Flexible Fiberoptic Exam True Vocal Cords abducted True Vocal Cords adducted *Fiberoptic endoscopy, image is true.
Cerumen Removal Position Patient -Explain Procedure Visualize Canal/Landmarks Determine BEST Procedure -Remove Cerumen Re-Inspect Ear Modified semireclined position allows visualization of attic space. Use largest size speculum that fits & place deep enough to clear the hair-bearing skin. Hold speculum between first & second finger to retract the pinna up & backward in an adult. Visualize membrane and identify landmarks. Suction Currette Alligator Forceps Warm Irrigation
Manual Pneumatic Otoscopy Pull the ear upwards and backwards to straighten the canal before inserting otoscope. Insert the otoscope to a point just beyond the protective hairs in the ear canal. Use the largest speculum that will fit comfortably. Anchor otoscope - hold the otoscope with your thumb and fingers so that your hand makes contact with the patient. Insufflate with non-dominant hand. Observe movement of tympanic membrane. Pneumatic Otoscopy Kit measures pressure.
Removal Foreign Body (Ear) Foreign Bodies eraser heads, beads, cotton tips, bugs, etc removal requires direct visualization prior to removal either via warm irrigation with syringe, or instruments like an alligator forceps, currette or suction. Drown insects with mineral oil or lidocaine before attempting removal. Use warm water as cold water may cause dizziness.
Removal Foreign Body (Nose) Good visualization: headlamp & nasal speculum. Alligator forceps should be used to remove cloth, cotton, or paper Bayonet forceps or Kelly clamps are great for hard FB, or they may be rolled out by getting behind it using an ear curette, single skin hook, or right angle ear hook.
Control Anterior Epistaxis Apply direct manual pressure for at least 10 minutes. Spray or apply topical anesthetic with decongestant. Reapply direct manual pressure an additional 10 minutes. Control bleeding with silver nitrate cauterization. (start from outside in). Caution bilateral cauterization as may result in septal perforation. Lubricate naris with Vaseline or Neosporin ointment. Let sit for 10-15 minutes to ensure hemostasis. Keep cotton in nares for at least 1 hour to prevent staining. Avoid sneezing, forceful nose blowing, nose picking, etc. Follow up 2 weeks as re-cauterization may be necessary.
Control Posterior Epistaxis Thoroughly soak in sterile water for 30 seconds. Insert Rapid Rhino into the patient s nostril parallel to the septal floor, or following along the superior aspect of the hard palate, until the blue indicator ring is inside the opening of the nostril. Using a 20 cc syringe, slowly inflate the posterior (green stripe) balloon first with air only inside the patient s nose. Inflate second balloon with air. Allow the patient to sit for 15-20 minutes prior to discharge. Swelling in the nasal anatomy will reduce and the balloons may need to be inflated more to avoid movement of the device. Don t forget prophylaxis antibiotics! To remove, deflate balloons 24-72 hours later. Procedures Workshop: Advanced Course
Tracheostomy Care Obstruction Change Trach Decannulation Mercado 2011 Leaks Bleeding Advanced Course
PTA Needle Aspiration Mercado 2011 Mercado 2011 1. Apply topical anesthetic, inject local anesthetic. 2. Insert large bore needle with guard (optional) over area of greatest fluctuance (imaging). 3. Aspirate pus (release pressure when with drawing). 4. Oral antibiotics PCN based and oral steroids. Advanced Course
Fine Needle Aspiration 1. Use a 3, 5, 10 or 20 ml syringe with at least 1 ½ inch needle 22 to 25 gauge. 2. Stabilize the mass with nondominant hand. 3. Insert needle through the skin with a quick motion. 4. Aim needle toward the center of small masses but toward the periphery of larger masses as the center may be necrotic. 5. With the needle in the mass, the needle tip should be moved in short motions initially to loosen cells within the mass. 6. Aspirate and make multiple passes through lesion. 7. Release pressure as needle is withdrawn. 8. Transfer specimen to slide and fix with fixative. Mercado 2011 Mercado 2011 Advanced Course Mercado 2011