indications
the most obvious indication for the sterile technique is:
surgery
what is the ONLY complication to translaryngeal intubation?
laryngeal disruption
Trauma to the turbinate, nasopharynx, or both during passage of the tube --> bleeding
improper placement of the tube in the lungs can cause penumonia or pnuemothorax
Erosion or necrosis of the nasal mucosa or Gastric erosion with hemorrhage
aspiration pneumonia
When Donning and Doffing PPE for surgery, what order is appropriate?
Donning:
1. mask, eye goggles, surgical cap
2. gown then gloves (after scrubbing in)
Doffing:
1. gown then gloves, then eyewear, mask and cap
A 20-year-old woman presents for a wellness visit after recently becoming sexually active. She is concerned because her mother had HPV-associated cervical cancer and asks if she needs a Pap smear or HPV screening today. She has no history of abnormal Pap tests and has never had a pelvic exam.
Based on current screening guidelines, how should you respond?
reassure her that cervical cancer screening begins at age 21, regardless of sexual activity or family history, and she does not need a Pap smear or HPV test today
A 68-year-old man with a history of benign prostatic hyperplasia (BPH) presents to the emergency department with lower abdominal discomfort, inability to urinate for the past 12 hours, and a distended bladder noted on physical exam. He is afebrile and denies flank pain or dysuria. Initial labs are pending.
What is the most appropriate next step in management to relieve the patient’s symptoms and prevent further renal complications.
bladder catheterization
A 54-year-old woman presents with fever, altered mental status, and photophobia. You suspect meningitis and prepare to perform a lumbar puncture. Her labs reveal a platelet count of 42,000/μL and an INR of 2.1 indicating a problem with her clotting factors due to underlying liver disease. Neurologic exam reveals no focal deficits and no signs of increased intracranial pressure.
this finding presents an absolute contraindication to performing the lumbar puncture at this time.
coagulopathy
common complications from bladder catheterization:
Stricutres
trauma
Infection
Paraphimosis
in order, describe the steps of the surgical scrub from start to finish
1) antiseptic soap rinse of hands and arms
2) unwrap sterile scrub brush and nail cleaner (clean under nail), wash nails
3) 30 strokes on each finger (on each side of the 4 sides)
4) 20 strokes on each 4 surfaces of arm
5) inside elbow, outside elbow, and 2 cm ABOVE elbow
6) run hand through water to arm ONLY ONCE and do not move back and forth if soap remains then do a second pass in the same direction.
for lumbar punctures, it is important to ensure what has occurred before sending a patient home
that the LP site has sealed over and there is no leakage of the CSF
ABG can be used to diagnose
acute dysfunction in CO2/O2 exchange in diseases like asthma, PE, shock, and drug overdoses.
A 72-year-old woman with a history of left-sided breast cancer presents to the hospital for pneumonia. Her medical records indicate she underwent a left mastectomy with axillary lymph node dissection five years ago.
What is a reason that IV insertion is contraindicated on her left antecubital fossa?
Impaired circulation due to prior axillary lymph node dissection
most common complication from a lumbar puncture
Postdural puncture headache (PDPH)
- described as a throbbing or pressure headache that is bilateral at the base of the neck (occipital) worsened with sitting upright
How do you preform the Allen test
1. Apply firm pressure to occlude the radial and ulnar arteries until the hand is blanched
2. have pt lower hand and open fist
3. maintain pressure on one artery while letting go of the other
4. observe for return of color = identifies significant collateral circulation
A 24-year-old male returns to clinic five days after being placed in an ulnar gutter splint for a boxer's fracture. He complains of itching under the cast. at presentation, you note a foul odor from the cast and see that the cast is dry despite some noted drainage and mild staining near the distal forearm.
what part of patient education was likely missed and may have contributed to his current symptoms.
Avoid inserting objects into the cast, as this can lead to skin breakdown and infection
intraosseous fluid administration should be done on what kind of bone [bonus: where can you find these bones (3)] and is indicated when???
* bonus is worth 15 points *
1) flat bone
- bonus (tibial tuberosity, humeral head, or sternum)
2) emergency situations when fluid is needed fast and other fluid lines cannot be placed quick enough
you are on your ER rotation and you are taking an H&P on a 45 yo male coming in with a deep laceration on his face. Upon further questioning, he reveals that he sustained the injury last night during a bar fight where he was punched in the face. Your perform your physical exam and results are as follows: PERRL, normocephalic, nontender head, vesicular breath sounds and a crisp S1 and S2. skin with mild abrasions found throughout the upper extremities and a deep 4cm long laceration of the left lateral zygomatic bone.
based on the information above, what presents a contraindication to primary intention suturing of his facial laceration?
Delayed presentation of a traumatic laceration in a potentially contaminated setting (assault/fight wound).
A 28-year-old man presents to the emergency department one day after sustaining a closed tibial fracture that was treated with a long leg cast. He now reports severe pain in his lower leg that is worsening despite oral pain medication. On exam, his leg is tense to palpation and extremely tender. Capillary refill is slightly delayed, and the toes are cool, though distal pulses are present.
What is the most concerning complication given his symptoms.
compartment syndrome
1. How to quickly confirm endotracheal tube placement:
&
2. most definitive way to confirm placement:
1. Listen about 3-7 cm above carina (the stomach) with stethoscope while putting positive pressure into the tube!!
- should not hear bubbling that would indicate placement through the esophagus and not the trachea.
2. X ray
after NPA, OPA, or endotracheal intubation placement to establish an airway, what are 3 important things to maintain for patient comport and protection:
secure the tube with tape and change the placement of the tape ever so often to avoid sores.
administer humidified oxygen to prevent the tube from kinking
for intubation make sure the patient has proper sedation and analgesia to prevent self extubation
A 46-year-old man is brought to the emergency department after being found unresponsive in a hotel room. EMS reports shallow breathing, pinpoint pupils, and a nearly empty bottle of oxycodone nearby. On arrival, he is somnolent but withdraws to painful stimuli. His respiratory rate is 8, and oxygen saturation is 85% on room air. His jaw is clenched tightly, and a jaw-thrust maneuver is only partially effective. An oral airway was attempted in the field but was met with resistance and a gag response. You anticipate needing to provide bag-valve-mask ventilation while preparing for definitive airway management.
What is the most appropriate immediate airway intervention.
nasopharyngeal airway (NPA)
60 year old woman presents to the ER complaining of dysuria and hesitancy. She reports hematuria when she urinated yesterday and is currently stating she feels the sensation that she needs to go, but can't. you perform a PE and notice extensive distention and tenderness in the suprapubic area. You discuss treatment options with your preceptor who states they want to get an US. You get to perform the US which comes back showing 800mL of retained urine. you start to panic because there is a contraindication to the preferred treatment of catheterization. What is it?
Hematuria indicating a bladder neck injury
You are a PA student on your surgery rotation. Your preceptor is wildly confident in your suturing abilities and steps out of the OR leaving you to close a large elliptical excision over the posterior shoulder. You carefully approximate the deep dermal layers and begin your interrupted epidermal sutures. You forgot Professor Curry's warning to start in the middle and work toward the ends to make even bites. Unfortunately, this leads to..... and how do you need to fix it?
1) a puckered, protruding flap of skin rising from one end called a dog ear deformity
2) there are two options: remove interrupted sutures and try again or create a 45° incision at affected side. Undermine tissue, create a flap, and excise extra tissue. Close with a “hockey-stick” shape.
During a skills lab, your classmate is having trouble suturing. You notice they’re gripping the needle too close to the tip, pinching skin too firmly with their forceps, and cutting their knots with their scissor blade angled weirdly allowing the tip of the blade to far surpass the suture. Based on standard technique, list at least two corrections they should make to improve their instrument handling.
Grasp the needle at the proximal-to-middle third, not the tip.
Hold the forceps like a pencil and avoid overly tight grips to minimize tissue trauma.
Use the tripod grip on scissors and cut at a 45° angle.
Use the needle driver with a tripod grip in the dominant hand.
an IV site should be changed every __ hours.
why?
96
reduce the risk of infection