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