Week 10 (exam 3) Flashcards by Leslie Valdez

What are some considerations for foreign bodies in ears

lift up on auricle to open canal better

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What is the approach for removal of a foreign body in ears

best to use alligator forceps
flushing
dermaond (caution!)
lidocaine gel for bugs
refer to ENT

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What are the methods of removal for ears

ear curette (lighted) for mechanical debridement

softening agents/mineral oils/hydrogen peroxide

irrigations

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What do you do for a tympanic rupture

give antibiotics
- oral and topical

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What are the most common objects used as softening agents for home for prevention

debrox and colace

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Visual acuity is scored as a fraction, what do the first and second numbers mean?

first number: represents the testing distance between the chart and the patient

second number: represents the smallest row of letters that the patient’s eye can read

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What are the indications for using a fluorescien stain/woods lamp for eyes

r/o foreign in the eye

r/o corneal abrasions, ulcers, or other minor trauma

r/o viral etiology for patient symptoms

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fluorescein binds to damaged corneal epithelium and fluoresces green under a BLANK to light through a BLANK

wood’s lamp

cobalt-blue filter

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What are the indications in non-ophthalmology for using a slit lamp for eyes

any acute condition that requires magnification to inspect the naterior segment of the eye

to facilitate ocular foreign body removal

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What is another way to identify and remove other foreign bodies that may be present

evert the lid

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Define lid eversion

use q-tip to “roll” eyelid and invert it to look for foreign bodies stuck to inside of upper lid

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What can you use for foreign body removal in eyes

fine needle tip, eye spud, or eye burr

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What can we used to anesthetize the cornea with a local anesthetic

proparacaine/tetricaine

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What do you do if the foreign body is tightly adherent to o embedded in the cornea

STOP and send to opthalmalagy

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What do you do first after anestehsia for foreign body removal in eyes

irrigate with normal saline first

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What should be removed by an ophthalmologist

Full-thickness corneal foreign bodies

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When a metallic foreign body is present for more than a few hours a what develops

rust ring develops around the metal

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The presence of a BLANK evident in the anterior chamber on slit lamp examination suggests BLANK

gross hyphema or a microhyphema

globe perforation

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Once the metallic foreign bod is removed what happens to the rust ring

rust ring area softens overnight and can be more easily removed in the office the next day

If a patient has a history of metal foreign bodies in the eye what do you want to do before an MRI

a skull x-ray

What are the causes of anterior epistaxis

anticoagulants, clotting disorders, trauma, dry air, recent colds, allergies, bad luck

What plexus is the target vasculature anteriorly

kesselbach’s plexus

Posterior epistaxis is usually seen in the BLANk

elderly with other comobordities

What pleuxus is often the origin of posterior epistaxis

woodruff plexus (splenopalatine artery)

What are the treatments for posterior epistaxis

balloon placement, arterial ligation, angiographic arterial embolization

What is the procedure for epistaxis treatment

1. try to visualize the source of bleeding 2. apply pressure to the anterior cartilage of the nose 3. afrin nasal spray 2x/each nostril 4. use a nasal tampon, foley catheter or other tampnade device (merocele) 5. cautery 6. rhino rocket or nasal packing 7. if all this fails, call ENT

What are the methods for foreign body removal in the nose

mother's kiss alligator forceps balloon catheters ENT

What are the indications for oropharyngeal (mouth insert)

those at risk for airway obstruction by tongue or upper airway muscles

What are the indications for nasopharyngeal (conduit through nasopharyngeal pathway)

when opa is difficult or dangerous - can be conscious or unconscious

What are the indications for suctioning

secretion, blood, vomit obstructing airway

What are the complications for oropharyngeal (mouth insert)

may induce vomiting if wrong size, may obstruct airway more

What are the complications for nasopharyngeal (conduit through nasopharyngeal pathway)

epistaxis, turbinate fracture, intracranial placement throigh a basilar skull fracture, retropharyngeal dissection or laceration

What are the complications for suctioning

hypoxia and tachycardia - monitor vitals when doing this

What are the contraindications for oropharyngeal (mouth insert)

severe airway edema or trauma NOT on anyone who is conscious/semiconscious or has gag reflex

What are the contraindications for nasopharyngeal (conduit through nasopharyngeal pathway)

severe airway edema or trauma facial fractures

What are the contraindications for suctioning

severe airway edema or trauma no more than 10 seconds at a time

What are the 2 airway devices

endotracheal tube intubation laryngeal mask intubation

Define endotracheal tube intubation

tube constructed of polyvinyl chloride that is place between the vocal cords through the trachea

Define laryngeal mask intubation

keeps airway open during anesthesia or while they are unconscious - supraglottic airway device

Name the different mallampati scores

class 1: complete visualization of the soft palate - easy to intubate class 2: complete visualization of the uvula class 3: visualization of only the base of the uvula class 4: soft palate is not visible at all - hard to intubate

What is the size of the tube for adults

6.5-8 cm tube that is secured at the 21-23 cm at the lip

What do you give first and then second for intubation procedure

sedative first, then the paralytic

What are the common sedatives for the intubation procedure

etomidate, ketamine, and proprofol

What are the common paralytics for the intubation procedure

succinylcholine and rocuronium

How do you know if you are in the right spot for intubation

1. you see the tube pass through the cords 2. bilateral breath sounds and chest rise 3. no gastric sounds 4. end tidal calorimetry (checks for CO2) - yellow means yes 5. pulse ox improves 6. chest x-ray ALWAYS - carina area