. .
.
2553
.
National Licensing Examination Part III Formative evaluation EX (examination, ) SS self study NLE part III (4 20 ) . , 20-23 NLE part III
.
1
(
2553
)
1
24
44 57 76
87
1.
Drug injection a.
Intramuscular drug injection
b.
Subcutaneous drug injection
a.
Venepucture
b.
IV Fluid
2.
( Venepucture and IV Fluid)
3.
arterial blood gas
4.
5.
transfusion) (Blood and blood components
6.
(Urinary catheterization)
a. b. 7.
(Female urinary catheterization)
(Male urinary catheterization)
Nasogastric tube
1
1
1. Drug injection
1.1
(Intramuscular injection) EX
(
1
2)
(5
1. 1.
2.
3. 4.
//////////////////
)
(3
//////////////////
//////////////////
21-25 G (antiseptic)
70%
ethanol
5.
diclofenac IM , Benzatine penicilin
(
IM, Hepatitis B vaccine )
6.
platelet dysfunction,
coaggulopathy
2. 1.
//////////////////
//////////////////
upper one-third of upper arm 2-3 acromion process) (upper outer quadrant of gluteal muscle) 1 5 1 3. 4. 2.
(deltoid muscle
5.
7.
2
(antiseptic)
6.
landmark
2
)
//////////////////
(0
)
9. 10. 1-2 3. ////////////////// ////////////////// ////////////////// 1. Sciatic nerve injury 2. median nerve injury upper one-third 3. ( ) 4. 5. 6. 7. 8.
3
1
Subcutaneous (Subcutaneous injection )
1.2
EX
(
2)
(5
1.
1.
//////////////////
3. 4.
//////////////////
(3
)
(0
)
//////////////////
insulin (antiseptic)
2.
)
24-25
70%
ethanol
( insulin subcutaneous, NPH = , RI= )
5.
2.
1.
2.
3.
insulin insulin
*
6.
8. 9.
syringe
10. 11.
4
insulin
syringe
insulin
insulin
70% alcohol
syringe
//////////////////
insulin
syringe
syringe
7.
syringe
70% alcohol insulin
insulin
//////////////////
*
//////////////////
insulin
4.
5.
12.
syringe
(
3.
5.
1. 2.
4.
45-90°
13.
3.
syringe
//////////////////
)
//////////////////
//////////////////
5
1
( Venepucture and IV Fluid)
2.
2.1 Venepucture EX
(
2)
(5
1. 1.
2.
//////////////////
(3 )
)
//////////////////
//////////////////
3.
4.
) 6. (antiseptic) 70% ethyl alcohol, 2% tincture iodine ( 2% tincture iodine 70% ethyl alcohol) 7. 5 10 ( 10 ) 8. - 5.
20
2 1.
20-21 G (
//////////////////
//////////////////
//////////////////
2. 3.
septicemia
infective endocarditis 3.
1. 2.
cubital) 6
//////////////////
//////////////////
3.
(
)
(
(0
//////////////////
)
4.
5.
30-60
(antiseptic) 2 ethyl alcohol
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
4. 1. 2.
2-3
//////////////////
//////////////////
/////////////////
7
1
2.2 IV Fluid EX
(
2)
(5
1.
//////////////////
(3
(0
)
)
//////////////////
//////////////////
)
1.
2.
3.
4.
5.
scalp vein
Medicut
21
18-21 G (
20 G
20-18 G)
6.
(antiseptic)
70% ethyl
alcohol
7.
1. 2.
//////////////////
1. 2.
cubital
//////////////////
( ) (
//////////////////
//////////////////
)
5. 6. 70% ethyl alcohol 2 30-60 ethyl alcohol
8
//////////////////
3.
4.
2
3.
//////////////////
7.
8.
scalp vein
(
)
9.
10.
11.
12.
13.
1. 2.
medicut
)
3. 4.
)
14. 4.
(
(
(thrombosis
//////////////////
/////////////////
(phlebitis)
//////////////////
9
1
3.
arterial blood gas
EX
(
2)
(5
1.
//////////////////
)
(3
//////////////////
)
//////////////////
1. insulin syringe 2. unfractionated heparin (5,000
3.
4. 5.
ethyl
8.
2.
1. 2.
70%
1
24 G
insulin syringe
//////////////////
3.
2% tincture iodine
7.
)
(antiseptic)
alcohol
6.
/
//////////////////
//////////////////
//////////////////
unfractionated heparin insulin syringe 3. heparin 4. radial, brachial femoral 5. Modified Allen’s test ( radia ulnae artery
//////////////////
//////////////////
1. 2.
24 G
ulnae artery 6.
10
)
( ) ( ) (antiseptic)
(0
)
7.
2% tincture iodine
1
9. insulin syringe 45 10. insulin syringe 11. insulin syringe 12. 0.8-1.0 13. 5-10 ( ) 14. 70% ethyl alcohol
8.
15.
insulin syringe
insulin syringe
16.
heparin
17.
//////////////////
//////////////////
//////////////////
1. 2.
insulin syringe
4.
insulin syringe
11
1
4.
(Blood and blood components transfusion) SS
(
2) (5
1.
1–
1.
2.
(3
//////////////////
)
(0
//////////////////
OPD card
)
//////////////////
(compatibility
3.
4. label)
unit number 2.
2
//////////////////
1.
//////////////////
(PRC, LPB, FFP, PLT)
2.
identification number
3.
unit number (
2-4 ml/Kg/hr)
4 hr 4.
5.
12
record vital signs
, 15
record
//////////////////
)
3.
1.
//////////////////
//////////////////
//////////////////
//////////////////
//////////////////
2
blood component
2.
3.
4. 5.
HN
) Record vital signs sterile technique
(
blood transfusion set 6.
4.
progress note indication
//////////////////
13
1
5.
EX
(
3)
(5
1. 1.1 1.2
//////////////////
spinal 23-25 sterile
2. 2.1
-
(3 )
//////////////////
//////////////////
//////////////////
//////////////////
//////////////////
intracranial mass
1. 2.
3. Intracranial mass 4. 3.
coagulopathy
• •
•
L4
•
14
3.2
•
//////////////////
3.1
•
//////////////////
lumbar puncture
1% lidocaine
iliac crests
L3-
25
(0
)
stylet
intracranial pressure
-
2.2
//////////////////
)
spinal
•
•
23-25
stylet
(cephalad)
•
subarachnoid
•
stylet
manometer
threeCSF
manometer
manometer
way stopcock
CSF
20
cm H2O. CSF cell count , cell diff, protein, sugar Indian ink , gram, AFB stain , culture •
manometer
•
manometer
CSF
•
three-way stop cock
CSF
manometer
stylet
three-way stop cock
•
4-6
.
4. 1. 2.
three-way stop cock
//////////////////
//////////////////
//////////////////
(postdural puncture headache)
3. Transient paresthesia 4.
(
spinal anesthesia)
15
1
6.
(Urinary catheterization)
6.1
(Male urinary catheterization) EX
(
4)
(5
1.
2. 3. Forceps
//////////////////
2% xylocain jelly
4. 5. 6. 7.
Foley catheter
Forceps
,
,
2.
Foley catheter
jelly
Foley catheter
2% xylocain jelly
6.
5.
16
//////////////////
4.
//////////////////
16F
3.
//////////////////
NSS
:
//////////////////
(Transpore)
1.
//////////////////
12. 2.
)
10. K-Y jelly 11.
(3
10 CC
8. Syringe 9.
)
(0
)
7.
8.
9.
Foley
syringe Foley
Foley
10.
5-10 CC
Foley
17
1
6.2
(Female urinary catheterization) EX
(
5)
(5
1. 2. 3. Forceps
//////////////////
jelly 2% xylocain
4. 5. 6. 7.
NSS
12.
1.
Forceps
2.
Foley catheter
//////////////////
Foley catheter 2% xylocain jelly
6.
//////////////////
5.
4.
//////////////////
3.
18
(Transpore)
2.
10 CC
)
//////////////////
10. K-Y jelly 11.
(3
16F
8. Syringe
Foley catheter
9.
)
//////////////////
jelly
(0
)
7.
9.
10.
Foley
Foley
syringe Foley
8.
Foley
5-10 CC
19
1
7.
Nasogastric tube EX
(
6)
(5
1.3 1.4 1.5 1.6 2.
1. 2.
/
//////////////////
nasogastric tube
2.2
,
nasal tip
//////////////////
//////////////////
xiphoid
process
2.4
syringe for irrigation 50 ml
2.5
20
stethoscope
epigastium
(0
Nasogastric tube
1.2
2.3
)
////////////////// ////////////////// ////////////////// 18, 16 F K-Y jelly Syringe for irrigation 50 ml Stethoscope (transpore) ////////////////// ////////////////// //////////////////
1.1
2.1
(3
1.
3.
)
)
8.
( Endotracheal tube) EX
(
7)
(5
1.
1.
• • Mask
//////////////////
(3
(0
)
)
//////////////////
//////////////////
)
, self-inflating bag 3, 4, 5
• Oropharyngeal and nasopharyngeal airway
6-8
2. Laryngoscopy •
suction
10, 12, 14
suction • Magill forceps
3,4
• Laryngoscope blade
•
“sniff position”
3. endotracheal tube
4.
battery
7.5-8
7-7.5
•
• Stethoscope
2
1.
//////////////////
//////////////////
//////////////////
(ventilatory support)
2. 3.
4.
3.
1.
cervical spine atlantooccipital) 10 ( 4 D)
sniffing position (
//////////////////
//////////////////
thoracic spine
//////////////////
7-
21
1
2.
blade
laryngoscope blade
(Miller, Jacksonblade epiglottis blade (Macintosh) blade vallecula epiglottis ( 5)
•
Wisconsin) •
3. • -
cuff
•
endotracheal tube
endotracheal tube tube
I.D. 7.0-7.5 8
(I.D.) 7.5-8
cuff
tube (uncuffed )size I.D.=
/4 + 4
tube (cuffed) size I.D. =
5.
laryngoscope
tube
vocal card
6.
endotracheal tube
16-23
tube length ( tube length (
endotracheal tube
< 2 > 2
tube length (
.) = ID
(epigastrium)
.) = 15 + (
ET x 3
.) = 12 + (
7.
22
)
)
cuff
8.
(blade
epiglottis
½-1
•
endotracheal tube
.
crossed-finger technique
epiglottis (blade glottis
.
/4 + 3
laryngoscope blade blade
.
.
tube endotracheal
tube
4.
/2) /2)
2
gurgling
4. •
(Trauma)
,
//////////////////
• • • endotracheal • Autonomic reflexes • endotracheal stylet • endotracheal cuff ,
//////////////////
/////////////////
pharynx
23
2
1. Drug injection 1.1 Subcutaneous drug injection 1.2 Intradermal drug injection
2.
(Venepucture)
3. Capillary puncture (Heel puncture) 4.
Oxygen 6.1 6.2 6.3 6.4
7. 7.1 7.2
(Lumbar puncture)
6.
24
( conventional phototherapy )
5.
(cannula) (oxygen mask) (Oxygen therapy via Oxygen box) Bag – valve-mask ventilation Aerosol therapy MDI small volume medication nebulizer
1. Drug injection
Subcutaneous
1.1
(Subcutaneous drug injection) SS
(
8) (5
1.
1.
//////////////////
)
//////////////////
(3
)
(0
)
//////////////////
2. alcohol
no 27
3.
2.
0.5
4.
//////////////////
,
//////////////////
//////////////////
//////////////////
//////////////////
MMR
3.
4.
2. 3. 4.
5.
6.
5. 1.
alcohol
2. 3.
1.
7.
//////////////////
//////////////////
//////////////////
45
//////////////////
//////////////////
//////////////////
//////////////////
4. Lipodystrophy , lipoatrophy,
25
2
1.2
(Intradermal drug injection) SS
(
BCG vaccine
1.
1.
8)
(5
//////////////////
)
//////////////////
(3
)
//////////////////
2. alcohol syringe) no (tuberculin
3. 26,27
4. 2.
//////////////////
1.
2.
3.
3. 4. alcohol 5. 15 6.
2. 3.
26
//////////////////
//////////////////
dermis
//////////////////
//////////////////
5.
//////////////////
//////////////////
2.
//////////////////
BCG
1.
1.
4.
3 .
//////////////////
(0
)
2.
(Venepucture)
SS
(
8)
(5
1.
1.
2.
(3
(0
)
)
//////////////////
//////////////////
//////////////////
//////////////////
//////////////////
//////////////////
)
21
1.5
3. Syringe 5 cc
2.
1.
70%
3
(
)
2.
3. 4.
5.
syringe
3.
1. 2.
30
6.
//////////////////
//////////////////
//////////////////
27
2
3. Capillary puncture (Heel puncture) ss
(
8)
)
(5
1.
1.
//////////////////
//////////////////
(3
)
//////////////////
2. alcohol
3. lancet no 11
4.
no 21,22
5.
6.
2.
//////////////////
//////////////////
//////////////////
//////////////////
//////////////////
CBC,HCT,microbilirubin ,capillary blood gas ,VCT
3.
//////////////////
1.
2. Local edema 3. Local infection 4. Polycythemia
4.
Hct
70
//////////////////
2. 3. 4. 5 alcohol 5. 6. lancet 2 7. 8. 9. gauze 10. 11. 2-3 12. 1.
1.
2.
28
5.
//////////////////
//////////////////
(0
)
4.
( conventional phototherapy )
SS
(
8
9)
(5 ) 1.
1. 2.
)
)
////////////////
2.
///////////////
///////////////
///////////////
///////////////
1.neonatal hyperbilirubunemia
3.
1.
2.
9.
2-3
8.
4-6
30
4.
7.
2-3
6.
////////////////
6-12 microwatt/cm.square/nm.
5.
///////////////
fluorescent 4-8 bilirubin 3-4 mg/dl/day
3.
10.
///////////////
2-3
hypo/hyperthermia
urine specific gravity
dehydration 12.
bilirubin
13.
14.
phototherapy
hyperbilirubinemia
direct hyperbilirubinemia
15.
bronze
(0
3.
////////////////
(3
29
2
5.
(Lumbar puncture) SS
(
8) (5
1.
1.1
spinal
//////////////////
23
)
//////////////////
//////////////////
sterile
//////////////////
myelography
2.2
1.
papilledema
2.
3.
1.
brain
//////////////////
6
4.
(
1% xylocaine
subcutaneous
)
//////////////////
povidine iodine (
) 3.
2.
30
space occupying lesion
abcess, cerebral tumor
)
stylet
2. ////////////////// ////////////////// 2.1 1. encephalitis 2. 3. hydrocephalus communicating 4. lumbar 1.2
(3
(
23
)
25
//////////////////
(0
)
3 )
6.
)
7.
.
20 gauge (stylet) 22 subarachnoid space style
5.
(
(
3-4
1. Brain herniation
//////////////////
epidermoid tumor
paresis
//////////////////
(stylet)
//////////////////
3.
xylocaine
)
(
4.
2.
1-2
(stylet)
9.
8.
1%
subarachnoid space
31
2
6.
Oxygen
6.1
(cannula)
SS (
8
10)
(5
(0 )
(3
) )
pediatric 2 prongs nasal cannular (Humidifier)
1.
1.nasal cannular neonatal 2. 3.
4.
2.
//////////////
cannular
//////////////
//////////////
//////////////
1. 2.
2. 3.
1. 2.
3.
/
//////////////
1-5
//////////////
//////////////
(flow rate)
nasal cannular cannular
4.
nasal cannular
1.
32
/////////////
2
(small bore tubing)
5.
3.
//////////////
6
/ 2 /
1.
Fowler’s position
2.
12-24
nasal cannular
cannular
3.
cannular
nasal cannular
4.
nasal prongs humidified
//////////////
//////////////
oxygen
//////////////
33
2
34
6.2
(oxygen mask)
SS
(
8
10)
)
(5
1.
1.Oxygen mask oxygen mask 2.
2
simple
////////////////
non- reservoir
partial rebreathing mask
1. 2.
)
)
(0
////////////////
reservoir
non- rebreathing mask
2.
////////////////
(3
////////////////
////////////////
////////////////
3.
1. 2.
3.
Oxygen mask
1. 2.
////////////////
reservoir bag 100% reservoir bag
mask
volume
(FiO2 0.35 tidal volume tidal
0.80)
(flow rate)
Oxygen mask
3.
4.
////////////////
reservoir mask
////////////////
35
2
1.
Fowler’s position Oxygen mask Oxygen with reservoir bag
2.
3. Oxygen mask
4.
36
reservoir bag
12-24
6.3
(Oxygen therapy via Oxygen box) SS
(
8
10)
(5
1.
//////////////////
)
//////////////////
(3
)
(0
)
//////////////////
1.Oxygen box 2.
(humidifier) tube) (corrugated
oxygen
3. 4. 2.
2.
//////////////////
3.
//////////////////
oxygen box
1.
2. 3.
4. corrugate tube meter)
5.
humidifier
7LPM
//////////////////
//////////////////
(flow
10-15
box
box
6.
7.
8.
box
tent house
12-24
4.
//////////////////
cold stress
5.
1. 2.
//////////////////
//////////////////
2. 3. 4.
//////////////////
1.
1.
//////////////////
//////////////////
//////////////////
//////////////////
37
2
6.4
Bag – valve-mask ventilation SS
(
8
10)
(5 )
1.
//////////////////
1. face mask(
////////////////// )
4. oxygen gas source, flow meter, humidifier
oxygen
6. suction 7. oropharyngeal airway, nasopharyngeal airway 8. pulse oximeter 2.
: Apnea, hypoventilation :1. Congenital diaphragmatic hernia
//////////////////
//////////////////
//////////////////
2. tracheoesophageal fistula 3.
1.
2.
face mask
3.
resuscitation bag
resuscitation bag
face mask
//////////////////
//////////////////
//////////////////
indication
oxygen reservoir
self inflating
oxygen
self
oxygen
resuscitation bag
4.
oxygen flow 8-10
/
10
/
5.
6.
(
head tilt chin lift maneuver
neutral
)
sniff
position
7.
8.
mask mask 3
38
face mask
face mask
mask mask (mandible) carotid artery
)
//////////////////
3. oxygen reservoir
(0
)
2. self-inflating resuscitation bag
5.
(3
9.
10.
/ ( ) 30 100 /
resuscitation bag 20-60
39
2
7.
Aerosol therapy
7.1
MDI
SS
(
8
10)
)
(5
1.
//////////////////
//////////////////
(3
)
)
(0
//////////////////
1. MDI 2. spacer
3. facemask
6 MDI Spacer
2.
1.
2.
3. 1.
//////////////////
//////////////////
inhaled steroid
//////////////////
//////////////////
//////////////////
//////////////////
without
spacer 2. 4. 1.
//////////////////
//////////////////
//////////////////
2.
3.
4.
spacer face mask
40
spacer
spacer mouth piece spacer
face mask
5.
spacer
5-6
2
6.
total lung capacity
spacer
4-10 2-3 spacer 5-10
15-30
7.
steroid
8. , PR
tachycardia, arrhythmia
RR,
,
41
2
7.2
small volume medication nebulizer SS
(
8
10)
(5
1.
//////////////////
)
(3
//////////////////
)
(0
)
//////////////////
1. small volume nebulizer setup
2. 3. 2.
1. 2. 3.
1.
2. ,
//////////////////
2.
NSS
3.
4-6
42
mouthpiece
//////////////////
//////////////////
//////////////////
//////////////////
//////////////////
. Max 5ml/
4 ml
//////////////////
Salbutamol 0.05-0.15ml/kg/
5.
//////////////////
bronchial hygiene therapy
1.
4.
////////////////// Resp Rate, , Pulse Rate
3.
4.
TV
6.
10-15
7.
8.
steroid
43
3
1.
(Local infiltration)
2.
3. 4.
Digital nerve block
5.
6. 7.
Incision and Drainage
8.
Excision subcutaneous tumor/cyst
9.
Ostomy care
10. Stump bandage
44
1.
SS (
1)
)
(5
1. 1.1
1.2
//////////////////
2.2
2.3
180
)
//////////////////
//////////////////
//////////////////
2.5 2.6
//////////////////
(0
//////////////////
2.4
)
2. 2.1
(3
3.
//////////////////
3.1
//////////////////
//////////////////
3.2
45
3
2.
SS
(
11 )
)
(5
1. 1. 2.
/
1.
2
-
line)
46
2
//////////////////
//////////////////
3. -
-
//////////////////
-
2.
4.
-
-
//////////////////
2.
//////////////////
(3
(nipple areola)
2 pectoralis muscle (anterior axillary
//////////////////
)
(0
)
3.
(Local infiltration)
SS
(
12 ) (5
1.
//////////////////
1. Xylocain 1-2%
)
//////////////////
(3
)
(0
)
//////////////////
5-7 mg/kg
2.
G 23-25
3.
2
5-10 ml
4. antiseptic
2.
1.
2.
3.
23-25 G
intramuscular ,
2
.
wheal
22
subcutaneous, intrafascial,
0.5
wheal
G
( intradermal)
4.
intradermal wheal 1 2
field block
2
47
3
4. Digital nerve block
SS
(
2)
(5
1.
1.2
(0
)
)
//////////////////
//////////////////
)
sterile
1.3
without adrenaline
1.4 2.
//////////////////
1.1 set dressing
(3
24 G
////////////////// : : Traumatic nerve injury , Infection at the site of
//////////////////
//////////////////
injection, Peripheral vascular disease, Raynaud’s phenomenon
3.
1. 2.
//////////////////
//////////////////
//////////////////
indication
supination
3.Land mark :between dorsal and palmar at base of the MCP joint ,medial&lateral side of finger
4.
landmark
web space
5.
6.
periosteum lidocain without adrenaline 1-1.5 ml syringe push vessel 3-5 procedure
24
4.
//////////////////
//////////////////
//////////////////
Bleeding, Hematoma, Vascular or nerve injury, Ischemia
lidocaine with adrenaline
-
48
5.
EX
(
12 ) (5
1.
1.
//////////////////
)
//////////////////
(3
)
(0
)
//////////////////
1.1 Needle holder 1.2 Tooth forceps 1.3 Nontooth forceps
1.4
Cutting
1.5
Non cutting
00
1.6 1.7
/
2
//////////////////
3.
2. 3.
3. 4.
Needle holder
//////////////////
//////////////////
Needle holder
1.
//////////////////
1.
//////////////////
//////////////////
Cutting needle
2.
5.
6. 7. 8. 9.
10. knot
1/3
Tooth forceps
vertical mattress needle surgical holder
square
49
3
11.
3
12.
13.
(
14. 1.0-1.5
.
15.
)
contaminate
6.
EX
(
12 ) (5
1.
//////////////////
)
//////////////////
(3
)
//////////////////
1 Forceps 2. 2
1. 2.
50
Forceps
//////////////////
//////////////////
//////////////////
(0
)
7.Incision and Drainage
SS
(
-- )
(5
1.
//////////////////
)
//////////////////
(3
)
(0
)
//////////////////
1.1 set dressing 1.2 sterile
1.3 Blade
1.4
1.5 gauze drainage
2.
//////////////////
//////////////////
//////////////////
Cutaneous abscesses 3.
1.
2. 3.
field block
3.
blade
clamp
5.
gauze drainage
6. 7.
//////////////////
skin tension line
quadrant
normal saline
5.Irrigate
4.
//////////////////
abscess
drainage
//////////////////
indication
quadrant
adequate
abscess
abscess
remove
gauze
8.
4.
antibiotic cellulitis pus swab culture
1.
Bleeding
2.
Hematoma
skin
//////////////////
//////////////////
//////////////////
51
3
52
1
3
2
4
8.Excision subcutaneous tumor/cyst SS
(
--)
)
(5
1.
//////////////////
//////////////////
(3
)
(0
)
//////////////////
1.1 set dressing 1.2 sterile 1.3 Blade
1.4
1.5 gauze, 1.6
Sterile (
1.7
2.
)
//////////////////
//////////////////
//////////////////
1.
1.8
3.
//////////////////
//////////////////
//////////////////
indication
2. 3. 4.
field block
blade
elliptical incision
Skin crease Artery Clamp 6. Allis tissue 7. simple or vertical mattress ) 7. 8. antibiotic 9. Sterile Formaline NSS 1:10 5.
Metzenbaum
(
53
3
4.
54
1.
Bleeding
2.
Hematoma
//////////////////
//////////////////
//////////////////
8. Ostomy care EX
(
13 )
(5
1.
////////////////
1.
)
////////////////
(3
)
(0
)
////////////////
2.
)
3.
4.
5. (
6. 7.
8.
9.
11.
13.
14.
-
Skin
30 , 4
15.
16.
12.
Skin barrier paste
barrier powder 10.
5-7
55
3
9.
tump band ge EX
(
14 )
(5
1.
1.
EB
6
)
(3
)
(0
)
//////////////////
////////////// ////
//////////// /////
//////////////////
////////////// ////
//////////// /////
BKA
AKA 2.
1.
2.
EB
BKA
4
-
A A-
5.
6. 30
56
BKA -
4.
6
AKA
3.
7.
(
(cyli drical)
(coni al)
( circu lar -6 orthosis )
ab ove 1 joint)
2. 3. 4. 5. 6. 7. 8.
1.
(Endotracheal tube , Adults, Pediatrics)
(Endotracheal tube , Newborn)
(CPR-BCLS) (Pediatrics Resuscitation) (CPR-ACLS) (ATLS)
CVP
(First Aid Management)
57
4
1.
(Endotracheal tube, Adults, Pediatrics) EX
(
15) (5
1.
1.
•
//////////////////
)
//////////////////
(3
//////////////////
, self-inflating bag
• Mask
3, 4, 5
• Oropharyngeal and nasopharyngeal airway
6-8
2. Laryngoscopy •
suction
10, 12, 14
suction
• Magill forceps
3,4
• Laryngoscope blade
battery
•
“sniff position”
3. endotracheal tube
7.5-8
7-
7.5 4. •
• Stethoscope
2 1.
//////////////////
//////////////////
//////////////////
(ventilatory support)
2. 3.
4.
3.
1.
58
//////////////////
//////////////////
sniffing position ( thoracic spine cervical spine atlantooccipital) 7-10 ( 4 D)
)
//////////////////
(0
)
2.
blade
laryngoscope blade
•
(Miller, Jacksonblade
Wisconsin) epiglottis
•
blade (Macintosh) vallecula epiglottis (
blade
5)
3. • -
endotracheal tube
endotracheal tube
cuff
tube
(I.D.) 7.5-8
. -
•
I.D. 7.0-7.5 8
.
endotracheal tube
cuff
tube
/4 + 3
tube (uncuffed )size I.D.=
/4 + 4
tube (cuffed) size I.D. =
4.
crossed-finger technique
laryngoscope blade
blade
5.
cuff
(blade
)
)
laryngoscope
epiglottis
endotracheal tube
tube
vocal card
½-1
6. •
epiglottis (blade glottis
. .
endotracheal tube
16-23
tube length ( tube length (
endotracheal tube
< 2 > 2
tube length (
.) = ID .) = 12 + ( .) = 15 + (
ET x 3 /2) /2)
59
4
7.
(epigastrium)
8.
4. •
(Trauma)
pharynx • • • endotracheal • Autonomic reflexes • endotracheal • cuff
60
,
,
2
gurgling
//////////////////
//////////////////
/////////////////
stylet endotracheal
2.
(Endotracheal tube , Newborn) SS
(
-- )
(5
(3 )
1.
//////////////////
)
//////////////////
3.5
3.
(0 )
: 1. Laryngoscope 2. ET tube
//////////////////
4. Stethoscope
2
1.
1.
2.
oxygen
mask
//////////////////
//////////////////
larynx
positive pressure
bag
3.
//////////////////
//////////////////
mid position
2.
//////////////////
(respiratory failure)
3.
//////////////////
endotracheal tube
endotracheal tube
Internal diameter (mm) = 4 + distal phalanx
4 1
4. (
IV fluid
)
61
4
5.
endotracheal intubation
diazepam
0.1-0.3
muscle relaxant
./
diazepam, midazolam 1
.
muscle relaxant
upper airway obstruction
bag mask complete airway obstruction ( ) 6. laryngoscope vocal cord endotracheal tube suction pressure positive
tube
7.
2. Trauma
//////////////////
3. Laryngospasm 4. Esophageal intubation 5. Endobronchial intubaion
62
tube endotracheal
laryngoscope
6. Cardiac arrest
)
1. Hypoxemia
endotracheal tube
4.
(
endotracheal tube
2
X-ray
endotracheal tube 8.
//////////////////
endotracheal tube
/////////////////
3.
(CPR-BCLS)
EX
(
16 ) (5
1.
//////////////////
//////////////////
)
(3
)
(0
)
//////////////////
1.
cardiac arrest acidosis hypoxemia cardiac arrest 2. cardiac arrest 2. ////////////////// ////////////////// //////////////////
A. Airway (
)
Head till-chin lift maneuver
B. Breathing (
)
mouth
to-mouth breathing
2 C. Circulation ( ) chest compression 60 / poor chest perfusion compression
carotid pulse
brachial pulse
chest compression
1.
Mouth-to-mouth-and-nose breathing
63
4
2.
1
2
3.
100 /
0.5 1 80-100 / 1-1.5 chest compression 30:2 1 CPR ABC recovery position CPR
3.
compression
cardiac compression
//////////////////
fracture ribs, rupture
-
//////////////////
external cardiac
,
-
64
//////////////////
external
cardiac compression external
pulse
4.
(Pediatrics Resuscitation)
SS
(
8)
(5
1. 1.
//////////////////
//////////////////
2.
A. Airway (
)
Head till-chin lift maneuver
)
//////////////////
)
(0
B. Breathing (
)
2.
(3
//////////////////
hypoxemia acidosis cardiac arrest cardiac arrest ////////////////// ////////////////// cardiac arrest
)
mouth-to
Mouth-to-mouth-and-nose breathing
mouth breathing
2
C. Circulation (
poor perfusion
60
)
chest compression
/
chest compression
carotid pulse
brachial pulse
65
4
chest compression
1. 2.
1
2
3.
3.
, compression
66
100 0.5 1 / 80-100 / 1-1.5 chest compression 30:2 15:2 1 2 1 CPR ABC recovery position CPR
compression
//////////////////
external cardiac
//////////////////
fracture ribs, rupture
//////////////////
external cardiac pulse cardiac compression external
5.
(CPR-ACLS) SS
(
16
17)
1 : 68 Management ( endotracheal BP tube , monitor •
pulse oximetry)
check airway, breathing, conscious, circulation
Key : •
, SpO
=70%
CPR (chest compression + Key :
2
ambu)
180
2
/mm BP = 90/40
management
•
Key :
Paddle
EKG
•
lead EKG
EKG
Key : regular, wide complex tachycardia •
P
management
BP
Key : synchronized cardioversion
defibrillation/cardioversion unit
synchronized
100 J (monophasic)
paddle
jelly
paddles
apex
paddle
2
jelly
right upper sternum
paddle
clavicle
apex paddle
“clear”
fully charged paddle
2
2-3 cm.
charge
paddle
25 lb/paddle
discharge/shock
paddle
cardiac rhythm, P, BP 67
4
Key : 1. electrolytes imbalance 2. ischemic heart disease 3. pneumothorax lab : K = 7.0 meq/l
Key : 1. 10 % Ca gluconate
2. Insulin + 50% glucose 50 cc / 7.5%
NaHCO3 50 cc
3. Kayexalate
) ICU ICU : 1 :( ) : EKG ( asystole) BP : lead EKG CPR A,B,C CPR monitor EKG Adrenaline 1 mg IV CPR 5 cycle check pulse EKG 5 (EKG asystole) Adrenaline atropine CPR 5 cycles 1 mg check pulse(EKG –normal sinus , pulse EKG + 5H,5T asystole) :(
2:
:
68
check
6H, T
ypoxemia •
Tx: Hyp thermia Algorithm Assess: Collapsed vascu lature
Tx: Fluids
Tx: Bica b, CaCl, alb terol neb, ins ulin/glucose, dialysis, diur sis, kayexal te
ydrogen ion"emia" (acido is) -Assess: Diabetic pati nt, ABGs •
Tx: Bica b 1 mEq/kg, hyperventilati on
ypoglycemia-Assess: Blo d sugar
ablets/toxins overdose -A sess: Hx of •
asystole
BGs
ypo- or Hyp r- kalemia (preexisting) - ssess: Renal patient, EK , serum K le el •
Tx: Oxy en, ventilation
ypovolemia •
ypothermia - Assess: Core temperatur •
ssess: Airw y, cyanosis,
edications, drug use
Tx: Trea accordingly
amponade, ardiac -Assess: Heart sou nd, Jugular vein distensio , narrow pul e pressure prior to
arre st , BP , EKG •
•
Tx: Nee le thoracost my
hrombosis, coronary -Assess: History, EKG •
Tx: Pericardiocentesi
ension pneu othorax -Assess: No pul e w/ CPR, J D, tracheal eviation
Tx: Acut Coronary Syndrome alg rithm
hrombosis, pulmonary embolism -Asse ss: No pulse w/ CPR, JVD •
Tx: Thrombolytics, su gery
“
ACLS 2005”
69
4
6.
(ATLS) SS
1:
(
: : :
16
17)
( : : Primary survey
MCA
)
evaluate
1. A Airway maintenance with C-spine protection
: :
(
hard collar
)
2. B Breathing and ventilation :
steth
:
suspected pneumothorax rt
trachea , oxygen mask
thoracenthesis
2
nd
ICS MCL
stabilized
needle
4.5 cm (2 inch). one-way ICD chest X ray
14
3. C Circulation with hemorrhage control
: *Clinical of poor tissue perfusion *Level of consciousness *Skin color *Pulse rate and quality *Urine output
hypotension NO.16-18 2 line resuscitation isotonic saline rate free flow
:
4. D Disability:Neurologic status : GCS
ET ???
SECONDARY SURVEY (2 SURVEY)- *Head – to – toe examination * *
70
(adjunct to 2
nd
survey)
7.
CVP EX
(
17
(5
(3 )
1.
///////////// ////
1.
0
3.
(0
) //////////// //////
) //////////////////
atrium
intercostals spac e
mid- axillary line 2.
4
cut do n
manometer
tree-way top cock 4.
5.
manom eter
anometer
6.
(IV liine)
cut
manomete
7.
tree-way top cock
dow n
8-12 stop cock ree-way cut down CVP
(CVP) CVP
ma ometer
trium
Th ee-way stopcock 71
4
8.
(First Aid Management) SS
1; Fracture Clavicle with Figure of eight Dx. Fracture middle 1/3 of Lt. clavicle
Figure of eight
(
--)
(5
)
(3
)
//////////////////
-
//////////////////
//////////////////
stockinette
-
2 stockinette
-
figure of eight
hyperextend
stockinette 8 ( hyperextend ) nerve vessel
- Complication
reposition malunion, non-union
- Advice
4-6
week -
72
(0
)
-
/
-
2; Gait aid fracture right tibia .
SS
(
--)
(5
(3 )
//////////////////
//////////////////
(0
)
)
//////////////////
-
axillary crutch
-
- Hand piece
80%
radial nerve crutch
- Axillary piece
palsy
(20-30*)
trochanter greater
-
-
anterior axillary fold
anterior axillary fold
anterolateral 6
Gait pattern -Three point gait :
73
4
3;
25
SS
(
--)
(5 )
///////////// ////
(Pr -hospital tre atment – First
Aid)
74
)
1 (
15
0
1
(3
(0
) //////////// /////
) /////////// //////
4;
25
(
•
(3
)
//////////////////
(0
)
//////////////////
: A (Airway),
B (Breathing), C (Circulation)
•
)
//////////////////
ABC
(5
•
--)
povidine
iodine
•
echymosis,
Venous clotting time (VCT)
•
: vital sign,
(fang mark)
petechiae
CBC + platelet
(urinalysis)
BUN, creatinine,
electrolyte •
Admit
•
24
6
VCT
NSAIDs
VCT
VCT
75
5
1. 2. 3. 4.
76
pap smear
(amniotomy)
-
1.
EX
(
18)
(5
1.
)
(3
)
//////////////////
//////////////////
//////////////////
//////////////////
//////////////////
//////////////////
(0
)
1. Specula 2. (dispossable)
2.
1. 2.
3. 4.
dorsal lithotomy
5.
mons pubis, vulva
anus
6.
labia majora, labia minora, vaginal
orifice, urethral orifice
Bartholin’s glands
pelvic support
7. speculum speculum 8.
speculum
speculum blades speculum posterior oblique posterior fornix blades speculum blades speculum fornices 9. Papanicolaou’s smear speculum fix 10. speculum speculum
oblique
labia minora lubricate sterile gel posterior posterior fornix ( ) labia minora
11.
77
5
12.
13.
lower abdominal tenderness, guarding tenderness
cul de sac
rebound
, consistency,
cervical motion tenderness 14.
fornices
urethritis
16.
17.
urethra
vagina
Bartholin’s gland
lubricate
examination
consistency
15.
rectovaginal
rectum
anal sphincter tone, rectovaginal septum, rectal mucosa
parametrium
pelvic organs
3.
1.
//////////////////
2.
psychic trauma
78
//////////////////
//////////////////
2.
-
pap smear EX
(
18)
(5
: 1.2 :
1.
//////////////////
1.1
)
(0
)
//////////////////
,
2.1
//////////////////
:
2
(3
1.3 Lithotomy :
)
//////////////////
//////////////////
//////////////////
sterile
3.
3.1
3.2
4.
/////////////////
4.1
:
//////////////////
//////////////////
savlon
4.2
(Inspection) - Monpubis :
pubic
hair;
-Perineum : lesion
- Labia majora and minora :
-
,
:
-Introitus : hymenal ring 4.3
(Palpation) .
labia :
labia labia
79
5
.
urethra :
discharge
urethrocele
: : : .
Batholine gland
Labia minora
:
4, 8
. Cystorectocele, prolapse uterus
:
rectum
vagina
.
(Stress
incontinence)
:
urethra bladder
Neck
2
pubic symphysis
stress
Incontinence
4.4 Speculum exam
.
:
.
.
. : speculum
speculum
urethra
:
80
speculum
-
:
speculum
.
discharge
: (
: Lock
)
.
Pap smear : VCE technique
-
Ayre’s spatula
vaginal discharge
Posterior fornix -
Ayre’s spatula
scrape
360
2
-
saline normal
endocervical 2-3 specimen
Canal -
3
endocervix cervix
Vagina
-Fixed slide
15
(Biopsy)
. :
Polyp
95% alcohol
lesion
CA Cervix
Punch biopsy
:
5
.
speculum -
Lock
81
5
-
-
speculum
-
vagina
Speculum
4.5
-
labia minora
-
-
-
K-Y jelly
.
-
pubic
symphysis
-
consistency
-
Consistency mobility ,
-
-
cul de sac posterior fornix
82
nodule
uterosacral ligament
-
Rectovaginal exam
-
KY jelly
-
rectovaginal
septum, cul de sac , uterosacral
discharge
ligaments parametium .
5.
////////////////
5.1
5.2
/////////////////
/////////////////
specimen
5.3
5.4
investigation
83
5
3.
( a nio tomy) EX
(
19)
( )
1.
2. 2.1 2.2
84
(3
(0
)
)
/////////////////
///////// ////////
/////////////////
/
/
/
/////////////////
///////// ////////
/////////////////
4.
-
EX
(
19)
(5
1.
2.
1.
2.
3.
4.
////////////////
////////////////
////////////////
////////////////
////////////////
(0
)
mediolateral
3-4
8.
pubic symphysis
subocciput region
////////////////
)
5.
7.
(3
dorsal lithotomy
6.
)
normal saline
85
5
9.
10.
cord clamp
umbilical cord clamp
2-3
1. 2.
86
clamp clamp
3.
birth injuries
4-5
2
////////////////
umbilical
////////////////
////////////////
Technique for diagnostic probing and irrigation of the lacrimal system
•
Corneal and conjunctival foreign bodies removal
•
Applying pressure patches
•
Incision and curettage
•
Fundus examination with direct ophthalmoscope
•
•
Anterior nasal packing
87
6
1 : Techniqu for diagno tic probing and irrigatio of the lacri
1 (
Basic an
Clinical Scie nce Course
ection 7. San Francisco : American
Academy of Ophthalm logy, 1999-2 000 ; 226.)
2
88
al system
lower analiculi
1. 2. Syringe 3.
2 ml.
4.
23-25
45
1
(irrigation canula) 5.
6. Punctum dilator
1.
2.
3.
4.
(punctum)
5.
punctum dilator 8 ( 1, 2)
punctum
2
.
89
6
2 : Corneal an
1.
3
conjunctiv l foreign bodies remova l
2. 3.
Corneal foreign bo y
1. 2.
Forceps
3. 4.
1. 2. 3.
4.
5.
90
25
Opht almic drill
remove
rust ring
2 forceps 25 rust ring) op hthalmic drill corneal abrasion corne l ulcer
3 : A
4
fluore cein
corn al abrasion
irregula corneal light reflex
plying pres ure patches
Pres ure patchin
1. 2.
eye pad 1-2
3. 4. 5.
1. 2. 3.
4.
2
1 -6 6 (antibiotic eye ointment corneal abrasion 70 % alcohol antibiotic ye ointment lower fornix 1 corneal brasion contact lens pressure patching pse domonas 2-4 pressur patching eye pad 1 2 eye pad 1 eye pad
2 5.
6.
24
patching
6
zygom
corneal abr sion 2-3
eye pad
pr essure
corneal ulcer
91
6
4 : Inc sion and cu ettage
1.
sebac ous glands
2
stap ylococcus aureus internal hordeolum
(hord eolum)
eyelids
external hordeol m (stye)
glands of Zeis or Moll meibo ian gland
incision
tarsal plate
incision
2. Chala ion
obstructi on tarsus oft tissue Internal hordeolum lid scrubbing
meibomian gra uloma
hot compression
meib mian glands
5
Incision an
th
Practical ophthalmology . 4 edition.
ophthalm logy, 1996 ; 234)
1.
92
2.
2 % ylocaine with adrenalin
3.
Syrin e
4.
Eyeli clamp
5.
Blade No.11
6.
Curette
20, 2 7
chalazion cla p
an francisco : American
curettage
(
cademy of
6
7
Ch lazion clamp
Vertical inci ion
inter al hordeolum
1.
2.
3.
% xylocain with adrenal in
le ion
ext rnal hordeol m
internal hor eolum
chalazion
conjunctiva
4.
Incision
6. 7.
horizontal incision
skin cre se
vertical Incision conjunctiva chalazion external cla p ordeolum clamp hordeolum plate conju nctiva inter nal hordeolu chalaz late ion c njunctiva ( chalazion clamp 6) internal hordeolum
I cision
5.
external h ordeolum
lade
11
curettage
chalazion
lid m rgin 2-3
incision
chal zion clamp
4
curettle ( 7)
1
93
6
5 : Fundus examination with direct ophthalmoscope 1.
direct ophthalmoscope
1.1 Battery handle 2.4 V
battery
3.6 V
1.2 Head of ophthalmoscope
1.2.1 Viewing aperture
dust cover
95 % 1.2.2 Lens selection disc
+40 diopter
polaroid filter
rekoss disk
built-in dial up lens
1.2.3
recharge battery
-25 diopter
( angular magnification 25 .) field of view 5 plus lens minus lens Aperture selection disc Full spot aperture pupil Small spot pupil
15
•
• •
Red-free filter filter , microaneurysm
•
Slit
3 diopter •
•
0.2
Fixation target
Reticule or grid
spectrum
nerve fiber layer
1
central
eccentric fixation 1.2.4 On/off switch and rheostat control
-
1. 2.
94
direct ophthalmoscope posterior pole stereopsis, dept of focus
2.
Direct ophthalmoscope
rapid onset, short duration
(pupillary dilation)
sympathomimetic drug (2.5-10 % phenylephrine eye drop)
(1% tropicamide) 4-8
parasympatholytic drug
adequate dilation
45
anterior chamber , Iris- observe 1. 2. 3. direct ophthalmoscope aperture direct ophthalmoscope 4. aperture lens selection disc rekoss disk 5. direct ophthalmoscope aperture pupil 15 . red reflex pupil 6. aperture axis 7. red reflex pupil axis direct ophthalmoscope 2-3 . distance target accommodate distance 8. retina focusing lens lens selection disc refractive error ( ), retinal lesion accommodation
supported intraocular lens
9.
corneal light reflex
9.2
9.1
dust cover
reflection 95 % small spot aperture
polaroid filter
aperture
corneal
9.3 10. Fundus evaluation
10.1
pupil
center
-
pupil
optic disc, peripapillary, retinal blood vessels
95
6
10.2
blood vessel
inferotemporal 10.3
macula fix
distance axis
10.4
background
superonasal, inferonasal,
superotemporal quadrant
fix
red-free filter
fix
nerve fiber layer
vascular wall 10.5
fixation target
Slit beam aperture
10.6
target
96
central foveal reflex
retinal lesion
central
eccentric location
drawing chart retina color code diagram fundus
11. Fundus record
distortion
optic disc
Anterior nasal packing SS
(
20)
1. 2.
3. 4. 5.
6.
(5
)
(3
)
(0
)
, 10% Xylocaine ( 5% cocaine) + Ephedine pack 5 – 10 ( ) Nasal speculum Chloramph oint Vaseline guaze bayonet forcep Vaseline gauze 10 - 15 cm. speculum gauze speculum forcep
7.
guaze
8.
guaze 9.
cath.
10.
bleed admit
Posterior packing
2
Foley’s
97
