medical procedures
TRANSCRIPT
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Medical Procedures:Concepts & Basics
Jirapong Supasaovapak M.D.Jirapong Supasaovapak M.D.Department of Emergency MedicineDepartment of Emergency MedicineRajavithi HospitalRajavithi Hospital
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Please get better!Please get better!
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ConceptsConcepts
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First, First, Do no harmDo no harm– Hippocrates
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Indications?Indications?
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ContraContraindications?indications?
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PreparationPreparation
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TechniqueTechnique
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AssessmentAssessment
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SpO2
68Complications?Complications?
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AftercareAftercare
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Medical Procedures:The Concepts
Indications
Contraindications
Preparation
Technique
Assessment
Complications
Aftercare
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First, First, Do no harmDo no harm– Hippocrates
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Exercise #1
NasoGastric tube
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x
Indications
Contraindications
Preparation
Technique
Assessment
Complications
Aftercare
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NG Tube measuringNG Tube measuringTechnique
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AssessmentAssessment
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Wound careWound care
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Wound ClassificationWound Classification
Mechanism of InjuryMechanism of Injury
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Wound ClassificationWound Classification
ContaminationContamination
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x
Clean woundClean wound
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Contaminated woundContaminated wound
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Suture ?Suture ?
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Infection Healing
Time of Injury
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1224 h
612 h
6 h
6 h
Golden PeriodGolden Period for Wound Repair
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Primary IntentionPrimary Intention wound closure
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Secondary IntentionSecondary Intentionwound closure
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Tertiary Intention (Delayed Primary)Tertiary Intention (Delayed Primary)wound closure
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Wound Assessment
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LocationLocation&&
DepthDepthlaceration3x1 cm
Cut wound 3 cm
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TendonTendon
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VascularVascular
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NerveNerve
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Suture techniquesSuture techniques
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1% Xylocaine
1 cc = 10 mg
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Xylocaine: Maximum dose
without Adrenaline = 5 mg/kg
with Adrenaline = 7 mg/kg
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Digital Nerve BlockDigital Nerve Block
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Tetanus ProphylaxisTetanus Prophylaxis
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Tetanus-prone wound?Tetanus-prone wound?
Contaminants
Dead tissue
Infection
Time > 6 h
Depth > 1 cm
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Unknown />10 y
510 y
<5 y
TT x 3TAT
TT x 1
Tetanus-prone NotTetanus-prone
TT x 3
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Antibiotics?Antibiotics?
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Animal Bites
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ชาย อายุ ชาย อายุ 30 30 ปี ถกูสุนัขจรจัดกัด ปี ถกูสุนัขจรจัดกัด
Management?Management?
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Category I
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Category II
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Category III
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Post-exposure prophylaxisRabiesRabiesVaccine
RIG
Category II,III
Category III
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HE
x 40 u/kg
x 20 u/kg RIG
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Vaccine regimensVaccine regimens
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IMDay 0, 3, 7, 14, 28
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ID
804011
222011
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เคยฉีดวัคซีนแล้วเคยฉีดวัคซีนแล้ว
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Post-exposure boosterRabiesRabiesVaccine
Category II,III
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Rabies Vaccine Rabies Vaccine boosterbooster
< 6 mo
>=6 mo
Day 0
Day 0, 3
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Exercise #2
Foley's Catheter
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Medical Procedures:The Concepts
Indications
Contraindications
Preparation
Technique
Assessment
Complications
Aftercare
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ContraContraindicationsindications
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Contraindication forFoley's Catheter
= Suspected Urethral injury
●Perineal hematoma
●Bleeding per urethral meatus
●High riding prostate
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Interesting ProceduresInteresting Procedures
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Ring RemovalRing Removal
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Lubricant techniqueLubricant technique
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String techniqueString technique
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String techniqueString technique
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Glove techniqueGlove technique
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Ring cutterRing cutter
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Fishhook Removal
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Pull-through techniquePull-through technique
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Pull-through with Pull-through with multi-barbed fishhookmulti-barbed fishhook
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Zipper Injury &
Penile block
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Penile BlockPenile Block
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ZipperZipper
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Median Bar CuttingMedian Bar Cutting
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Median Bar CuttingMedian Bar Cutting
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Cutting AroundCutting Around
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Indications
Contraindications
Preparation
Technique
Assessment
Complications
Aftercare
Summary:Basic procedure concepts