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29 Cards in this Set
- Front
- Back
- 3rd side (hint)
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when do you get consent before performing a procedure
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ALWAYS
**make sure the procedure form indicates that a student can help |
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what is included in a procedure note
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1. Dx
2. Procedure 3. Surgeon/Assist 4. anesthesia type and amt 5. description of sterile technique used 6. description of procedure done 7. complications, blood loss 8. specimens 9. wound closure, suture type used 10. dressing used 11. how pt tolerated procedure 12. bathing, wound care, FU instructions |
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what is avoided in the nose, toes, hose, and lobes
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epinephrine injection with local
**epi extends the duration of local by constriction |
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when might you NOT want to use epi along with the local
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1. nose, toes, hose, lobes
2. PVD, DM, HTN, thyrotoxisis, CVD 3. periorbital in narrow angle glaucoma Epi prolongs the effect of a local by vasoconstriction |
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can you use lidocaine (xylocaine) in a pt who is allergic to novacaine
whats the dose |
YEP!!! there is no cross reactivity
**just use one vial though, the preservative is simliar |
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my pt is allergic to procaine, can I use lidocaine instead
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you bet, there is no cross reactivity btwn the amides (2 i's) and esters (one i)
**but the preservative is simliar so just use one voal of the lidocaine |
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does epinephrine extend or shorten the duration of action of a local
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extend always
**works through constriction |
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what is less painful
sub Q or intradermal |
sub Q is less painful
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how can you decrease pain with an injection, pts say intradermal is more painful
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1 distract them
2. use small needle 3. inject slowely 4. do sub Q instead of intradermal 5. add Nabicarb 6. warm the medicine 7. cool the skin or use topical |
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EMLA
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topical anesthetic that MUST be used on IN TACT skin
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what is the topical anesthetic that is used for in tact skin only
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EMLA- takes like an hour to kick in
**LET can be used for lacerations |
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how long before a digital nerve block kicks in
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5-10 min
*dont inject your 4 cc and then IMMEdiATLY ask the pt if they can feel it so add more. wait for it to work before you add more. **dont use epi |
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how long does it take for EMLA to kick in as a topical anesthetic
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1 hour
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when you are placing your hemostat under the nail to remove an ingrown toenail. where is your pressure directed
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direction pressure up and away from nail bed
pull the nail away- up/out with distal pull. cut longitudinally cauterize germinal tissue with phenol |
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whats phenol
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its used to cauterize tissue during an ingrown toenail removal (cauterize the germinal tissue)
**the phenol can cauterize any tissue so put some vaselline on areas you dont wish to cauterize. after your done swab with EtOH to neutralize the phenol |
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1. subungual hemotoma
2. subungal melanoma 3. splinter hemorrhage 4. green nail syndrome |
1. subungual hemotoma: usually a blob at the base. horizontal, no pigment on skin
2. subungal melanoma: usually a longitudinal and pigment can get on finger- hutchinson 3. splinter hemorrhage: small little lines, usually at distal end 4. green nail syndrome: pseudomonas |
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ick my pt has a big black bleb on their finger and its even getting into their skin. will this person have a hx of trauma
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nope, sounds like melanoma
**Hutchinsons sign is pigment on skin **will be longitudinal pgment (in subungual hemotoma its horizontal) |
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hoe do you remove a 1 barb fish hook
how do you remove a 2 barb fish hook |
1 barb: the back out. use local over the tip of the hook. pull the hook though the skin and cut off the tip of the barb. then back it out
2: the push through: push tip through, cut off end of hook and pull all the way through |
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how to remove a tick
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pull straight out, dont pinch, squeeze. light or anything crazy. just get near its mouth and lift up
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how do you do a punch biopsy. how do you know if you are through the sub Q tissue
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clean but not sterile
1. stretch skin perpendicular to tension line 2. choose punch that is 2 cm larger than the lesion 3. punch- twist, you will feel a decrease in resistance once you make it past the subQ and the dermis is completly penetrated 4. when you pull the punch out the tissue shoudl kinda pop out. pull it up and cut it free. if its flush with the skin you didnt punch deep enough |
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how many mm beyond the lesion must you freeze for a benign lesion
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1-3 mm
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whats a CI and disadvantage of cryotherapy
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Disadvantage:
1. kills melanocytes in darker ppl 2. kills hair 3. susceptible to sunburn after frozen 4. nerve damage on superficial nerves CI: 1. melanoma 2. areas w/end stage circulation 3. pt refusal based on cosmetics 4. recurrent basal/sq cell CA relative CI include: urticaria, cold intolerance, cryoglobulinuria, |
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whats a punch biopsy used for
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to determine dx of unkown lesion or remove a small lesion <5 mm
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whats a shave bx used for
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benign things liek warts, skin tags, sebohhreic keratosis
**it heals slower but better cosmetics :) |
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what type of suture size is best for skin and what size is used on the body
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nylon
4-5 on scalp, 6 on face |
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what is the preferred technique to bx pigmented lesion
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excisional bx
sterile, sut to sub Q and remove it all. make elipse and dont cross hatch at the top |
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why is a cervical polyp removed
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if its large or sx
**usually benign, but send to path anyway |
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when is tetanus Ig given
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in a dirty wound when the person has no previous vaccination
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what is hutchinsons sign
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when a melanoma in the nail bed creeps into the skin
**this is NOT seen in a subungual hematoma |
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