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21 Cards in this Set

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What are 2 ways to use landmarks to find the femoral vein for central line placement?
If you cannot find a pulse, you can find the symphysis and the anterior iliac spine and attempt to find the vein midway between the 2 and 2cm below the inguinal ligament. It can also be found 1cm medial to the femoral artery. The order of structures at the femoral canal are Nerve, Artery, Vein, Empty space, Lymphatics, going from lateral toward the NAVEL.
Which central line has the highest incidence of infection?
Femoral
Which central line has the lowest incidence of infection?
Subclavian
What is the correct dose of succinylcholine in induction for ET intubation?
1-2 mg/kg in adults, about 2mg/kg in children
What are contraindications to succinylcholine use?
Renal failure, known hyperkalemia, subacute extensive burns, paraplegia/quadraplegia
A patient has shunt failure. You need to sedate the patient for intubation. Which agent is contraindicated: propofol, ketamine, versed, succinylcholine
ketamine. ketamine increases intracranial pressure.
Where is the correct location for placement of an IO line in a child?
1-2 finger breadths below the tibial tuberosity on the anteromedial (flat) portion of the tibia with the point of the needle aimed slightly caudal to avoid the physis.
Why should you tug on the abdominal skin to make a "Z-line" when performing a paracentesis?
Patients with ascites often have low albumin and poor healing, as well as increased abdominal pressure. if you make a straight shot into the abdomen, you may cause the patient to have a persistent leak. if you pull the skin, you can create a self-closing needle track.
Propofol is an appropriate single agent to sedate a patient for a joint relocation, true or false.
false. propofol does not control pain. it can be used with fentanyl or with local joint injection.
A patient is awake and alert, complaining of a severe headache and a fever. The patient has no comorbidities and has a nonfocal exam. You must CT the patient prior to LP. true or false.
false.
What landmarks do you use to determine needle placement for LP?
midline, at the level of the iliac crests.
Why should LP performed in the lateral decubitus position, rather than with the patient seated?
You can only measure an opening pressure in a patient who is lying down, and this information is very valuable in diagnosing pseudotumor, as well as potentially ruling out SAH and meningitis.
At what level do you enter the spinal canal when doing an LP, and why?
L4-5 or L3-4, because at this level, the spinal cord has ended and the cauda equina is present, which makes the tap safer.
True or false: epinephrine with lidocaine is safe for digital blocks
true. there has never been a single case of digital necrosis from commercial preparations of lidocaine with epi
what is the positive pressure technique for removal of a nasal foreign body?
this technique can be done with a puff of air into the patient's mouth (by ambu) or with a puff of air into the non-involved nostril. the patient will reflexively close his glottis and push out the object. success is 79% with appropriate objects.
a patient has a button battery in his ear and you can't get it out. can you have it removed tomorrow in the ENT office, or do you need to call the ENT in?
you need to get the ENT's ass out of bed. these can cause significant tissue damage in a matter of a few hours.
a patient has a piece of popcorn in her ear. which method should not be attempted?
a. irrigation
b. forceps
c. right angle
d. suction
a. irrigation. this will cause swelling of popcorn, making it harder to remove.
how can you get superglue out of someone's ear?
you can add nailpolish remover, which will dissolve it, or you can wait about 48 hours, when the ear will have re-epithelialized, and it will curette out easily
when doing a thoracotomy and delivering the heart from the pericardial sac, what incision do you make and why?
longitudinal incision. this is so you don't cut the phrenic nerve.
when doing a pericardiocentesis without ultrasound guidance, why do you do a subxyphoid approach?
to make it less likely that you lacerate a coronary artery. 'cuz that sucks.
how do you do an arthrocentesis of a knee?
i like a lateral approach. have the patient straighten the knee, so there is optimum tendon and ligament laxity. place your non-dominant hand on the knee cap's medial edge so that the lateral edge tips up. have your needle enter 1cm lateral and 1cm superior to the superolateral edge of the knee cap, and aim for the joint space.