Medical procedures

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Medical procedures

  1. 1. Medical Procedures: Concepts & Basics Jirapong Supasaovapak M.D.Jirapong Supasaovapak M.D. Department of Emergency MedicineDepartment of Emergency Medicine Rajavithi HospitalRajavithi Hospital
  2. 2. Please get better!Please get better!
  3. 3. ConceptsConcepts
  4. 4. First,First, Do no harmDo no harm – Hippocrates
  5. 5. Indications?Indications?
  6. 6. ContraContraindications?indications?
  7. 7. PreparationPreparation
  8. 8. TechniqueTechnique
  9. 9. AssessmentAssessment
  10. 10. SpO2 68 Complications?Complications?
  11. 11. AftercareAftercare
  12. 12. Medical Procedures: The Concepts Indications Contraindications Preparation Technique Assessment Complications Aftercare
  13. 13. First,First, Do no harmDo no harm – Hippocrates
  14. 14. Exercise #1 NasoGastric tube
  15. 15. x Indications Contraindications Preparation Technique Assessment Complications Aftercare
  16. 16. NG Tube measuringNG Tube measuring Technique
  17. 17. AssessmentAssessment
  18. 18. Wound careWound care
  19. 19. Wound ClassificationWound Classification Mechanism of InjuryMechanism of Injury
  20. 20. Wound ClassificationWound Classification ContaminationContamination
  21. 21. x Clean woundClean wound
  22. 22. Contaminated woundContaminated wound
  23. 23. Suture ?Suture ?
  24. 24. Infection Healing Time of Injury
  25. 25. 12­24 h 6­12 h 6 h 6 h Golden PeriodGolden Period for Wound Repair
  26. 26. Primary IntentionPrimary Intention wound closure
  27. 27. Secondary IntentionSecondary Intention wound closure
  28. 28. Tertiary Intention (Delayed Primary)Tertiary Intention (Delayed Primary) wound closure
  29. 29. Wound Assessment
  30. 30. LocationLocation && DepthDepth laceration 3x1 cm Cut wound 3 cm
  31. 31. TendonTendon
  32. 32. VascularVascular
  33. 33. NerveNerve
  34. 34. Suture techniquesSuture techniques
  35. 35. 1% Xylocaine 1 cc = 10 mg
  36. 36. Xylocaine: Maximum dose without Adrenaline = 5 mg/kg with Adrenaline = 7 mg/kg
  37. 37. Digital Nerve BlockDigital Nerve Block
  38. 38. Tetanus ProphylaxisTetanus Prophylaxis
  39. 39. Tetanus-prone wound?Tetanus-prone wound? Contaminants Dead tissue Infection Time > 6 h Depth > 1 cm
  40. 40. Unknown / >10 y 5­10 y <5 y TT x 3 TAT TT x 1 Tetanus-prone Not Tetanus-prone ­­ ­­ ­­ TT x 3
  41. 41. Antibiotics?Antibiotics?
  42. 42. Animal Bites
  43. 43. ชาย อายุชาย อายุ 3030 ปี ถูกสุนัขจรจัดกัดปี ถูกสุนัขจรจัดกัด Management?Management?
  44. 44. Category I
  45. 45. Category II
  46. 46. Category III
  47. 47. Post-exposure prophylaxisRabiesRabies Vaccine RIG Category II,III Category III
  48. 48. H Ex 40 u/kg x 20 u/kg RIG
  49. 49. Vaccine regimensVaccine regimens
  50. 50. IM Day 0, 3, 7, 14, 28
  51. 51. ID 8­0­4­0­1­1 2­2­2­0­1­1
  52. 52. เคยฉีดวัคซีนแล้วเคยฉีดวัคซีนแล้ว
  53. 53. Post-exposure boosterRabiesRabies Vaccine Category II,III
  54. 54. Rabies VaccineRabies Vaccine boosterbooster < 6 mo >=6 mo Day 0 Day 0, 3
  55. 55. Exercise #2 Foley's Catheter
  56. 56. Medical Procedures: The Concepts Indications Contraindications Preparation Technique Assessment Complications Aftercare
  57. 57. ContraContraindicationsindications
  58. 58. Contraindication for Foley's Catheter = Suspected Urethral injury ●Perineal hematoma ●Bleeding per urethral meatus ●High riding prostate
  59. 59. Interesting ProceduresInteresting Procedures
  60. 60. Ring RemovalRing Removal
  61. 61. Lubricant techniqueLubricant technique
  62. 62. String techniqueString technique
  63. 63. String techniqueString technique
  64. 64. Glove techniqueGlove technique
  65. 65. Ring cutterRing cutter
  66. 66. Fishhook Removal
  67. 67. Pull-through techniquePull-through technique
  68. 68. Pull-through withPull-through with multi-barbed fishhookmulti-barbed fishhook
  69. 69. Zipper Injury & Penile block
  70. 70. Penile BlockPenile Block
  71. 71. ZipperZipper
  72. 72. Median Bar CuttingMedian Bar Cutting
  73. 73. Median Bar CuttingMedian Bar Cutting
  74. 74. Cutting AroundCutting Around
  75. 75. Indications Contraindications Preparation Technique Assessment Complications Aftercare Summary: Basic procedure concepts

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