 10 more seconds before removing it.

Question 60

Intra-Dermal Meds

Answer 60

PPD some vaccines, allergy testing Tiny bits of medicine Tiny needles: 26/27 gauge short like sq: 0.5 - 5/8" needles

Question 61

Needle Gauge depends on

Answer 61

Viscocity of med 25/26 gauge for thin meds 20/22 for thick gooey meds 14-18 are your large bore needles for fast IV hydration

Question 62

knuckle + finger joints proximal to distal

Answer 62

MCP, PIP then DIP

Question 63

suture size

Answer 63

3.0 - Absorbable in the abdomen 4-5.0 Extremiteis and over 4-0 over Joints 5. 0 Brow 6. 0 Face 6-7.0 for eyelid

Question 64

Suture for man's chin

Answer 64

Blue Vicryl Non-Absorbable 6.0

Question 65

Contraindications to Lumbar Puncture

Answer 65

Increased Intracranial pressure - brain stem herniation Blood Disorder Spinal compression Skin lesions over L2-L5

Question 66

CT these pts before lumbar puncture

Answer 66

Over 60 Seizure w/in a week Papilladema (ICP) Focal Neuro findings on exam (ICP)

Question 67

Needle Gauge for Adult Long?

Answer 67

22 guage 3" for over 12 yrs

Question 68

Normal CSF pressure

Answer 68

7-18 mm Hg Can't Increased in meningitis

Question 69

The pop happens when you pierce the

Answer 69

Dura Mater Then advance very carefully until you get csf return.

Question 70

Post Procedure

Answer 70

Lie Flat Caffeine and Water to offset headache Blood Patch is your own blood instilled into the lumbar puncture site to coag there and form a clot

Question 71

4 Tubes

Answer 71

``` 1- Cell Count WBC less than 5 RBC less than 10 Glucose 50-80 Protein 14-45 ``` 2- Glucose + Protein 3. Gram Stain STAT and Culture 4. Cell Count or HOLD

Question 72

Straw Colored CSF

Answer 72

Xanthochromia Sub Arachnoid Hemorrhage or other blood in the the CSF breaking down to bilirubin, which is the cause of the yellow color

Question 73

Protein High in CSF

Answer 73

Infection - WBCs breaking down

Question 74

Infant cord terminates at

Answer 74

L3 Cona Medulalris

Question 75

Glucose Low in CSF

Answer 75

Infection, bacteria eating up the sugar

Question 76

Meningitis Bugs

Answer 76

``` Strep Pneumo (+) Neisseria Meningititus (-) ```

Question 77

Amide local anesthetic

Answer 77

Lidocaine "Caines with two i's" contraindications: Liver Dz

Question 78

Ester local anesthetic

Answer 78

Procaine "Caines" with one "i" Contraindication is Renal Dz E for rEnal

Question 79

Epi with your anesthesia, why

Answer 79

Doubles the effect of the anesthesia Decreases bleeding and systemic uptake Not in Fingers Toes Penis Nose Not in Graves/ Adrenal Tumor that over produces Epi Keep the Epi below 3mg as it is a powerful antiarrythmic

Question 80

Tac Tetracian Epi cocaine

Answer 80

Local cream anesthetic Not on fingers toes penis nose not on open wound 5 cm or less not on mucus membranes TAC has been replaced with LET which is Lidocaine, Epi and Tetracaine

Question 81

Cryoanesthetic

Answer 81

Ethyl Chloride spray

Question 82

Digital Block

Answer 82

Big Wheal of Lidocaine in web-space on either side of affected finger. No Epi. Aspirate to ensure you're not in a vessel.

Question 83

Stitch within

Answer 83

8 hrs, | Face Neck and Scalp within 24hrs

Question 84

Mono vs Multifilment sutures

Answer 84

Mono - single strand Mulit - braided, very strong, harbor pathogens

Question 85

Tetanis protocol

Answer 85

Tetanis prone wound over 5 yrs Tdap Tetanis prone and can't recall Tdap + IgG Non-Tetanus Prone wound over 10 ten years Tdap

Question 86

Vicryl

Answer 86

Absorbable For surgury/deep/ mucus membranes

Question 87

Clean Clean/Contaminated Contaminated Infected

Answer 87

Surgical cuts. Accidents are never clean Most cuts are clean contaminated GI/GU surgery cuts are clean/contaminated Bile is considered contaminated Stool is considered infected

Question 88

DeHis

Answer 88

Wound doesn't close

Question 89

Inverts wound edges

Answer 89

Purse String

Question 90

Everts wound edges

Answer 90

Mattress

Question 91

Tensile Strength

Answer 91

How strong the suture is Match tensile strength to tensile burden of the tissue you're stitching

Question 92

Post stitch

Answer 92

Change the wound dressing daily Elevate Watch for infection Return for check or removal in 7 days Face remove in 4-5 Feet 10-14 Retention Sutures 2-6 weeks

Question 93

Gut made from poly galactin (Vicryl)

Answer 93

Sheep intenstine Synthetic absorbable leave 1/4 inch tail, it will get absorbed non absorbables leave 1/8" tail as you can go back to fix superficial stitches

Question 94

IV Contraindications

Answer 94

AV Fistula Breast Cancer, do it on other side Venous Insufficiency - what ever you put into that vein isn't going to move any better than what's in there now Skin Infection

Question 95

IV steps

Answer 95

Use 18-20 gauge for Meds 14-16 gauge for Fluid Restoration ``` Flush Hub with sterile saline, leave syringe attached Tourniquet Palp vein Clean Tourniquet Insert IV needle Slide catheter over needle apply pressure to site + attached flushed hub Remove tourniquet Flush IV Remove syringe Lock IV ```

Question 96

risks of iv

Answer 96

``` cellulitis phlebitis PE (central line) DVT Air Embolus Allergic Rxn ```

Question 97

I+D Contraindications

Answer 97

Solid, not fluctuant. Wait til its fluctuant Cellulitis Facial Furuncles between nose, corner of mouth triangle

Question 98

gauge for lidocaine

Answer 98

25-30 gauge needle

Question 99

blade for incision

Answer 99

11 blade

Question 100

Iodoform packing

Answer 100

insert it using sterile technique

Question 101

Loculation

Answer 101

intracystal adhesions form compartments within the cyst, break them up with your forceps before expressing contents of the cyst

Question 102

I+D

Answer 102

``` Clean Lidocaine Incise with 11 blade Break up loculations Express contents Irrigate with saline pack with iodoform bandage ``` Report fever, pain, pus Come back for repacking 1-3 days

Question 103

Cryosurgery

Answer 103

NO, NO2, CO2 - 10 to -20 C Normal Cell death occurs - 40 to -50 kills cancer Freeze off a Wart Freeze off a Keloid Scar-can reduce size of scar Actinic Keratosis that does not appear malignant if you think its malignant, biopsy instead Genital Warts Molluscum Contagiousum Skin Tags Lentigo- dk spots Lentigo Maligna gets treated by specialists only but can be frozen Basal Cell, Squamous cel, Melnaoma all by specialists Blister forms within 24-48 hrs Crusts within 72 hrs Epithelialized from the margin in.

Question 104

Erythema vs Hyperemia

Answer 104

red vs engorged

Question 105

Cryosurgury contras

Answer 105

``` Reynauds Ulnar Fossa Cryoglobinemia Auto immune eyebrows dark skin may get hypo pigmented ```

Question 106

Freeze Times

Answer 106

15 seconds facial 40 seconds non facial molluscum 20 Plantar warts and skin tags keratoses 40 sec 1-2 cm away pulsitile rotary spiral at 90 degrees Make a small halo around the base - in gen 1mm Warts though 1-2 mm Depth is 1.5X the diameter of the halo FREEZE thaw REFREEZE