Exam 4 Therapeutic Procedures Flashcards Preview

Q4 EM Surg > Exam 4 Therapeutic Procedures > Flashcards

Flashcards in Exam 4 Therapeutic Procedures Deck (39):
1

Cerumen Impaction Removal indicated when? (4)

Hearing loss
Tinnitus
Vertigo
Otalgia (earache)

2

Cerumen Impaction Removal contraindicated when? (4)

Uncooperative
Distorted/abn anatomy
Prior ear surgery
Suspect TM perf

3

Cerumen Impaction Removal complications? (4)

TM perf
Otitis externa
Vertigo/NV/Tinnitus
Internal Auditory Canal abrasion

4

Subungual Hematoma is?

Evacuation indicated when?

Contraindicated when? (2)

Bleed b/w nail and digit from trauma

Visible/Painful

Crushed/Fractured bed
Involves > 50% of nail

5

Subungual Hematoma Evacuation procedure?

Heated paperclip or cautery ->
place on nail

6

Nasogastric Tube Insertion indicated when? (4)

Decompress stomach from outlet obstruction or ileus
SBO
Gastric lavage for overdose or bleeding
Enteral feeding

7

Nasogastric Tube Insertion contraindicated when? (4)

Basilar skull fxr
Facial trauma
Nasal obstruction
Esophageal dz

8

NG Tube complications? (3)

Sinusitis
Gastric irritation
Aspiration PNA (keep head elevated)

9

I&D indicated when?

C/I when?

Abscess

Located in nasolabial folds (drain into sphenoid sinus)

10

I&D F/U?

Complications? (4)

Wound check 24-48 hrs
Repack daily

Pain
Recurrence
Scar
Worse infection

11

Arthrocentesis indicated when? (2)

C/I when? (5)

Eval fluid
Pain relief

Cellulitis or broken skin
Coagulopathy
Infected bursa
Bacteremia
Joint prosthesis (refer)

12

Arthrocentesis needle gauges?

Complications? (5)

22-27 for injection
18-21 for aspiration

Bleed
Infection
NN trauma
Cartilage/tendon damage
Drug rxn

13

Thoracentesis indicated when? (3)

Remove air/fluid from chest (pleural effusion, empyema, pneumothor)
Fluid analysis
Instill sclerosing meds

14

Thoracentesis C/I when? (2)

Coagulopathy
Uncontrolled cough/hiccups

15

Thoracentesis lidocaine injected where?

Aspiration needle inserted where? (3)

Tip of needle pointing up for what?

Down for what?

Above rib to avoid neuromuscular bundle that runs below rib

1-2 ICS below level of ↓BS, dull percussion
Above 9th rib to avoid diaphragm puncture
Midway b/w spine and post axillary line

Up for air
Down for fluid
(air will rise above fluid)

16

Thoracentesis complication? (3)

Pneumo- hemothorax
Diaphragm puncture
Re-expansion edema (Do not take > 1L, do not perform bilaterally)

17

Paracentesis indicated when?

C/I when? (5)

Ascites (dx and therapeutic)

Acute abdomen
Coag
Distended bladder/bowel
Preggo
Infection at site

18

Paracentesis procedure?

Complications? (3)

Pt supine w/ raised HOB or L lat decubitus
Insert 1/3 distance b/w umbilicus and ant iliac crest

Rare: perf, infection, hematoma

19

Lumbar Puncture indicated for diagnostics when? (5)

CNS infection
MS
SAH
Tumor
Normal Pressure Hydrocephalus

20

Lumbar Puncture indicated for tx when? (2)

Admin meds (anesthesia, chemo, ABX)
Remove CSF (pseudotumor cerebri)

21

Lumbar Puncture C/I when? (3)

Intracranial lesion (focal deficit, papilledema)
Local skin infect
Coagulopathy or thrombcytopenia

22

Lumbar Puncture insert where?

L4-5
20-30° towards umbilicus

23

Opening pressure at lumbar puncture tells us?

Normal pressure values?

↑ pressure = tumor, infect, bleeding, MS

N lying pressure = 5-14 mmHg
Sitting = 5-27

24

Lumbar Puncture complications? (4)

CSF leak w/ HA
Infection
Nerve impingement
Herniation

25

Central Venous Catheter indicated when? (7)

Hemo/CV pressure monitoring
Meds (pressors, chemo, ABX)
TPN
No viable peripheral sites
Emergent vascular access
Hemodialysis
Repetitive blood draws

26

Central Venous Catheter C/I when? (4)

Distorted landmarks
Coag
Infection at site
Pneumo- hemothorax on contralat side

27

Central Venous Catheter sites? (4)

Internal/External jugular
Subclavian vv
Femoral vv
Brachial vv

28

Central Venous Catheter landmarks for Internal Jugular approach?

Apex of triangle formed by sternal and clavicular heads of SCM mm and clavicle

29

Central Venous Catheter: Benefits of subclavian approach? (2)

Drawbacks?

Good landmarks
More comfortable for pt

Higher risk of pneumothor

30

Central Venous Catheter complications? (4)

Hemorr
Pneumo- hemothorax
Arrhythmia
Infection

31

Immediately post-placement, do what?

CXR to verify placement and no hemo- pneumo-

Tip should be in SVC near RA

32

Chest Tube indicated when? (4)

Pneumo- hemothorax
Recurrent pleural effusion
Empyema
Penetrating chest truma

33

Chest Tube C/I when (3)

Coag
Loculated pleural eff (confined to one or more fixed pockets)
Previous chest tube

34

Chest Tube insertion location?

Procedure? (3 steps)

4th/5th ICS, anterior axillary or MCL

2-4 cm incision parallel to ICS
Blunt dissection -> SQ tunnel over top of next rib
F/U CXR

35

Chest Tube complications? (3)

Heart/vessel/lung/diaph injury
Pneumo-/Hemo-
Infection

36

Bone Marrow Aspiration/Bx indicated when? (6)

Unexplained anemia/leuko or thrombo penias
Abn periph smear
Unexplained splenomegaly
Unexplained fever
Dx/stage leukemia/lymphoma
BM transplant

37

Bone Marrow Aspiration/Bx C/I when? (2)

Bleed disorder
Skin infection

38

Bone Marrow Aspiration/Bx site?

Iliac crest ->
3 fingers from midline and 2 inferior to iliac crest

39

Bone Marrow Aspiration/Bx complications? (4)

Bleed
Infection
Pain
Perf of sternal plate