Medical
Instruments
by
dr. Saif darif
- What is this?
It
- what is indications ?
- what is complications / contraindications ?
- How to use it ?
to
- Indication:- Sengstaken Blackmore Tube
minnesota tube
Esophageal & gastric Varices (to Stop the Bleeding in Stomach &
Esophagus).
- Complications or Contradictions:-
1. Esophageal necrosis due to pressure Ischemia OR Rupture.
2. Esophageal ulceration.
3. Chocking & Aspiration.
4. Asphyxia.
5. Hiccups
- How to use >>>>> Sengstaken Blackmore Tube
minnesota tube
It Has 2 Balloons :- Funds of stomach & the Other For Esophagus
It Has 2 Suction; Esophageal Suction & Gastric Suction.
- How to use >>>>> Sengstaken Blackmore Tube
minnesota tube
Ensure it’s unexpired and it’s functional , no Any Leak in Balloons.
Anesthetize the Pharynx by local Anesthesia.
Insert the Tube Gently & use K-Y Gel , From Nose Or Mouth & Ask the
Patient to Swallow.
Confirm placement in Stomach By Auscultation the Stomach While
Inject Air in Stomach,or Checked By X- Ray.
Inflate Gastric Balloon Firstly (200-250ml of Air) and Do slight Traction.
If the Bleeding Not Stopped ; Then Inflate Esophageal Balloon.
Esophageal Balloon should Deflate To Avoid Esophageal Ischemia OR
Rupture.10Minutes each 3Hours.
- What is this?
- what is indications ?
- what is complications / contraindications ?
- How to use it ?
- Indication:-
- Naso-Gastric tube ( ryles ).
1- Decompression (Gastric Lavage & GIT bleeding).
2- Feeding (patient has dysphagia to prevent Aspiration).
3- Administration of Medication.
- Complications
1- Nasal Erosion and Bleeding.
2- Chocking & Aspiration.
3- Esophageal Perforation.
4- False insertion usually to right main bronchus.
- Contradictions:
1- facial or head Trauma.
2- Possible Esophageal Perforation.
3- Nasal Polyps.
4- Recent Nasal Surgery.
- How to use >>>>> Naso-Gastric tube ( ryles ).
Patient in Sitting Position ( or 45 degree) take permission
Wear Sterile Gloves.
Measure the Tube From Nose to the Ear Lobe, Then Down to the
Xiphoid Process
Use K-Y for Tube and Insert it in to the Nose Gently.
When the Tube Reach to the Pharynx ,Ask the Patient to Swallow.
Confirm placement by Hear bubble of Air by Stethoscope in Epigastric Area
and Inject Air By Syringe Into the Tube.
- What is this?
- what is indications ?
- what is complications / contraindications ?
- How to use it ?
- Indication:-
Pneumothorax
-0
Chest tube
Plural effusion
Hydro- pneumothorax.
Empyema
Plurodesis
- Complications
Pneumothorax , Hemo-Pneumothorax.
ReExpansion pulmonary edema.
Sub-Cutaneous Emphysema.
Arrhythmia.
Nerve or vascular Damage.
Infection.
Contradictions:-
Infection at Site of Insertion.
Uncontrolled Bleeding.
- How to use >>>>>
Under Complete Aseptic Technique at Mid Axillary Line
Give the Patient Local Anesthesia (Lidocain) at Site of Insertion.
Make a Transverse Incision By Knife at 4th OR 5th Inter-Costal Space at the Site of Mid
Axillary Line.
Use Forceps to Dissect the Sub-Cutaneous Until the Forceps Reach to the Pleural Space.
Gently Insert Your Gloved Sterile Index Finger to Reach the Pleural Space.
Insert the Chest Tube Until All Holes of the Tube Completely Going Inside.
Connect the Tube to the Under-Water Seal.
Stitch the Site of the Tube Insertion.
Make Sure If the Under Water Seal Working By Asking the Patient to Cough to Watch If
There is the Air Bubbles OR Not.
Chest Tube Can Be Removed after 24 Hours From Stopping of Air Bubbling in Under
Water Seal.
If Bubbling continuously for more than 3 Days Then Transfer the Patient to Thoracic Surgery.
- What is this?
- what is indications ?
- what is complications / contraindications ?
- How to use it ?
- Indication:- -
Endo-Tracheal Tube
Respiratory & Cardiac Arrest (Resuscitation).
General Anesthesia.
Administration of Medication ( oxygen , Adrenaline, Atropin,
Lignocien, Naloxone).
Complications
Trauma ( teeth , mouth , Vocal Cords ).
False insertion ( bronchus —one lung , Esophageal Intubation).
Aspiration & Chocking
.Laryngeal Spasm OR Tracheal Spasm
Contradictions
Foreign Body .
Epiglottic Pathology.
Blunt Trauma to Larynx.
Relative short wide neck with upper airway edema.
Types of ETT
Cuffed ETT. ( not used in children)
Fixation.
Prevent aspiration.
Prevent gases escape.
Non-Cuffed ETT.
- How to use >>>>> Endo Tracheal Tube
Patient’s Head & the Neck in Extension Position.
Use the Laryngoscope By Your Left Hand and Keep the Patient
Mouth Opened By Your Right hand.
Visualize the Larynx and Vocal Cords By Light of Laryngoscope.
Pass the tube Between Vocal Cords.
Auscultate Both Lungs While the Air Injected.
Ensure That the ETT in the Trachea Not in the Bronchi.
Auscultate Epigastric Area to ensure that the ETT not Misdirected to
the Stomach.
Connect the ETT to the Mechanical Ventilator and Observe the Chest
Movement If it was Equal.
- What is this?
¥
- what is indications ?
- what is complications / contraindications ?
- How to use it ?
- Indication:- is
Laryngoscope
Visualize the upper air way ( Vocal Cords and Epiglottis ) For
Endo Tracheal Intubation.
Complications
Mouth or Dental trauma .
Injury to Lips, Gum, Tongue & Pharynx , vocal cord
Contradictions
Injury of Cervical Spine.
Massive Airway Obstruction
- How to use >>>>> Laryngoscope
Patient’s Head & the Neck in Extension Position.
Use the Laryngoscope By Your Left Hand and Keep the Patient
Mouth Opened By Your Right hand.
Visualize the Larynx and Vocal Cords By Light of Laryngoscope.
- What is this?
-
- what is indications ?
-
- what is complications / contraindications ?
s
- How to use it ?
- Indication:- is
Tracheostomy Tube
Obstruction of Upper Airway .
Prolonged Intubation.
Excessive Secretion.
Inability to insert ETT.
Major Head Surgery OR Trauma.
Complications
Traumatic during insertion
Infection
Obstruction of tube.
Cosmetically scar
Horsiness of voice & speech difficulty.
Contradictions
Infection at site of insertion.
- What is this?
-
- what is indications ?
-
- what is complications / contraindications ?
s
- How to use it ?
- Indication:- -0
Oro-Pharyngeal Tube
Maintain Airways patent in Unconscious Patients
Preventing the Tongue pitting during fits & preventing Tongue to
Covering the Epiglottis.
Help to do suction of foreign body and secretion.
Complications
Vomiting & Aspiration.
Obstruction of Tube.
Dental Damage.
- What is this?
-
- what is indications ?
-
- what is complications / contraindications ?
s
- How to use it ?
poly mask
Low flow
High concentration
24 -
60%
Nasal Canula
11
Nasal bronchus
Low flow = High concentration
24 -
bot.
=
Low flow o Masks
,
[Link]
④ poly mask → uses to
y pt Hypoxia except
give 24% -
bot
COPD
.
.
④ Nasal canula or Nasal bronchus 24 -
60%
used for LTOT Help to eat I speak .
Low flow o Masks
,
[Link]
Re
breathing mask .
Go -75%
-
Now Re
breathing mask .
75 - loot .
- uses for RFI
-
High flow
- Low Oz Doses or High .
-
24% -
281 .
Can
give up to Go %
- What is this?
-
- what is indications ?
-
- what is complications / contraindications ?
s
- How to use it ?
Nebulizer
"
0 Mask .
give In h alar Medication
.
give Humidified Oz
.
.
peaked C- xp flow
Meter
To measure
; .
peaked expiratory flow
Rate
How fast
air
used for defect
expired
B. Asthma
can be
① Variability in .
By lung
.
② Severity and stage
x .
Abram 's Needle used to take plural biopsy
-
-
C 15 → Infection at site of entry .
uncontrolled
Respiratory Disease is .
complication → p Tx , Infection Bleeding
,
.
-
Suction tube .
- used to suction & clear the air way from
fluid or secretion .
Central veins catheter
Set of central veins
Line .
•••
- Indication
-
① Monitoring Cup .
② give Medication → chemotherapy .
Antibiotics
③ Dialysis
.
Antiarrhythmic
④ [Link] PA .
Medication lead
@ Complication
-
to
phebitis in
① Truman ptxolltemothorak
my "pvNe ?
.
② Infection
.gg÷÷÷:÷:÷ie
.
CIE
In :i÷:
'
•o•
How to use it ?
-
After permission & explain to pt .
-
Under complete d full sterilization .
-
Mark between 2 heads of Sterno mastoid
ms
Local anaesthesia
jugular
-
.
-
Int .
v
subclavian place ECG
-
.
-
.
-
femoral vein .
-
Insert Hollow needle ,
tell Veins blood
-
even
€ line .
Aspirated .
dilate r device Guide wire
put over
.
.
-
Insert central venous
line .
- Remove Guide wire .
Ensure placed & working .
•••
-
Heparin iced syringe for
ABG s maple
ABG
syringe .
Use
'
for obtain Blood from artery
[ to measure
to obtain
gases .
Blood for cardiac Enz .
-
Take blood from Radial Brachial femoral 9.
, ,
.
-
Allen 's test should performed be for Radial sample .
45
⑥ Localize § by palpation .
against B flow
② Insert the opening of Needle
.
③ Bright Red
-
pulsatile → as
.
⑨ -
Dark Blood with low flow → Veins .
Complication → painful ,
Hematoma . In j ,
Ischemia .
Radian
Insulin e
b
syringe
Use → gives Eines :!
\ BCG vaccine
GH
.
.
g
Drug Abusers .
Site → arm
, Abdomen , thigh .
No Need Al Chol .
warming after Im J -
Insulin e SIE
-
① Hypoglycemia ⑤ H2o Retention → 9 Hf .
② wt gain ⑥ Insulin e Ab → Resistant .
③ ⑦ ins
Local
Allergy Lipodystrophy at site .
④ peripheral edema .
DM I 4 I
Insulin used for →
Dx of Hypopituitarism
e
→ .
Ra of 9kt .
Intravenous set
-
I .
Used for i -
① IV f .
② All para antral medication .
③ Blood transfusion .
Complication
-
① Infection .
② Displacement .
③ Blocked .
@Complication
① phelbitis .
② Extravasation f
"
Hematoma -
③ thrombosis .
[ Cannula ]
Use
-
give all parent rat medication in
p veins
.
.
IVF .
[Link] .
- Take venous blood Sample .
Spinal
i
Needle
t
Spinal Needle
Indication
Dx CLT
Mingitis
① cars infection Is ① Medication
Encephalitis Intrathecal .
② Multiple sclerosis f-
③ GBS .
Methotrexate Anesthesia
ALL Regional
④ SAH .
② Benign PICP .
Spinal Needle
Absolute
-
relative
① Coma t ① uncooperative pt
p
'
② Back deformities
② suspected I. C. Mass
-
③ spinel surgery .
③ sever thrombocytopenia -
① Hy potent ion .
④ Cardio Resp arrest
-
.
⑤ papin edema -t focal Neuralcat dificit
⑥ Infection at site of entry .
Complication LP
i
① post puncture Headache
.
② Back pain .
③ Bleeding Hematoma .
⑨ Tru ma Coda $
-
equine
.
⑤ Infection .
How to use it
foley catheter
45
@ Complication
① ① pelvic #
@ Infection ② Urethral Inj .
③ Bleeding .
③ x Traum
op
Indications .
① Deco m pan ate of urine Retention .
② Monitoring urine out pout → post op , coma , Crite al
pl
.
urine
③ collecting
.
④ paralytic pt .
give Mediation
in bladder BCG
⑤
.
Trephine needle
for BM Ex .