Kettering-Special Procedures
Terms
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- What is a bronchoscopy?
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-Allows the technologgist to visualize the trachea and bronchi
- Performed for diagnostic and therapeutic reasons
- Recommended for intubation with suspected neck fracture - What medication is used for a bronchoscope
- Lidocaine to control the gag reflex and prevent laryngospasm. Given down ET tube or trach tube
- What is the most common complication of a broncoscopy?
- -Mild epistaxis (nasal bleeding)
- What should you do if the patient gets a major nose bleed?
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1. *Instill epinephrine
2. Compress site with scope
3. Insert a fogarty catheter - What is a thoracentesis?
- A diagnostic/therapuetic procedure where a needle is inserted into the chest to remove air/fluid from the pleural space.
- What is the most common disorder that requires thoracentesis
- Plearal effusion
- How can you establish the presence of a pleual effusion
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1. X-ray: lateral decubitis with concave upper border
2. Flat percussion and diminished breath sounds and tracheal shift away from site
3. Ultrasound - What is the most common position for a patient to be in for a thoracentesis
- Patient sits up and leans forward.
- How much pleural fluid should be withdrawn during thoracentesis
- 100-300 mL
- What is transudate fluid and what does it indicate
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-It is clear with a light straw color. Also called serous fluid
- Associated with congestive heart failure - What is exudate and what does it indicate?
- -Empyema with an opaque color. Yellow or mikly exudate fluid indicates infection
- What is cardioversion?
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A therapeutic procedure that involves a administrating a low voltage current to heart tissue in an attempt to convert a cardiac dysrhythmia to a normal sinus rhythsm
-**Make sure synchronizing switch is ON before cardioverting*** - How many watts should you give during cardioversion
- 50 or less
- What drug is usually given during cardioversion
- Midazolam (Versed) is a strong, short acting sedative given prior to the cardioversion
- What is defibrillation
- Similar to cardioversion except that it is used when emergency cardiac dysrhythmias are present
- What are the indecations for defibrillation
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1. Pulseless ventricular tachycardia
2. Ventricular Flutter
3. V Fibrillation - What are indications of central apnea
- If naals flow decreases AND respiratory effort decreases than desaturation is a central problem
- What are indications of Obstructive sleep apnea
- If nasal flow decreases BUT respiratory effor increases
- How might you treap apnea
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-CPAP/Bipap
- Adjust levels to provide relief of symptoms - What conditions require chest tubes
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-If air enters the pleural space with little or no fluid it is a pneumothorax
- Fluid that enters the pleural cavity with no air is called a hemothorax or pleual effusion - What should you do if you suspect a pneumo
- Immediate action should be to insert a large bore needle to relieve the pressure. Then insert a chest tube and apply the most appropriate chest tube drainage system.
- Where should the chest tube be placed if you are draining air?
- In the anterior chest (second interspace in the midclavicular line)
- Where should the chest tube be placed if you are draining fluid?
- Between the fourth and fifty interspace in the midaxillary line.
- In a two bottle water seal chest drainage system, what do fluctuations in the water level tell you?
- There is a good respiratory effor.
- In a two bottle water seal chest drainage system, what do disappearance of fluctuations in the water level tell you?
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1. No more air leak (no more pneumo)
2. Obstruction or kinking of tube. Clear obstructions by milking tubing away from chest toward bottle - In a three bottle water seal chest drainage system, what does the water height in the suction control bottle indicate
- The suction control bottle, in relation to Tube C, will determine the amount of negative pressure regardless of the amount of suction through Tube D
- In a three bottle water seal chest drainage system, what does the middle bottle do?
- It is the water seal bottle preventing air from entering the pleural cavity. There should be little or no bubbling. Continuous bubbling indicates an air leak
- In a three bottle water seal chest drainage system, what should you do if the water seal breaks
- -Submerge chest tube in a glass of water. If patient is receiving mechanical vent, leave the tube open to atmospheric air until a new system can be set up
- What should you remember with a disporable drainage unit
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If on mechanical ventilation, measure volume lost through chest drainage system and adjust vent. based upon ABG
- When collection chamber is full, replace it. - What should you do before removing a chest tube?
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-Have patient take a deep breath, exhale and perform Valsaslva maneuver
- Base decision of BOTH bedside assessment and lab. data - Special Procedures
- note
- Emergency Care
- Emergency Care