Questions and Answers
What is the definition of Battery in a medical context?
What are contraindications to venipuncture? (Select all that apply)
What is a common complication of venipuncture?
What is the target vein for venipuncture?
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What angle should the needle be inserted for venipuncture?
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Where should a tourniquet be placed during venipuncture?
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What direction should the bevel of the needle face when inserting for venipuncture?
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What are the most commonly used catheters for IV access?
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What gauge are large bore IVs typically?
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What is the most commonly used artery for arterial puncture?
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What is an indication for arterial puncture?
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What is a common complication of arterial puncture?
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What should be done to prevent hematoma after arterial puncture?
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What are contraindications for arterial puncture? (Select all that apply)
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Which sites are common for IM injections?
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What is the optimal site for intradermal injection?
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What is the needle size range for local anesthesia?
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The _____ stitch lies in a plane perpendicular to the skin and is useful for closing deeper wounds.
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Incisions should be made along tension lines.
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What are the three conditions that must be met for informed consent?
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What does PARQ stand for in medical consent?
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Verbal consent is as binding as written consent.
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Study Notes
Battery
- Intentional non-consensual touching of a patient.
Contraindications to Venipuncture
- Avoid areas with skin infection, extensive scarring, or previous IV sites.
- Do not puncture on the side of ipsilateral mastectomy, hematomas, or fistulas.
Complications of Venipuncture
- Potential complications include infection, thrombosis, vein laceration, hematoma (most common), and vasovagal syncope.
Boundaries of the Cubital Fossa
- Defined by lateral epicondyle, pronator teres, and brachioradialis muscles.
Target Vein for Venipuncture
- The median cubital vein is the preferred site.
Venipuncture Angle
- Insert needle at an angle of 15-20 degrees.
Tourniquet Placement
- Apply 3-4 inches above the planned venipuncture site.
Needle Orientation for Venipuncture
- Bevel of the needle should face upward during insertion.
Common Catheters for IV Access
- Over-the-needle catheters are typically used.
Large Bore IV Size
- Use 16 or 18 gauge needles for large bore IVs.
Contraindications to IV Access
- Avoid IV access in burned, swollen, or injured extremities, cellulitis, and areas of poor circulation.
Common Artery for Arterial Puncture
- The radial artery is predominantly used for this procedure.
Indications for Arterial Puncture
- To obtain accurate levels of gases dissolved in blood to assess ventilation and oxygenation.
Complications of Arterial Puncture
- Risks include hematoma (most common), thrombosis, arterial spasm, nerve damage, and rare infections.
Hematoma Prevention Post-Arterial Puncture
- Apply pressure to the puncture site for 10 minutes to minimize hematoma formation.
Contraindications to Arterial Puncture
- Avoid if the arterial pulse is not palpable, due to arterial diseases, coagulopathy, or infection in certain areas.
Common IM Injection Sites
- Deltoid, ventrogluteal (first choice), vastus lateralis (preferred in infants), and dorsogluteal.
Purpose of Intradermal Injections
- Commonly used for skin testing, including allergies and TB testing.
Needle Sizes for Injections
- IM injections: 18-22 gauge, Subcutaneous: 26-29 gauge, Intradermal: 25-27 gauge.
Optimal Intradermal Injection Site
- The ventral forearm is the best site for intradermal injections.
Endotracheal Tube Insertion Depth
- In adults, the tube should be inserted 18-24 cm.
Sedatives for Endotracheal Intubation
- Fentanyl and midazolam are commonly used sedatives.
Paralysis Agents for Intubation
- Succinylcholine is typically employed for muscle relaxation during intubation.
Indications for Endotracheal Intubation
- Necessary when a patient cannot maintain a patent airway or if they're at risk of inadequate ventilation.
Contraindications to Endotracheal Intubation
- Laryngeal disruption can prevent intubation.
Contraindications for Applying a Cast
- Do not apply casts during acute injury phases or over existing infections or wounds.
Types of Splints
- Include gutter splint, posterior mold, and sugar tong splint.
Indications for Volar Splint
- Used for fractures of the 4th and 5th phalanges and metacarpals.
Indications for Sugar Tong Splint
- Effective for colles and forearm fractures.
Timing for Cast or Splint Checks
- Re-assess the condition within 3-7 days after application.
Categories of Local Anesthetics
- Classified into esters and amides.
Examples of Esters
- Include benzocaine, cocaine, procaine, and tetracaine.
Examples of Amides
- Include lidocaine, mepivacaine, bupivacaine, dibucaine, and prolocaine.
Factors Affecting Local Anesthesia
- Rate of conduction, nerve fiber diameter, presence of myelin, anesthetic solution, vascularity, and concentration impact anesthesia effectiveness.
Indications for Local Anesthesia
- Suitable for any procedure localized to one area with expected discomfort.
Contraindications to Local Anesthesia
- Include unstable BP, true allergies, severe liver or renal disease, and mental instability.
Needle Size for Local Anesthesia
- Use 27-30 gauge needles.
Type of Nerve Block for Incision & Drainage
- A regional field block is typically used.
Incision Technique
- Incisions should follow tension lines.
Common Complication of Local Anesthesia
- The most frequent issue is anxiety over injection leading to a vasovagal reaction.
Systemic Complications of Local Anesthesia
- May include hypotension, bradycardia, and central nervous system reactions.
Contraindications for Suturing
- Assess each case individually; avoid in immunocompromised patients, grossly contaminated wounds, or puncture wounds.
Suture Sizes
- Use 6-0 for facial lacerations; 3-0, 4-0, or 5-0 for torso or extremities.
Suture Placement Angle
- Maintain a 90-degree angle or less during placement.
Time Frame for Sutures Removal
- Face: 5 days; scalp, torso, extremities: 7-10 days; high-tension areas: 10-14 days.
Simple Interrupted Stitch
- A basic suture technique with alternating throw motions.
Vertical Mattress Stitch
- Suture lies perpendicular to skin; effective for deeper wound closure.
Horizontal Mattress Stitch
- Stitch parallels skin; useful for tissue flaps or when tension needs to be applied to one side.
Continuous-Running Baseball Stitch
- Utilizes a series of running stitches for effective closure.
Indications for Incision and Drainage
- To address localized infections that are tender and not resolving.
Contraindications for Incision and Drainage
- Avoid on facial furuncles near the mouth and abscesses near the rectum/genitalia in high-risk patients.
Conditions for Informed Consent
- Patient's capacity for decision-making, provision of adequate information, and voluntary consent.
PARQ Elements
- Procedure, Alternatives, Risks, Questions.
Reasonable Person Standard
- Providers must disclose all material information necessary for a reasonable patient's decision-making.
Exceptions to Informed Consent
- Emergencies, patients unable to consent, waiver of consent, public health needs, and therapeutic privilege.
Therapeutic Privilege
- Allows providers to withhold certain information based on patient's mental state, where disclosure may cause harm.
Verbal vs. Written Consent
- Verbal consent carries the same weight as written consent, though the latter is preferred.
Injection Degrees of Entry
- Intradermal: 15 degrees, Subcutaneous: 45 degrees, Intramuscular: 90 degrees.
Anesthetic Injection Timing
- Anesthetic should be injected upon withdrawing the needle.
Digital Block
- Used to anesthetize fingers; beneficial for suturing and relocating fingers, utilizing 1-2% lidocaine without epinephrine.
Indication for Surgeon's Knot
- Important when consistent tension must be maintained during closures.
Standard Precautions
- Guidelines designed to reduce the spread of infectious diseases through contact with body fluids.
Surgical Hand Scrub Materials
- Use chlorhexidine gluconate or povidone iodine solutions for effective sterilization.
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Description
This quiz covers essential terms and definitions related to diagnostics in healthcare, focusing on procedures such as venipuncture. It includes key concepts like battery, contraindications, and complications. Perfect for healthcare professionals preparing for examinations.
