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