- Contraindication for Tube Thoracostomy in an unstable patient:
a. Coagulopathy
b. Lung Disease
c. Emphysematous Blebs
d. Not Contracindication
d.Not Contracindication
- Where do you incise to start a Chest Tube?
a. Mid to Anterior Axillary Line at 4th to 5th Intercostal Space
b. Mid Clavicular Line at 4th to 5th Intercostal Space
c. Mid to Anterior Axillary Line at 9th to 10th Intercostal Space
d. Mid Clavicular Line at 9th to 10th Intercostal Space
a.Mid to Anterior Axillary Line at 4th to 5th Intercostal Space
- What is the primary concern if making an incision too large (>5 cm)?
a. Subcutaneous Air Leaks
b. Subcutaneous Infection
c. Lung Infection
d. Empyema
a.Subcutaneous Air Leaks
- After securing the chest tube, what should you do?
a. Antibiotic Ointment Application
b. Dermabond the surrounding tissue
c. Order Chest XRay
d. Order MRI
c.Order Chest XRay
- What size chest tube would you use for a hemothorax?
a. 16-22
b. 28-32
c. 22-28
d. 32-38
b.28-32
- For a Cricothyroidotomy, where and in what direction do you make the first incision?
a. Cricothyroid Membrane; Horizontally
b. Cricothyroid Membrane; Vertically
c. Skin; Horizontally
d. Skin; Vertically
d.Skin; Vertically
- For a Cricothyroidotomy, where and in what direction do you make the second incision?
a. Cricothyroid Membrane; Horizontally
b. Cricothyroid Membrane; Vertically
c. Skin; Horizontally
d. Skin; Vertically
a.Cricothyroid Membrane; Horizontally
- Indications for Cricothyroidotomy:
a. Bypassing Lower Airway Obstruction
b. Avoiding Major Neck Surgery
c. Obstructive Sleep Apnea Relief
d. G-tube placement
c.Obstructive Sleep Apnea Relief
9.T/F: Skin Stapling has been shown to have similar wound healing results and rates of infection as Sutures.
True
- When performing Knee Arthrocentesis, what position should the knee be in?
a. Flexed, 30-45 degrees
b. Extended, 30-45 degrees
c. Flexed, 15-20 degrees
d. Extended 15-20 degrees.
c.Flexed, 15-20 degrees
What are the indications for a tube thoracostomy?
Pneumothorax
Hemothorax
Empyema/Effusions
Chylothorax
What are the contraindications for a tube thoracostomy?
No absolute contraindications in an unstable patient!
Relative Contraindications:
Coagulopathies
Lung disease with scar tissue or emphysematous blebs
What is a pneumothorax?
PTX occurs when air enters the potential space between the visceral and parietal pleura.
Describe how to place a chest tube.
Mid to anterior axillary line at the 4th to 5th intercostal space, Lateral to the edge of the pectoralis major and breast tissue.
3 to 5 cm. long Initial skin incision is made over a rib or two lower than the intercostal space that the tube will pass through.
What do we use to spread the tissue?
Kelly clamp
External clues that intubation may be difficult
Marked obesity
Trauma
Deformity or fractures of the face and neck
Macroglossia
Edema, or hemorrhage in and around the airway
C-spine instability
What is the chief indication for surgical cricothyrotomy?
the inability to secure the airway by noninvasive techniques in a patient with impending or ongoing hypoxia.
What is a tracheostomy?
A tracheostomy is a procedure that exteriorizes the trachea to the cervical skin, resulting in a more permanent tracheal cutaneous fistula; therefore, the term tracheostomy should be reserved for these particular procedures.
What are the indications for a tracheostomy?
Tracheostomy indicated for:
Bypassing an upper airway obstruction
Providing a means for assisting mechanical ventilation
Enabling more efficient pulmonary hygiene
Temporarily securing an airway in patients undergoing major neck surgery and relieving obstructive sleep apnea
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IV Fluids Revisited15
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Mechanical Ventilation40
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Hyperlipidemia19
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HTN and CHF20
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GI Medications24
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Infectious Disease Medications27
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DM and Metabolic Syndrome31
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Anticoagulants and Antiplatelets42
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CXR17
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ABD X-Ray1
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MSK X-Ray0
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Coding4
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Breathing made Simple8
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Intro to ICU3
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Pelvic Exams6
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Cadaver Lab19
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Electronic Medical Records7
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Respiratory Medication13
