MRCEM OSCE > Procedures > Flashcards

Procedures Flashcards

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1
Q

Potential Indications for a facial nerve block

A

Burn care

Fractures and dislocations

Large lacerations that would require a harmful dose of anaesthetic

Facial lacerations where distortion of the wound would affect the quality of repair

Wound exploration

Pain control (headaches, toothaches)

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2
Q

Contraindications for a nerve block

A

Infection around the injection site

Bleeding disorders

Preexisting nerve damage is a relative contraindication and should be well-documented before the procedure

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3
Q

Risks for a facial nerve block

A

Nerve injury
- advance needle slowly, withdraw if paraesthesia
- Use USS

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4
Q

Bupivacaine (0.25%) max dose

A

2mg /kg

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5
Q

Supraorbital foramen location

A

Midline of the supraorbital ridge

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6
Q

infraorbital foramen position

A

1cm inferior to the mid-infraorbital ridge and in line with the pupil.

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7
Q

Intraoral approach for infraorbital nerve block

A

Insert your needle into the gingival reflection superior to the maxillary canine, advance towards the foramen

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8
Q

Supra orbital nerve is a branch of the ?

A

Opthalmic branch of the trigeminal

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9
Q

Infra orbital nerve is a branch of ?

A

Maxillary branch of the trigeminal nerve

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10
Q

Mental nerve is a branch of ?

A

Mandibular branch of the trigeminal nerve

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11
Q

Gauge of needle used for local anaesthetic

A

25G (orange)

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12
Q

Green cannula gauge =

A

18

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13
Q

Median nerve block anatomy

A

Between palmaris longus and flexor carpi radialis

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14
Q

Ulnar nerve block anatomy

A

Medial to flexor carpiulnaris, enusring withdrawing to check not in the ulnar artery

Should be proximal to the pisiform and distal to the ulnar styloid

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15
Q

Radial nerve block anatomy

A

Into the anatomical snuff box

Between extensor pollicis longus and brevis

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16
Q

LEMON assessment

A

Look (anatomy, beards etc)
Evaluate 3,3,2
Mallampati
Obstruction or obesity
Neck (extension)

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17
Q

Consenting for a procedure you need to outline:

A

Indications
Contraindications
Other options
Risk

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18
Q

For any procedure, to prepare you must…

C
L
E
A
N

A

Consent & contraindications
Location
Equipment
Assistance
Now you can proceed

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19
Q

Indications for ascitic tap

A

Diagnostic - SBP

Therapeutic - discomfort

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20
Q

Contraindications for ascitic tap

A

Infection over the needle insertion site

Surgical abdomen

Bowel obstruction

Too little fluid to tap

Severe coagulopathy or plat <40

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21
Q

Insert the needle in ascitic tap away from?

A

Surgical scars
Superficial veins
Masses

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22
Q

Potential complications in ascitic tap?

A

Haematoma
Infection
Hypovolaemia
Needle perforates viscera (very uncommon)
Haemoperitoniun (very uncommon)

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23
Q

Usual site for ascitic tap?

A

15cm lateral and 2-3cm below the umbilicus

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24
Q

Size of needle used to give lidocaine?

A

25G

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25
Size of needle used for an ascitic tap?
21G
26
Indications for a CVC
Often in a patient destined for ICU, requiring mediactions that can only be given centrally, or need to be given a large number of medications at once Inotropes such as noradrenaline can only be given centrally Can take blood samples regularly Central venous pressure monitoring - more details volume status
27
Contraindications of a CVC
All RELATATIVE Patient unable to lie still to have it done Infection over the insertion site Low platelets or coagulopathy Difficult landmarks
28
Complications of CVC
Early Repeated attempts at cannulations Cannulate an artery Haematoma Arrhythmia Air embolism Pneumothorax Late: Infection of the line Line becomes blocked Vein thrombosis
29
Size of CVC for neck
15cm
30
Indications for a surgical chest drain
Trauma - haemopneumothorax
31
Contraindications to surgical chest drain insertion
Relative - coagulopathy
32
Complications to a surgical chest drain insertion
Bleeding Haematoma Infection introduced Visceral injury
33
What must be checked after a CVC is inserted and before use
Venous wave form with pressure CXR
34
Base of the safe triangle
5th IC space
35
Steps of a surgical chest drain
Use a scalpel to cut a horizontal line just above the rib around 1cm Use forceps for blunt dissection Use a finger to do a sweep Insert the drain with the forceps attached a few holes down to help with insertion, aiming down
36
Important social hx in C-spine clearance
Drugs and alcohol
37
Indications for NIV
T2RF not responding to medical management - i.e. acidosis of 7.25-7.35 Cardiogenic pulmonary oedema unresponsive to CPAP
38
Contraindications to NIV
Facial burns or deformity Vomiting Fixed upper airway obstruction Pneumothorax (undrained) Relative: Low GCS Unable to tolerate / agitation Bowel obstruction Recent GI surgery
39
Complications of NIV
Failure / poor tolerance Pneumothorax Aspiration
40
Equipment needed for NIV
Tight fitting face mask Filter Circuit NIV machine
41
NIV initial settings
IPAP 10 EPAP 4 Set back up breaths as 12 BPM
42
Indications for DC cardioversion
Broad or narrow complex tachycardia Emergency - signs of shock / syncope / heart failure / myocardial ischaemia Or those that have failed to respond to medical management
43
Contraindications to DC cardioversion
AF of unclear duration and not anticoagulated - though if adverse signs should still be appropriate
44
Complications of DC cardioversion
May fail Patient may remember it or feel significant pain Can cause VF
45
Propofol initial sedation dose How long to see effect
0.5mg/kg (10mg/ml) 0.25/kg 1-2 mins
46
Starting J in narrow complex tachycardias
70-120J
47
Starting J in broad complex tachycardia
120-150J
48
Contraindications to IO access
Fractured bone proximal to the insertion site Metal work Ischaemic extremity Relative: Infection / trauama over the site of insertion
49
Complications of IO insertion
Failure Doesn't go deep enough - extravasation into soft tissues Iatrogenic # Infection Neurovascular injury Compartment syndrome
50
Once IO in you need to
Attempt aspiration If can send samples - need to be properly labelled Then connect the flushed connector and flush with saline - check no extravisation
51
Usual needle size used in an adult for IO?
25mm (unless going in the arm, then would be 45mm)
52
Indication for knee aspiration
Septic arthritis diagnostics To relieve pain
53
Contraindications to knee aspiration
Cellulitis Knee replacement Relative - coagulopathy
54
Complications of a knee aspiration
Haematoma Infection Unable to aspirate fluid Hemarthrosis Damage to knee structures
55
Best approach for knee aspiration
Lateral approach
56
What to send knee aspirates to the lab for
MC&S Gram stain Crystals
57
Indication for a femoral nerve block
Femoral #
58
Contraindications for a femoral nerve block
Allergy to the LA Infection over the insertion site
59
Complications of a femoral nerve block
Haematoma Infection Failure Damage to neurovascular structures Vascular injection
59
Bupivacaine max dosing (0.25%)
2mg/kg which = 0.8ml/kg
60
LA used in femoral and FIB blocks =
Bupivacaine
61
How long should those with a pneumothorax not fly for?
6 weeks
62
Indications for RSI
A – airway protection and patency B – respiratory failure (hypercapnic or hypoxic), increase FRC, decrease WOB, secretion management/ pulmonary toilet, to facilitate bronchoscopy C – minimise oxygen consumption and optimize oxygen delivery (e.g. sepsis) D – unresponsive to pain, terminate seizure, prevent secondary brain injury E — temperature control (e.g. serotonin syndrome) F — For humanitarian reasons (e.g. procedures) and for safety during transport (e.g. psychosis)
63
O2 MARBLES - equipment for RSI
Oxygen Mask Airway adjuncts RSI and resus drugs Bougie Laryngoscope (video), LMA ET tube and end tidal CO2 SUCTION
64
Common RSI induction agent and muscle relaxant with doses + opioid
Ketamine 1mg/kg Rocuronium 1mg/kg Fentanyl 1 microgram/mg
65
RSI standard induction pack may contain...
➢ Ketamine 200 mg/20mls ➢ Rocuronium 100 mg/10mls ➢ Fentanyl 500 micrograms/10mls
66
The calibration rectangle on an ECG should be how big?
2 large squares
67
Indications for pleural aspiration
Primary pneumothorax, >2cm And they would like symptomatic relief now
68
What needs to be checked before proceeding with a pleural aspiration or chest drain
CXR
69
Complications of a pleural aspiration
Bleeding Infection May not work
70
Indications for a surgical airway
Can't intubate can't ventilate
71
Contraindications to a surgical airway
Significant neck deformity may make the likelihood of success rate low
72
Complications of a surgical airway
Haematoma False passage Posterior perforation of the trachea or oesophagus Laryngeal stenosis
73
Equipment for a scalpel thyroidotomy
Wide bladed scalpel Bougie Cuffed tube (5-6)
74
ATLS indications for thoracotomy
Prompt drainage of 1500 ml blood, or a third of the patient’s circulating volume >200 ml/hr blood loss for 2-4 hrs Continued need for blood transfusion
75
Does and type of local anaesthetic in a Bier block
Prilocaine 0.5% 3mg/kg
76
Cuff inflation max and minimum in Bier block
The cuff should be inflated for a minimum of 20-25 minutes post injection of prilocaine and a maximum time of 60-90 minutes
77
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