Peer 9 - procedures

Question 1

Indications for thoracentesis?

Answer 1

relief of dyspnea associated with large effusion, suspected pleural space infection, new effusion without a clear clinical diagnosis

Question 2

treatment of unstable tachyarrythmias

Answer 2

synchronized cardioversion

Question 3

treatment of unstable bradyarrhythmias

Answer 3

transcutaneous/transvenous pacing

Question 4

most reliable way to confirm ET tube intubation

Answer 4

end tidal capnography

Question 5

men and postmenopausal women should receive what blood type?

Answer 5

O+

Question 6

women of child bearing years should receive what blood type transfusion?

Answer 6

O-

Question 7

indications for NG tube?

Answer 7

stomach herniation, gastric decompression, medication/contrast in intractable vomiting, monitor upper GI bleed

Question 8

contraindications to NG tube?

Answer 8

alkali injury/corrosive ingestion, basical skull fx or midface injury, coag, esophageal strictures, gastric bypass/lap band surgery

Question 9

indications for pacing?

Answer 9

AV block or sinus node dysfunction, or other arrhythmias such as torsades that would benefit –> not used in hypothermic patients

Question 10

tx of subungual hematoma occupying more than 50% of nail plate?

Answer 10

trephination

Question 11

when do you do nail plate removal instead of trephination?

Answer 11

nail avulsion or disruption of the nail fold

Question 12

size of ETT for neonates?

Answer 12

2.5 uncuffed if premature, 3.0 uncuffed if not premature

Question 13

when do you perform perimortem cesarean delivery?

Answer 13

maternal cardiac arrest at greater than 24 weeks’ gestation

Question 14

mother and neonate survive more likely when delivery is performed in what time span?

Answer 14

less than 5 minutes

Question 15

how big and where is the incision for perimortem c delivery?

Answer 15

vertically from pubic symphysis to the umbilicus

Question 16

when do you consider lateral canthotomy?

Answer 16

retrobulbar hemorrhage with intraocular pressure higher than 40 mm Hg

Question 17

best incision for thrombosed hemorrhoid for minimal complications?

Answer 17

elliptical incision

Question 18

contraindications to video or fiberoptic laryngoscopy?

Answer 18

airway containing blood or vomit

Question 19

ester local anesthetics? more likely to produce allergies

Answer 19

Can’t Treat Pain with Esters

Can’t - cocaine
Treat - tetracaine
Pain - Procaine/ chloroprocaine

Question 20

amide local anesthetics?

Answer 20

two i’s in their name

bupivacaine
lidocaine
prilocaine etc

Question 21

structure mos tlikely injured if peritonsillar abscess drainage is too far posterior and lateral?q

Answer 21

carotid artery

Question 22

steps to trouble shoot urinary retention caused by suspected urethral obstruction

Answer 22

• attempt 14 Fr Foley cath
• attempt to pass a coude cath
• consider requesting a urology consultation
• attempt suprapubic tube placement

Question 23

preferred med for shoulder dislocation with hypotension for procedural sedation?

Answer 23

fentanyl - minimal effect on BP, provides analgesia and sedation –> also reversible agent

Question 24

best closure technique with greatest tensile strength in a wound located over a joint

Answer 24

sutures

Question 25

volume of contrast injected into adult bladder in cystourethrogram?

Answer 25

400 ml

Question 26

in trauma always get ____ before getting cytogram?

Answer 26

retrograde urethrogram

Question 27

preferred access sites for placing a transvenous pacemaker?

Answer 27

right IJ and left subclavian vein

Question 28

absolute contraindication to transvenous pacing?

Answer 28

prosthetic tricuspid valve

Question 29

steps for controlling nosebleeds?

Answer 29

nasal pressure cautery nasal packing - otherwise assume posterior and call ENT

Question 30

contraindications to NIV

Answer 30

``` absent or agonal resp effort AMS life threatening epistaxis max/face trauma basical skull fx severe hypotension vomiting ```

Question 31

contraindications to IO line insertion?

Answer 31

``` fx of same bone previous IO attempt on same bone IVC injury osteogenesis imperfecta osteopetrosis overlying cellulitis ```

Question 32

contraindications to gastric lavage?

Answer 32

``` unprotected airway hydrocarbon ingestion corrosive ingestion FB ingestion bleeding diathesis known esophageal strictures history of gastric bypass small children ```

Question 33

findings with concern for compartment syndrome?

Answer 33

five Ps ``` pain with passive extension paresthesias paresis/paralysis pallor pulselessness ```

Question 34

first step of g tube dysfunction/clogging?

Answer 34

milking the proximal portion of the tube

Question 35

conus medullaris ends at which vertebrae in infants?

Answer 35

L2-L3

Question 36

conus medullaris ends at which vertebrae in adult?

Answer 36

L1-L2

Question 37

structure of concern when doing a left sided thoracotomy?

Answer 37

phrenic nerve