I&I Flashcards
Chest drain insertion procedure and complications?
Tension pneumonthorax.
Trauma to intrathoracic structures, intra-abdominal structures and intercostal muscles.
Re-expansion pulmonary oedema.
Haemorrhage.
Incorrect tube position.
Blocked tube.
Pleural drain falls out.
Subcutaneous emphysema.
Infection.
You will either sit with your head and arms resting on a pillow on a table or lie on your bed with your arm above your head. The drain is usually put into the side of your chest below the armpit.
The procedure is performed using an aseptic technique to minimise the risk of infection. Your skin is cleaned with an alcohol cleaner to kill any bacteria and a local anaesthetic is then injected to numb the area where the tube is to be inserted, this can ‘sting’ temporarily but resolves quickly. A small cut is then made in the anaesthetised area and the doctor gently opens up a path for the chest drain. It is normal to feel a sensation of pressure and tugging as the drain is gently eased into the chest.
The chest drain is held in place with stitches and the exit site is covered with gauze and a waterproof dressing. The end of the tubing is connected to a drainage bottle which acts as the underwater seal and collection chamber.
Your chest drain will be monitored regularly. You may be asked to cough, or take a deep breath. This enables the nurse to ensure the drain is still functioning. You will be given regular pain relief while the drain is in place. Pain may inhibit your movement and breathing which may prolong the time your lung takes to expand therefore it is important to report any pain and keep it under control.
Seldinger vs surgical chest drain?
The Seldinger technique has demonstrated a much lower risk of serious complications and also lower pain scores when compared with large bore chest drains
What are the causes of pneumoperitoneum?
What do you see on AXR?
perforated ulcer
atelectasis
bowel cancer
ischaemic bowel
ruptured megacolon
recent abdo surgery
RIGLER’S SIGN
What are the contraindications of catheter?
urethral injury
gross haematuria
urtheral infection
low bladder compliance
Causes of widened mediastinum?
thoracic aortic aneurysm
thymoma
lymphoma
achalasia
What are the causes of globular heart?
cardiac tamponade
pericardial effusion
ToF
What are the causes of sigmoid volvulus and caecal volvulus?
What are the complications?
High fibre diet, chronic constipation with chronic use of laxatives and/or enema, and associated myopathy like Duchene muscular dystrophy,
pelvic tumours, pregnancy, hirschsprungs
peritonitis , bowel perforation, gangrene
What are the xray findings in ank spond?
squaring of vertebra
bamboo spine - ossification of supraspinous ligament
syndesmophytes
Smiths vs Colles fracture?
Colle’s: FOOSH
Dorsal displacement and angulation of the distal radius
Smith’s: posterior back of hand fall
Volar angulation of distal radius fragment
SAH complications and risk factors?
rebleed
vasospasm - presents like stroke
death
PKD
Hypertension
Idiopathic
What do you see J waves in?
hypothermia - j waves and bradycardia
SAH
hypercalcaemia
When is a 3 way catheter used?
3 way catheter for Irrigation / Haematuria / Post TURP/ TURBT
types of NG tube?
standard
2 channel tube
orogastric tube for lavage
ryles tube for bowel obstruction
bilateral hilar lymphadenopathy
sarcoidosis: steroids if symptomatic
tb: MCS using AFB on ZN stain, mantoux test
Atelectasis
causes: pneumothorax,, pleural effusion, tumous, post-op
mild: go away
meds or bronchoschopy to stop secretions
chest physio
surgery
