Central Venous Catheterization
In medicine, a central venous catheter ("central line", "CVC", "central venous line" or "central venous access catheter") is a catheter placed into a large vein in the neck (internal jugular vein), chest (subclavian vein) or groin (femoral vein). It is used to administer medication or fluids, obtain blood tests (specifically the "mixed venous oxygen saturation"), and directly obtain cardiovascular measurements such as the central venous pressure. Certain medications, such as inotropes and amiodarone, are preferably given through a central line.
Abscess incision & Drainage
Incision and drainage
Abscess five days after incision and drainage.
The abscess should be inspected to identify if foreign objects are a cause, which may require their removal. If foreign objects are not the cause, a doctor will incise and drain the abscess and prescribe painkillers and possibly antibiotics.
Surgical drainage of the abscess (e.g., lancing) is usually indicated once the abscess has developed from a harder serous inflammation to a softer pus stage. This is expressed in the Latin medical aphorism: Ubi pus, ibi evacua.
In critical areas where surgery presents a high risk, it may be delayed or used as a last resort. The drainage of a lung abscess may be performed by positioning the patient in a way that enables the contents to be discharged via the respiratory tract. Warm compresses and elevation of the limb may be beneficial for a skin abscess.
Chest Tube Insertion
The insertion technique is described in detail in an article of the NEJM. The free end of the tube is usually attached to an underwater seal, below the level of the chest. This allows the air or fluid to escape from the pleural space, and prevents anything returning to the chest. Alternatively, the tube can be attached to a flutter valve. This allows patients with pneumothorax to remain more mobile.
British Thoracic Society recommends the tube is inserted in an area described as the "safe zone", a region bordered by: the lateral border of pectoralis major, a horizontal line inferior to the axilla, the anterior border of latissimus dorsi and a horizontal line superior to the nipple[citation needed]. More specifically, the tube is inserted into the 5th intercostal space slightly anterior to the mid axillary line.
Chest tubes are usually inserted under local anesthesia. The skin over the area of insertion is first cleansed with antiseptic solution, such as iodine, before sterile drapes are placed around the area. The local anesthetic is injected into the skin and down to the muscle, and after the area is numb a small incision is made in the skin and a passage made through the skin and muscle into the chest. The tube is placed through this passage. If necessary, patients may be given additional analgesics for the procedure. Once the tube is in place it is sutured to the skin to prevent it falling out and a dressing applied to the area. Once the drain is in place, a chest radiograph will be taken to check the location of the drain. The tube stays in for as long as there is air or fluid to be removed, or risk of air gathering.
Chest tubes can also be placed using a trocar, which is a pointed metallic bar used to guide the tube through the chest wall. This method is less popular due to an increased risk of iatrogenic lung injury. Placement using the Seldinger technique, in which a blunt guidewire is passed through a needle (over which the chest tube is then inserted) has been described.
Positive pressure ventilation
In emergency medicine positive pressure ventilation (PPV) refers to the process of forcing air into the lungs of a (usually apneic or dyspneic) patient, usually using a bag valve mask (BVM) or mechanical ventilator.
"NIPPV" is an abbreviation for "non-invasive positive pressure ventilation".[1]
During normal breathing, air is drawn into the lungs from the outside by the expansion of the chest wall and contraction of the diaphragm to increase volume inside the thoracic cavity. If the airway is sealed, the expansion of the thoracic cavity creates negative pressure inside the lungs relative to the atmospheric pressure outside the body. Hence, during normal breathing air is said to be drawn into the lungs by negative pressure. Positive pressure ventilation, however, works by forcing air into the lungs and thereby increasing the pressure inside the airway relative to the outside. Hence the name "positive pressure." Aside from the obvious advantage of ventilating an otherwise apneic or dyspneic patient, PPV can be effectively used in the treatment of flail segments, which characteristically render negative pressure breathing ineffective, but does not impede PPV.
Pelvic Examination
A pelvic examination, also pelvic exam, is a physical examination of the female pelvic organs.
Broadly, it can be divided into the external examination and internal examination.
It is also called "Bimanual Exam" & "Manual Uterine Palpation".
Orotracheal Intubation
Tracheal intubation (often simply referred to as intubation) is the placement of a flexible plastic tube into the trachea to protect the airway and provide a means of mechanical ventilation. The most common route for tracheal intubation is orotracheal where, with the assistance of a laryngoscope, an endotracheal tube is passed through the oropharynx, glottis, and larynx into the trachea. A high-volume, low-pressure cuff is then typically inflated near the distal tip of the tube to help secure it in place and protect the airway from blood, gastric contents and other secretions. Another route for tracheal intubation is nasotracheal, where an endotracheal tube is passed through the nasopharynx, glottis, and larynx into the trachea. Other routes for intubation of the trachea include the cricothyrotomy (used almost exclusively in emergency circumstances), and the tracheotomy (used primarily in circumstances where a prolonged need for airway support is anticipated).
After the trachea has been intubated and the tube has been secured to the face or neck, the proximal end of the tube is connected to a T-piece, anesthesia breathing circuit, bag valve mask device, or a mechanical ventilator. Once there is no longer a need for ventilatory assistance and/or protection of the airway, the tracheal tube may be removed; this is referred to as extubation of the trachea (or decannulation, in the case of a surgical airway such as a cricothyrotomy or a tracheotomy).
SOURCE: Wikipedia!
Please comment if any of the links are broken.
0 comments:
Posting Komentar