This document provides information on various medical procedures. It begins by defining cardiopulmonary resuscitation (CPR) and its components of assessing airway, breathing, circulation, and obtaining emergency help. It then describes procedures for inserting a nasogastric tube, placing an intravenous cannula, performing abdominal paracentesis and thoracentesis, and intubating a patient. Risks and steps for each procedure are outlined. References on clinical medicine and life support are also listed.

2.  DEFINITION.
 COMPONENTS.
Access
Asses
Call for help.
Airway
Breathing
Circulation
Defrilation.
Environment

3. Shake shoulders gently
Ask “Are you all right?”
If s/he responds.
• Leave as you find him.
• Find out what is wrong.
• Reassess regularly.

5. Head tilt and chin lift
- lay rescuers
- non-healthcare rescuers
No need for finger sweep
unless solid material can be seen in the
airway

6. Look, listen and feel for NORMAL
breathing
Do not confuse agonal breathing with
NORMAL breathing
Occurs shortly after the heart
stops
in up to 40% of cardiac
arrests
Described as barely, heavy,
noisy or gasping breathing
Recognise as a sign of cardiac
arrest

9. • Place the heel of one hand
in the centre of the chest
• Place other hand on top
• Interlock fingers
• Compress the chest
– Rate 100 min-1
– Depth 4-5 cm
– Equal compression :
relaxation
• When possible change CPR
operator every 2 min

10. Pinch the nose
Take a normal breath
Place lips over mouth
Blow until the chest rises
Take about 1 second
Allow chest to fall
Repeat

13. › Qualified help arrives and takes over
› The victim starts breathing normally
› Rescuer becomes exhausted

14.  INTRODUCTION
 DEFINITION.
 PROCEDURES
Hand washing.
Putting Gloves.
NG TUBING(RYLE’s Tubing)
IV Cannulae /Open IV.
Ascitic tap.
Pleural Tap.
Catheterizing the bladder.

15.  INTUBATION/ENDOTRACHEAL
INTUBATION.
 LAPARATOMY.
 CRICOTHYROIDOTOMY
 LUMBER PUNCTURE.
 BIOPSIES
 CSF ANALYSIS.
etc

18.  Nasogastric (Ryle's) tubes
 These tubes are passed into the stomach via either
the nose or the mouth, and drain externally. Sizes:
16 = large, 12 = medium, 10 = small.
 Uses:
To empty the stomach (pre-op, or in acute
pancreatitis, or paralytic ileus).
 For irreversible dysphagia (eg motor neurone
disease).
 For feeding ill patients (use a special fine-bore
tube).

20.  Wear sterile /non-sterile gloves.
 Explain the procedure.
 Take fresh new flexible tube.
 Get all requirements.
 Asses the lenth of tube by measurement.
 Lubricate the tube
 Stabilize pt. start process.
 When tube riches to throat ,encourage to
swallow.

21.  Continue until the pipe riches to stomach.
 Aspirate fluid, check pH.
 Stitch the tube to nostril.
 Use as requirement.

22.  Pain, or, rarely:
 Loss of electrolytes
 Oesophagitis
 Tracheal or duodenal intubation
 Necrosis: retro- or nasopharyngeal
 Perforation of the stomach

23.  Set up tray.
 Set up drip with stand.
 Take help if required.
 Explain procedure.
 Search hard and best vein.
 Sit comfortably.
 Tap the vein
 Clean the skin and open vein.

25.  Connect fluid tube and check flow.
 Fix cannulae with firm bandage.
 Immobilize if possible
 Calculate fluid rate and mention chart.

26.  Explain to the patient that veins are difficult.
 Fetch a bowl of warm water. This gives you
time to calm down.
 Immerse the patient's arm in the warm water
for 2min.
 Use a blood pressure cuff at 80mmHg as a
tourniquet—and try again.
 Alternatively, a small amount of GTN paste
over the vein may enlarge it

27.  Place the patient flat and tap out the ascites,
marking a point where fluid has been identified,
avoiding scars or vessels.
 Clean the skin. May need some local
anaesthetic.
 Insert a 21G needle on a 20mL syringe into the
skin and advance while aspirating until fluid is
withdrawn.
 Remove the needle and apply a sterile
dressing.
 Send fluid for microscopy, culture, chemistry
(protein), and cytology.

28.  Percuss the upper border of the pleural effusion and
choose a site 1 or 2 intercostal spaces below it
(usually posteriorly or laterally).
 Mark the spot and then clean the area with an
antiseptic solution.
 Infiltrate down to the pleura with 5–10mL of 1%
lidocaine.
 Attach a 21G needle to a syringe and insert it just
above the upper border of the rib below the mark
(avoids neurovascular bundle). Aspirate whilst
advancing the needle.
 Draw off 30mL of pleural fluid.

29.  Advance invasive procedure.
 Require skilled hand and anaesthetic.
 Require special device called laryngoscope.
 It is done in life-threatening respiratory
conditions.
 It is a life saving procedure.

32.  Asses the patient and confirm need for
intubation.
 Prepare the requirement.
 Obtain the laryngoscope and check it.
 Check the endo-tracheal tube.
 Maintain position in chin lift position.
 Start procedure
 Connect to ventilater.

34.  Oxford handbook of clinical medicine,6th
edition, langmore & murray et.al the oxford
university press.
 Harrison’s manual of medicine ,17th edition
,Mc-Graw hill publication.
 The journal on European medicine program
on basic life support.
 Mayo-clinic medicine review,7th edition,the
mayo-clinic publication.
 IMAGE SOURCE-EMR & GOOLE.