Emergency Medicine Procedures 2.

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Which of the following is CORRECT in reference to the insertion of the "Rapid Rhino" in epistaxis?

Insert it at 45 degrees to the septal floor.

Place it in water for 30sec before insertion to activate the hydroxymethyl cellulose.

On completing insertion make sure the blue indicator is outside the nostril.

Inflate with water only.

Insert it parallel to the septal floor after activating the hydroxymethyl cellulose in water for 30sec. The blue indicator sits just inside the nostril. Inflate with air. Use the pilot balloon to monitor the amount of air required.

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When do you use the yellow intraosseous needle when using an EZIO?

In patients with jaundice who suffer a cardiac arrest.

When using a sternal approach.

In patients under 6mths age.

In patients 40kg and over.

The yellow needle is the longest needle in the EZIO at 45mm length. It is used for patients >40kg.

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What is the POSI (Position Of Safe Immobilisation) when splinting hand injuries?

Wrist 20-30 deg extension, MCP 60-90 deg flexion, PIP and DIP in full extension.

Wrist 20-30 deg extension, MCP 60-90 deg extension, PIP and DIP in full extension.

Wrist 20-30 deg flexion, MCP 60-90 deg flexion, PIP and DIP in full extension.

Wrist--no extension, MCP 60-90 deg flexion, PIP and DIP in full extension.

Recommended position to minimise stiffness and contractures. The MCP, PIP, DIP ligaments are at their tightest in this position.

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Which of the following is INCORRECT about digital nerve blocks?

It was first described in 1889 using 20% Cocaine for the treatment of an in grown toe nail.

Commonly local anaesthetic is introduced on both the radial and ulnar side at the base of the finger.

1% or 2% Lignocaine is commonly used and takes 10 to 15min to take effect.

The digital nerves are on both sides of the finger on the dorsal side running just below the veins.

The digital nerves run just below their corresponding artery on each side of the finger on the palmar side. Having given myself a digital nerve block I can say that it does sting a bit.

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What does the 80,80 initial guideline for transcutaneous pacing refer to?

For those over 80years age look to get a systolic BP >80mmHg.

Set the rate to 80/min and the initial current to 80 milliamps.

At a current of 80 millamps you have 80minutes before you must get a definitive pacemaker.

Use 80mg Ketamine IV for 80 millamps of current.

I find it a useful starting point. This usually gives you electrical and mechanical capture. You can titrate the milliamps and rate after you confirm capture. Ketamine IV is a good option for sedation but individualise the dose.

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Which is the best answer when talking about performing a lumbar puncture?

In obese patients ultrasound can help you identify landmarks.

Doing the procedure in a sitting position often helps.

Post dural puncture headache occurs in approximately 20% of patients.

All of the above.

Good technique is the corner stone of performing a successful LP. Ultrasound can be very useful to identify land marks. If you are interested below is a link to Jacob Avila's 5 min Sono video on the topic.

https://youtu.be/rbbpwE_ijm0

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What anatomy defines the "Triangle of safety" for insertion of a pig tail catheter into the chest?

Lateral border of pectoralis major, anterior border of latissimus dorsi, 5th-6th intercostal space.

Lateral border of pectoralis major, anterior border of latissimus dorsi, 4th-5th intercostal space.

Lateral border of pectoralis minor, anterior border of latissimus dorsi, 4th -5th intercostal space.

Lateral border of pectoralis minor, anterior border of latissimus dorsi, 5th-6th intercostal space.

Using this triangle keeps you away from large muscles and generally keeps you well away from the diaphragm, liver or spleen.

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The video shows a "vertical mattress" suture. Which of the following would it NOT be advantageous to use it?

To gain temporary haemostasis in a scalp laceration.

Linear wounds not under tension.

Wounds under moderate tension.

Deep lacerations to decrease the "dead space".

It is easy to learn and is a useful suture to have in your "tool kit".

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Which is the most preferred technique to reduce a "pulled elbow"?

Thumb over the radial head and flex the elbow.

Thumb over the radial head then hyperpronate the forearm.

Thumb over the radial head then hyperextend the forearm

Thumb over the radial head and pull on the elbow.

On purpose I did not put in the option --thumb over the radial head then supinate the forearm and then flex the elbow. This is a valid option but meant to be slightly less sucessful than the hyperpronate technique.

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Which of the following was NOT a medical procedure error that occurred in the hit TV series "ER"?

Using vodka to sterilise the chest before inserting a chest tube.

Using a debrillator to "shock" asystole.

Inserting IV cannulas in the wrong direction.

Placing a tongue depressor in a patient having a seizure.

The vodka might have worked---but not recommended anyway.