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ctjghjkbgf > Procedures > Flashcards

Procedures Flashcards

1
Q

What are 4 historical and physical findings that predict difficult laryngoscopy?

A 
•	Mallampati score
•	Thyromental distabce 
•	Prior difficult intubation
•	Obesity
•	Difficulty with moving neck
LEMON = look, obstruction, mallampati, obesity, neck mobility
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2
Q

What are 4 rescue devices or techniques after one attempt at direct laryngoscopy fails and BVM is not possible?

A 
●	LMA
●	Bougie
●	Video laryngoscopy
●	Needle Cricothyroidectomy 
●	Fiberoptic bronchoscopy 
●	Surgical airway
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3
Q

What are 2 advantages in using cuffed endotracheal tubes? 2 clinical situations where cuffed is advantageous to non-cuffed?

A

Advantages:

  1. Decreased need for tube exchange due to inappropriate sizing
  2. Reduced air leak
  • airway edema
  • reduce aspiration
  • high vent pressures
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4
Q

5 ways to identify if a patient is intubated correctly without xray?

A
  • Capnography with waveform or colour change
  • Chest Rise
  • Air entry to both lung fields
  • Direct visualization of ETT through the vocal cords
  • Misting of the tube
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5
Q

List four items you would need to have if you had to do a needle cricothyroidotomy but didn’t have a commercial kit

A

● 12 to 18 gauge angiocatheter (12-16 for adolescent, 16-18 for infants/young children)
● 7 mm ID ETT
● 3 cc syringe with plunger removed
● Self-inflating bag

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6
Q

Name 3 landmarks for chest tube insertion.

A
  • 5th intercostal space - between 5th and 6th ribs (nipple line)
  • Posterior to the pectoralis muscle
  • Anterior to mid axillary line

This is called the triangle of safety

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7
Q

List six complications of chest tube placement.

A
  • Bleeding
  • Pulmonary contusion
  • Pneumothorax
  • Hemothorax
  • Infection
  • Bronchopleural fistula
  • Laceration of visceral organ: liver, spleen, diaphragm, heart
  • Subcutaneous emphysema
  • Re-expansion pulmonary edema
  • Intercostal neuralgia
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8
Q

What are the steps to a thoracotomy (4)?

A
  • Positioning/preparing your equipment and patient
  • Disinfect skin & apply sterile drapes
  • With scalpel blade #10, skin incision from margin of sternum along the 4th or 5th intercostal space until posterior axillary line
  • Take Mayo scissors or sterile trauma shears to cut medially towards sternum along the previous incision (sheering intercostal muscles)
  • Insert rib spreader (Finochietto) between ribs with handle towards axilla and open as wide as possible to maximize exposure
  • Damage control - pericardotomy, cross-clamp aorta, open cardiac massage
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9
Q

Indications for thoracotomy?

A
  • Penetrating trauma + unstable despite fluids or cardiac arrest < 15 minutes
  • Blunt trauma + unstable/loss of vital signs or chest tube output > 20mL/kg blood
  • ONLY IF SETTING HAS RESOURCES TO PROVIDE ONGOING CARE
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10
Q

Contra-indications for thoracotomy?

A
  • No signs of life at the scene
  • Asystole is presenting rhythm without tamponade
  • Prolonged pulselessness > 15 minutes
  • Massive non-survivable injuries have occured
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11
Q

What are four complications of casting/ splinting?

A
  • Pressure ulcers
  • Contact dermatitis
  • Contractures if prolonged or not in position of function
  • Neurovascular compromise (compartment syndrome)
  • Thermal injury (burns)
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12
Q

An 8 year presents with a foreign body in his ear. You see a bug in the canal.

What is one intervention that can facilitate removal of the bug

A

Use alcohol, mineral oil or viscous lidocaine

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13
Q

What is one foreign body requiring immediate removal from the ear canal

A

Button battery

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14
Q

What are 4 predictors of difficult ear canal foreign body removal

A

i. Glass or sharp edged
ii. Spherical or other that is tightly wedged
iii. Up against tympanic membrane
iv. Penetrating foreign bodies
v. Injury to EAC

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15
Q

5 ways to remove an ear foreign body

A
  • Curette (visualize +/- speculum, pass curette past the FB)
  • Forceps (again with speculum + visualization)
  • Irrigation (C/I if food material/ bean, or can’t see the TM)
  • Day ear hook
  • Katz extractor (inflatable balloon at the end)
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16
Q

List ten complications of central venous cannulation.

A 
●	Hematoma formation
●	Infection
●	Air embolus
●	Pseudoaneurysm
●	Catheter or wire fragment in central circulation
●	Accidental cannulation of artery
●	Arterial or venous laceration
●	Arrhythmia
●	Pneumothorax (IJ) / Hemothorax (IJ)
●	Pneumomediastinum (IJ)
●	Cardiac trauma (IJ)
●	Stenosis (long-term)
●	Thrombosis
●	Fistula
17
Q

femoral venous catheter - 3 advantages, 3 disadvantages?

A 
Advantages
Rapid access with high success rate
Does not interfere with CPR
Does not interfere with intubation
No risk of pneumothorax
Trendelenburg position not necessary during insertion
Disadvantages:
Delayed circulation of drugs during CPR
Prevents patient mobilization
Difficult to keep site sterile
Difficult for PA catheter insertion
Increased risk of iliofemoral thrombosis
18
Q

You have a 5 yo with a large laceration requiring repair. What are 6 ways to minimize the use of physical restraint?

A 
●	Child life
●	Local anesthesia
●	Procedural sedation 
●	Topical anesthesia
●	Distraction
●	General anesthesia 
●	Talking the child through the procedure
19
Q

What are 4 indications to physically restrain a patient in the ER?

A

● Imminent harm to others
● Imminent harm to the patient
● Significant disruption of important treatment or damage to the environment
● Continuation of an effective, ongoing behavior treatment program

20
Q

What are 4 potential complications of physical restraints in the undifferentiated agitated patient

A 
●	circulatory obstruction
●	Pressure sores 
●	Paresthesias
●	Rhabdomyolysis 
●	Unmet fluid and toileting needs
21
Q

What are four locations that you can place an IO?

A 
Proximal tibia
Distal femur
Distal tibia
Proximal humerus
Sternum
ASIS
22
Q

IO contraindications?

A
  • Infection at the site
  • Bleeding disorder
  • Osteogenesis imperfecta
  • Fractured bone
  • Previous IO attempt in same bone
23
Q

IO complications?

A
  • Extravasation of fluids into subcutaneous tissues -> compartment/skin necrosis
  • Subcutaneous abscess, osteomyelitis, septicemia
  • Physeal injury or fracture
  • Fat embolus
  • Damage to bone marrow (long-term)
24
Q

List 2 advantages and disadvantages for nitrous oxide use for analgesia

A

Advantages:
● Rapid onset, short duration of action
● Provides sedation, dissociation and amnesia
● No major cardiopulmonary events
● Situations where you can’t do local anesthetic

Disadvantages:
● Requires patient cooperation
● Expensive
● Inadequate analgesia for painful procedures
● Can cause N+V, dysphoria
● Bulky equipment, training required, needs scavenger system

25
Q

What are 4 complications of a femoral nerve block?

A 
●	Quadriceps weakness
●	Infection
●	Arterial or venous puncture 
●	Nerve injury 
●	Hematoma
●	Local anesthetic systemic toxicity
●	Allergic reaction
26
Q

What are the toxic doses of lidocaine with epinephrine and lidocaine without epinephrine?

A

7 mg/kg and 4 mg/kg

27
Q

List 2 tongue lacerations that would require suturing.

A
  • Deep lacerations that are at the lateral or anterior border of the tongue (risk for fork tongue deformity)
  • Lacerations > 1cm that are deep to the muscle layers or completely through the tongue
  • Large laceration at risk for food entrapment
  • Significant hemorrhage that can’t be stopped
28
Q

4 layers of the scalp

A 
SCALP:
skin
(sub)Cutaneous tissue
Aponeurosis (galea aponeurotica)
Loose areolar tissue
pericranium
29
Q

4 ways to close scalp lac (not including suturing)

A

Skin Tape
Tissue Adhesives (Glue)
Hair apposition technique
Staples

30
Q

Hair tourniquet - 3 methods for removal

A

● Blunt metal probe under hair
● Nair
● Cut down to the bone

31
Q

5 ways to remove a ring

A
  • Ring cutter
  • For hard metals (steel or titanium) may need a dental drill
  • String pull technique
  • String wrapping technique
  • Lubricant
  • Double penrose technique
  • Surgical glove technique
32
Q

2 situations when you should NOT remove a fishhook.

A

● No absolute CI

● If near eye, eyelid or vital structures need subspecialist

33
Q

Describe 2 different ways to remove a fishhook

A

● barb cut: at site of point entry use 1% lidocaine or digital block; using needle holder and wearing gloves advanced barb part of hook out of skin, cut with wire cutter than remove rest of hook from skin
● string removal: explain procedure, digital block or 1% lidocaine, loop a piece of string around the hook, with dominant hand depress hook against skin and then pull sharply

34
Q

How to assess pain?

A

o < 5 years old = can’t report on a scale, relies on observation (different charts exists including Behavioral Pain score, CHEO Pain scale – combination of behavioral and physiologic measurements
o Older: self-report pain scales = gold standard (faces scale, 1-10 scale)

35
Q

Factors that increase risk of aspiration in sedation?

A

deep sedation, stomach contents, anesthetic agent used (ie. Higher risk with volatile agents), PPV, hx of GERD

36
Q

Etomidate - good and bad features?

A
  • Good – short duration, less HD effects, dec ICP

- Bad – myoclonus, adrenal suppression, vomiting

37
Q

Propofol - good and bad features?

A
  • Good – rapid on/off, antiemetic, amnesia

- Bad – HD effects, narrow therapeutic range, don’t use in egg/soy allergy

38
Q

Ketamine - good and bad features

A
  • Good – no hypotension (causes HTN), preserved airway reflexes, bronchodilation, analgesia and sedation
  • Bad – CV collapse if catecholamine depleted, risk of laryngospasm (treat with PPV and paralysis), recovery agitation, vomiting
39
Q

Chloral hydrate - disadvantages?

A

Long duration of action, paradoxical reactions, slow onset

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