侵入性醫療感染管制作業基準 - cdc.gov.tw · iv 李潤川...
Transcript of 侵入性醫療感染管制作業基準 - cdc.gov.tw · iv 李潤川...
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invasive procedures
94-95
154
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I
()
( 1-3 )
( 4-5 )
( 6 )
( 7 )
( 8-12 )
( 13 )
( 14-15 )
( 16-18 )
( 19 )
( 20-21 )
( 22 )
( 23-24 )
( 25 )
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II
( 26-28 )
( 29-36 )
( 37-40 )
( 41-43 )
( 44-47 )
( 48 )
( 49 )
( 50 )
( 51 )
( 52 )
( 53 )
( 54-56 )
( 57-60 )
( 61-66 )
( 67 )
( 68-70 )
( 71-72 )
( 73 )
( 74-77 )
( 78 )
( 79 )
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III
( 80 )
( 81 )
( 82 )
( 83-84 )
( 85 )
( 86 )
( 87-88 )
( 89 )
( 90 )
( 91 )
( 92 )
( 93-96 )
( 97-99 )
( 100-102 )
( 103-105 )
( 106-114 )
( 115 )
( 116 )
( 117-120 )
( 121-127 )
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IV
( 128-129 )
( 130-133 )
(
134-136 )
( 137-140 )
( 141 )
( 142 )
( 143 )
( 144 )
( 145-149 )
( 150 )
( 151-153 )
( 154 )
()
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V
-
VI
Aseptic Technique.................................................................................. 1
Skin Antisepsis ............................................................................................... 9
Disinfection and Sterilization .......................................... 19
Advanced Cardiac Life Support.................................................. 31
Diagnostic Peritoneal Lavage.................................................. 37
Stereotactic Brain Biopsy ......................................... 41
Nasopharyngeal Electrode Recording.............................. 45
Cortical Stimulation for Brain Function Mapping ........ 49
Sphenoidal Electrode Recording .................................................... 53
Intracarotid Sodium Amytal Test or Wada Test57
Nerve Biopsy ............................................................................. 61
Muscle Biopsy ........................................................................... 65
Needle Electromyography ................................................................ 71
Cornea Scraping Test ......................................................................... 77
Photorefractive Keratectomy .......................................... 79
Indocyanine Green Scanning Laser
Ophthalmoscopy ............................................................................................................ 85
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VII
Eye Fundus Fluorescein Angiography ..............................89
Electroretinography ............................................................93
Nasolacrimal Duct Probing ...........................................................97
Electrocochleography ...................................................................101
Myringotomy....................................................................................107
Rhinomanometry ........................................................................... 111
Rigid Nasal Sinuscope..........................................................115
Transnasal Puncture and Irrigation of
Maxillary Sinus .............................................................................................................119
Laryngeal Electromyelography .................................................123
Rigid and Flexible Laryngoscopy .................127
Flexible Laryngovideostroboscopic
Surgery ............................................................................................................................133
Nasopharyngofiberoscopy ......................................139
Swan-Ganz Catheterization ...........................................143
Insertion of Temporary Pacemaker ........................147
Insertion of Permanent Pacemaker ....................151
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VIII
Pericardiocentesis.......................................................................... 155
Transesophageal Echocardiography (TEE) .............. 161
Coronary Angiography............................................................. 165
Left Ventriculography................................................................... 173
Right Ventriculography................................................................ 179
Chest Tube Insertion.................................................................... 185
Pleural Biopsy ..................................................................... 191
Bronchoscopy.............................................................................. 195
Analysis of Arterial Blood Gases...................................... 201
Tracheostomy.................................................................................. 205
Thoracentesis...................................................................................... 211
Thoracoscopy .................................................................................. 215
Insertion of Nasogastric Tube............................................... 221
Gastric Lavage .................................................................................... 225
Liver Biopsy ......................................................................... 231
Abdominal Paracentesis .......................................... 235
Total Parenteral Nutrition ................................................... 239
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IX
Esophagogastroduodenoscopy .................................245
Colonoscopy.........................................................................................257
Sigmoidoscopy........................................................................261
Peritoneoscopy ...............................................................................265
Endoscopic Retrograde
CholangiopancreatographyERCP....................................................................271
Hemodialysis .......................................................................................277
Implantation of Continuous Ambulatory
Peritoneal Dialysis Catheter ....................................................................................285
Kidney Biopsy......................................................................291
Urethral External Sphincter Electromyography .....297
Trans-Rectal Ultrasound Guided Prostate
Biopsy...............................................................................................................................301
Urethral Pressure Profilometry .............................................305
Cystometry.......................................................................................309
Foley Catheterization ...............................................................313
3 Way Foley Catheterization Bladder
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X
Irrigation......................................................................................................................... 319
Cystourethroscopy ................................................................ 323
Urethral Dilatation......................................................................... 327
Suprapubic Trocar Cystostomy ............................ 331
Retrograde Pyelography ......................................... 337
-() Periodontal
Therapy-Non-Surgical Therapy (Scaling; Localized, Full Mouth) and
Surgical Therapy.......................................................................................................... 343
Simple Extraction (Primary Tooth)......................... 347
() Pulpectomy (Primary Tooth) ......................... 351
Pulpotomy with Formocresol (Primary Tooth)355
Simple Extraction (Permanent Tooth)....................................... 359
Impaction Tooth Extraction ....................................................... 363
Endodontic Emergency Treatment.............. 367
Skeletal Traction ................................................................................ 371
Tendon Injection ................................................................................ 375
Arthrocentesis............................................................................. 379
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XI
............................................................................................................385
Skin Biopsy ..................................................................................391
Bone Marrow Aspiration and Biopsy ..........................................397
Blood Transfusion ..................................................................405
Port-A Catheter Implantation............................................429
Epidural Anesthesia ..................................................................435
Epidural Pain Control........................................................439
Hickman Catheter Implantation...................................445
Port-A Port-A for Epidural Pain Control.....451
Intraoperative Transesophageal
Echocardiography ........................................................................................................457
Lumbar Puncture ...............................................................................463
Spinal Anesthesia ..............................................................................469
Endotracheal Intubation .............................................................473
Peripheral Venous Catheterization..............................477
Central Venous Catheterization ...............................481
Arterial Catheterization .......................................................487
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XII
Infant Arterial and Venous Puncture ......................................... 493
Intravenous Infusion for Infant ........................................... 497
Pediatric Central Venous Catheterization..... 501
Suprapubic Puncture of Urinary Bladder.............. 507
Heel Stick for Blood Sampling.............................................. 511
Exchange Transfusion of Newborn.......................................... 513
Pediatric Lumbar Puncture..................................................... 519
Pediatric Arterial Catheterization ............................ 525
Umbilical Arterial Catheterization ................... 529
Umbilical Vein Catheterization ......................... 535
Pediatric Nasal Gastric Tube Intubation ................... 541
Pediatric Gastric Irrigation..................................................... 547
Pediatric Advanced Life Support.............................. 553
Pelvic Laparoscopy............................................ 559
Hysteroscopy .......................................................................................... 565
Dilatation and Curettage .................................................... 571
Culdocentesis .................................................................. 577
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XIII
Colposcopy ...............................................................................................581
Amniocentesis .................................................................................585
Hysterosalpingography........................................................591
Vaginal Embryo Transfer.........................................................597
Sonoguiding Vaginal Oocyte Retrival .............601
Cisternography ...................................................................................605
Clinical Guideline for Acupuncture and Moxibustion............609
Sonoguided Percutaneous Aspiration and
Drainage of Gall Bladder...........................................................................................615
Sonoguided
Aspiration and Drainage of Perirenal Fluid, Abscess, Hematoma or
Urinoma...........................................................................................................................619
Sonoguided
Aspiration and Drainage of Retroperitoneal or Pelvic Cavity Fluid or
Abscess ............................................................................................................................625
Fine Needle Aspiration Cytology of Breast
Tumor ...............................................................................................................................631
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XIV
Intravenous Urography ................................................... 635
Voiding Cystourethrography ..................................... 645
Antegrade Pyelography ....................................................... 649
Renal Angiography............................................................ 653
Corpus Cavernosography ........................................... 659
Retrograde Urethrography................................................. 663
Percutaneous Nephrostomy .................................................. 667
Computed Tomography........................................................... 673
Contrast Medium ................................................................................... 681
Sonoguided Aspiration, Biopsy and
Drainage ......................................................................................................................... 693
Sonoguided Aspiration of Superficial Fluid
Collection ........................................................................................................................ 701
Sonoguided Percutaneous
Aspiration and Drainage of Pleural Fluid or Empyema ................................. 705
Sonoguided Aspiration and Drainage of
Liver Abscess ................................................................................................................ 711
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XV
Sonoguided Fine Needle Aspiration
Cytology ..........................................................................................................................717
Sonoguided Needle
Aspiration Cytology of Intraabdominal Solid Organ ......................................723
Sonoguided Sclerosing Therapy of
Cysts .................................................................................................................................727
Celiac Angiography .......................................................733
X Video Pharyngography................................................739
X Upper Gastrointestinal Series ......743
X Barium Enema X-Ray Examination ................749
Arthrography ...................................................................................755
Myelography ........................................................................................759
Magnetic Resonance Imaging .......................................................765
Mammography and
Mammography-Guided Procedures ......................................................................773
Aortography .........................................................................779
Mesenteric Angiography..............................................787
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XVI
Splenoportography ....................................................... 793
Percutaneous Transhepatic
Cholangiography and Drainage.............................................................................. 797
T T-tube Cholangiography .................................................. 803
Pulmonary Angiography.................................................. 807
Sonoguided Aspiration of Scrotal
Hydrocele, Hematoma or Pyocele......................................................................... 813
Sonoguided Needle Biopsy of
Superficial Structures ................................................................................................ 817
Sonoguided Fine
Needle Aspiration Cytology of Mediastinal, Pleural or Pleura-based
Peripheral Lung Nodules ........................................................................................... 823
Cerebral Angiography .................................................................. 827
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1
Aseptic Technique
Aseptic Technique
()
()
()
-
2
()
()
1.
2.
3.
()
()
()(
)
()
() 10~15
()
()
()
()
()
()
()
()
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3
Aseptic Technique
()
()
()
()
()
()()
()
()
()
()
() 18~22 35~75
() 20
()
()
()
()(mechanical monitors)
-
4
1.
2.
3.
4.:
()(chemical indicators)
1.(external chemical indicators)
(1)
(2)
(3) H2O2
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5
Aseptic Technique
2.(internal chemical indicators)
(
)
()(biological indicators)
1
1.
(1):(Geobacillus stearothermophilus)
(2):(Bacillus atrophae)
2.:
(1)(spore strip):
(2)(self-contained biological indicator):
()
7 7
1
() 1
-
6
()
()
()
()
()
()
()
1. 1972
2. 1983
3. 1992
4. 1993
5. Daschner F. The hospital and pollution: role of the hospital epidemiologist in protecting the environment. In Wenzel RR, ed. Prevention and Control of Nosocomial Infection. 2nd ed. Baltimore: Williams and Wilkins, 1993:993-1000.
6. Zaidi M, Angulo M, Sifuentes-Osornio J. Disinfection and sterilization practices in Mexico. J Hosp Infect 1995;31:25-32.
7. APICAPIC infection control and applied epidemiology. Mosby, NY 1996,19-1~20-1.
8. Garner JS, Hospital Infection Control Practices Advisory Committee. Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol
-
7
Aseptic Technique
1996;17:53-80.
9 Weber DJ, Rutala WA. Environmental issues and nosocomial infections. In: Wenzel RP, ed.- Prevention and control of nosocomial infections. Baltimore: Williams and Wilkins, 1997:491-514.
10. O'Grady NP, Alexander M, Dellinger EP, et al. Guidelines for the prevention of intravascular catheter-related infections. MMWR 2002;51:1-29.
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9
Skin Antisepsis
Skin Antisepsis
(resident)(transient)
(colonies)
1.(hand wash)
2.
(hand antisepsis)
3.(surgical hand scrub)
()()
()
()
()
() 10~15
-
10
()()
()
()
()
() 10~15
()()
()
()
()
()
120
()
()
()
()
2
()
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11
Skin Antisepsis
(iodine)(iodophors)
() iodophors povidone(polyvinylpyrolidone)
iodine
()
()
() 7.5% 10%
()Tincture of iodine
Iodophors
(alcohol)
( ) (ethyl alcohol) (isopropyl
alcohol) 60~90% 50%
()
()
()
(chlorhexidine gluconate)
()(
)
()
6
()
Hexachlorophene
-
12
()
()
() 3
Para-chloro-meta-xylenol
()
()
() 5%
0.5%~3.75%
()
Triclosan
()
()
()
()
() 0.3% ~ 2.0%
()(semicritical items)
()
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13
Skin Antisepsis
()
()
() 50
() 90%
()
() Bacillus spp. Clostridium spp.
B
(echovirus)(coxsackievirus)
Chlorhexidine gluconate
()
()()
()
()
Hexachlorophene
()
()
()
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14
Para-chloro-meta-xylenol
()
()
Triclosan
()
()()
()
()()
()
()
()(colonization)
()
1.
2.
()
1.
2.
()
3.
4.(latex glove)
()
1.
-
15
Skin Antisepsis
2.
3.
()
1.
2.
3.
4.
()
1.
2.
3.
1. Larson EL. APIC Guidelines Committee. APIC guideline for handwashing and antisepsis in health care settings. Am J Infect Control 1955;23:35A-67A.
2. Spaulding EH. Chemical disinfection of medical and surgical material. In: Lawrence CA, Block SS, eds. Disinfection, Sterilization and Preservation. Philadelphia: Lea & Febiger, 1968:517-31.
3. Elaine LL, Mark SS, Charles AE. Analysis of three cariables in sampling solution used to assay bacteria of hands: type of solution, use of antiseptic neutralizers and solution temperature. J Clin Microbiol 1980;355-60.
4. Larson E. Guideline for use of topical antimicrobial agents. Am J Infect Control
-
16
1988;16:253-66.
5. Daschner F. The hospital and pollution: role of the hospital epidemiologist in protecting the environment. In Wenzel RR, ed. Prevention and Control of Nosocomial Infection. 2nd ed. Baltimore: Williams and Wilkins, 1993:993-1000.
6. Sattar SA, Jacobsen H, Springthorpe VS, Cusack TM, Rubino JR. Chemical disinfection to interrupttransfer of rhinovirus type 14 from environmental surfaces to hands. Appl Environ Microbiol 1993;59:1579-85.
7. Rutala WA. APIC Guidelines Committee; Association for Professionals in Infection Control and Epidemiology . APIC guideline for selection and use of disinfectants. Am J Infect Control 1996;24:313-42.
8. Garner JS, Hospital Infection Control Practices Advisory Committee. Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol 1996;17:53-80.
9. Rotter M. Hand washing and hand disinfection [Chapter 87]. In: Mayhall CG, ed. Hospital epidemiology and infection control. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins, 1999.
10. Boyce JM. It is time for action: improving hand hygiene in hospitals. Ann Intern Med 1999;130:153-5.
11. Boyce JM, Pittet D. Guideline for Hand Hygiene in Health-Care Settings Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force MMWR 2002;51(RR16):1-44.
12 O'Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, et al. Guidelines for the Prevention of Intravascular Catheter-Related Infections. MMWR Recomm Rep 2002;51:1-29.
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17
Skin Antisepsis
1. ()
2.
3.
4.
5.
6.
Chlorhexidine gluconate
GPCGPB*
GNB**
Acid-fast bacteria
Lipophilic viruses
Hydrophilic viruses
()
Bacterial spores
Fungi
Ameobas
Protozoan cysts
* GPCGram positive cocci, GPBGram positive bacilli
** GNBGram negative bacilli
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19
Disinfection and Sterilization
Disinfection and Sterilization
1968
Spaulding
(crtitical items)
(semicritical items)
(vegetative bacteria)
(noncritical items)
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20
()
()
1.
2.
()
1.
2.
()
()
()
()
-
21
Disinfection and Sterilization
()
()
1.(steam sterilization)
2.(dry heat sterilization)
3.(radiation sterilization)
4.(plasma sterilization)
()
1.(ethylene oxide gas sterilization)
2.(activated glutaraldehyde sterilization)
3.(peracetic acid sterilization)
()
20
1. 2(glutaraldehyde)(Cidex
Cido-durWavicide)
2. 6(hydrogen peroxide)
3.(peracetic acid)
4.(ortho-phthalaldehyde ; OPA)
5.(sodium hypochlorite)>1000ppm
10 (1 9 ) 5000ppm
6.(Pasteurization) 75 30
()
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22
1. 10 (iodine) 2
2. 70-75(w/v)(alcohol)
()
10
1.(phenolics)
2.(quaternay ammonium compounds)
3.(chlorhexidine gluconate)
4.(sodium hypochlorite)
100ppm
() 121
45~75
()
(6~24 )
()
-ray -ray
DNA
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23
Disinfection and Sterilization
()(ethylene oxide)
():
50(
)55~75
()
3 10 (0.2ppm)
()
FDA 7.35% hydrogen peroxide
0.23% peracetic acid 3
15 1.0% hydrogen peroxide 0.08%peracetic
acid 8 25 3
0.2%peracetic 55~56
12 30 40
()
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24
()
FDA
20~90 3~10
1.0
0.2ppm
()
6%~7.5% 20 20
10~25%3%
()
pH
()
0.55%(ortho-phthalaldehyde; OPA)
OPA
5 105
pH3~9
32
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25
Disinfection and Sterilization
()
5.25%~6%1000ppm(0.1%)( 1:50)
100ppm( 1:500)
()
()
60%~90%(v/v)
70%(v/v)
()
(hyperbilirubinemia) HIV
()
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26
1. Spaulding EH. Chemical disinfection of medical and surgical material. In: Lawrence CA, Block SS, eds. Disinfection, Sterilization and preservation. Philadelphia: Lea & Febiger, 1968:17-31.
2. Power EGM, Russell AD. Sporicidal action of alkaline glutaraldehyde: factors influencing activity and a comparison with other aldehydes. J Appl Bacteriol 1990;69:261-8.
3. Rutala WA. Disinfection, sterilization and waste disposal. In: Wenzel RP, ed. Prevention and control of nosocomial infections. 2nd ed. Baltimore: Williams and Wilkins, 1993:460-95.
4. Daschner F. The hospital and pollution: role of the hospital epidemiologist in protecting the environment. In Wenzel RR, ed. Prevention and Control of Nosocomial Infection. 2nd ed. Baltimore: Williams and Wilkins, 1993:993-1000.
5. Alfa MJ, Sitter DL. In-hospital evaluation of orthophthalaldehyde as a high level disinfectant forflexible endoscopes. J Hosp Infect 1994;26:15-26.
6. Zaidi M, Angulo M, Sifuentes-Osornio J. Disinfection and sterilization practices in Mexico. J Hosp Infect 1995;31:25-32.
7. Rutala WA. APIC Guidelines Committee; Association for Professionals in Infection Control and Epidemiology . APIC guideline for selection and use of disinfectants. Am J Infect Control 1996;24:313-42.
8. Weber DJ, Rutala WA. Environmental issues and nosocomial infections. In: Wenzel RP, ed.- Prevention and control of nosocomial infections. Baltimore: Williams and Wilkins, 1997:491-514.
9. Report of a Working Party of the British Society of Gastroenterology Endoscopy Committee. Cleaning and disinfection of equipment for gastrointestinal endoscopy. Gut 1998;42(4):585-93.
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27
Disinfection and Sterilization
10. CJ Alvarado, M. Reichelderfer. APIC guideline for infection prevention and control in flexible endoscopy. AJIC 2000;28:138-55.
11. Society of Gastroenterology Nurses and Associates, Inc. Guideline for the use of high-level disinfectants and sterilants for reprocessing of flexible gastrointestinal endoscopes. Gastroenterology Nursing 2000;23(4):180-7.
12. Favero MS, Bond WW. Chemical disinfection of medical and surgical materials. In: Block SS, ed.- Disinfection, sterilization, and preservation. Philadelphia: Lippincott Williams & Wilkins, 2001:881-917.
13. Food and Drug Administration. Sterilants and high level disinfectants cleared by FDA in a 510(k) as- of June 29, 2001 with general claims for processing reusable medical and dental devices,- htpp://www.fda.gov/cdrh/ode/germlab.html., 2001.
14. Block SS. Definition of terms. In: Block SS, ed. Disinfection, sterilization, and preservation. Philadelphia: Lippincott Williams & Wilkins, 2001:19-28.
15. FDA http://www.fda.gov/cdrh/ode/germlab.html
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28
1. 45-75 2. 3.
1.
2.
1. 2. 3. 4.
1.
2. 3.
1. 1. 2.
1. 2. 3.
1. (6-24 ) 2. 3.
1. 2. 3.
1. 3 10 2.
(
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29
Disinfection and Sterilization
2%
Glycine
3-10% 6%
3%
Catalase
0.35%
(OPA) 0.55%
Glycine
0.1-0.5% (1)
(2) (100ppm)
(3)
(4)
Sodium thiosulfate
30-50mg/l 70-150mg/l
Tincture Iodophors
Sodium thiosulfate
70-90% 0.5-10% 3%
() 10%
Tween 80 Lecithin
Chlorhexidine gluconate
()
Lecithin
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31
Advanced Cardiac Life Support
Advanced Cardiac Life Support
(advanced cardiac life supportACLS)
ACLS 1974
(early access)(early cardiopulmonary resuscitation,
CPR)(early defibrillation) ACLS
()
()
()
(disposable)
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32
--(bag-valve-mask)
(oralpharyngeal or nasopharyngeal airway)
()
(laryngoscope)
(endotracheal tube)
(intravenous catheter)
(electrocardiogram lead)
(suction tube)
(defibrillator)
(thumper)
(pulse oximeter)
(transcutaneous pacemakerTCP)
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33
Advanced Cardiac Life Support
ACLS
ACLS ( 4% Chlorhexidine gluconate)
()
()
() airway-breathing-circulation ABC A
B--
C
B C
()
1.Ventricular fibrillation (VF) ventricular tachycardia
(VT) 360 epinephrine 1 mg
360
lidocaineamiodarone
2.Asystoleepinephrine 1 mg 3-5
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34
epinephrine atropine ( 1 mg 3 mg)
3.Pulseless electrical activity (PEA) asystole
PEA
()
1.( 100/)
--
2.( 60/min)
TCP
()
ACLS
() 30 2
5
100
()
()epinephrine 1 mg 3-5
(3mg5mg)Lidocaine 1.0-1.5 mg/kg
()VF amiodarone (300 mg )lidocaine
(1.5mg/kg )
() 20ml
-
35
Advanced Cardiac Life Support
naloxoneatropinelidocaineepinephrinevalium
2-2.5 10ml
() 7.5-8.0 7.0-7.5
19-23
()
CO2(end tidal CO2 detector)
() CPR ACSL
asystole
10 asystole 34
30 asystole
() CPR CPR
()PEA hypovolemia
()CPR sodium bicarbonate
ACLS 10
()
CPR
()
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36
()
1.(
)
2.(
)
3. X
12
4.
1. Advanced Cardiac Life Support (ACLS): Principles and Practice. American Heart Association 2003:43-87.
2. 2005 America Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2005;112(24Suppl):1-203.
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37
Diagnostic Peritoneal Lavage
Diagnostic Peritoneal Lavage
()
()
()
()
()
()
()(lap-belt sign)
()(celiotomy)
()
1.
2.
3.
4.
(disposable)
-
38
()
()
( 70-75%)
(1000c.c.)
Mosquito forcep 2
1
Y 1
(1% 2% xylocaine)
(5c.c.10c.c.)
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39
Diagnostic Peritoneal Lavage
()( 4% Chlorhexidine gluconate)
( 70-75%
)
2
()
()
()
() 18
() 18 3
()
()
() 1 ( 10
ml/kg)/
()
()
()
100,000/mm3
500/mm3
-
40
()
()
()
()
1. American College of Surgeons, Committee on Trauma. Advanced Trauma Life Support for Doctors 2004:136-7.
2. American College of Surgeons, Committee on Trauma. Advanced Trauma Life Support for Doctors 2004:147-50.
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41
Stereotactic Brain Biopsy
Stereotactic Brain Biopsy
()
()
()
()
()
(disposable)
-
42
:
( 70-75%)
(Leksell frame)
()(
)
()(
)
()
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43
Stereotactic Brain Biopsy
()
() valium
()
()()
glucose
()( 4% Chlorhexidine gluconate)
()()
() localizer
(Gamma Plan)
()
()
()( 70-75%)
2
2-3
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44
()(X)
0.5 1.0 cm
()
2-3
1-2%
4-6
1. Tasker RR. Stereotactic Surgery: Principles and Techniques. In: Neurosurgery, Wilkins RH & Rengachary SS ed., 1985:2465-81
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45
Nasopharyngeal Electrode Recording
Nasopharyngeal Electrode Recording
()
()
()
()
()
()
(disposable)
:
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46
()
()
()
()
()( 4% Chlorhexidine gluconate)
()
()
()
()
()
()
()
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47
Nasopharyngeal Electrode Recording
1. Hans Luders. Epilepsy Surgery. 2nd ed. Ravens Press 1992.
2. Simkins-Bullock J. Beyond speech lateralization: a review of the variability, reliability, and validity of the intracarotid amobarbital procedure and its nonlanguage uses in epilepsy surgery candidates. Neuropsychol Rev 2000;10(1):41-74.
3. Silfvenius H. Fagerlund M. Saisa J. Olivecrona M. Christianson SA.Carotid angiography in conjunction with amytal testing of epilepsy patients. Brain Cognition 1997;33(1):33-49.
4. Dodrill CB. Preoperative criteria for identifying eloquent brain. Intracarotid amytal for language and memory testing. Neurosurg Clin N Am 1993;4(2):211-6.
5. Jones-Gotman M. Neuropsychological techniques in the identification of epileptic foci. Epilepsy Res 1992;5:87-94.
6. Rausch R. Role of the neuropsychological evaluation and the intracarotid sodium amobarbital procedure in the surgical treatment for epilepsy. Epilepsy Res 1992;5:77-86.
7. Jones-Gotman M. Localization of lesions by neuropsychological testing. Epilepsia 1991;5:S41-52.
8. Nilsson LG. Christianson SA. Silfvenius H. The accuracy of the dichotic, the visual half-field, and the intracarotid sodium amytal memory tests in preoperative neuropsychological investigation of epileptic patients. Acta Neurol Scand 1988;117:73-8.
-
49
Cortical Stimulation for Brain Function Mapping
Cortical Stimulation for Brain Function Mapping
()
()
()
()
()
()
(disposable)
:
(70-75%)
-
50
()()
()
() X 3D
()( 4% Chlorhexidine gluconate)
()() 70-75%
()(50 mg/min) Dilantin 300~500 mg
() X ( MRI )(reference electrode)
(epileptogenic zone) (exploring
electrodes)
1.
2.
3.(15 mA 10 )(symptom
)(sign) EEG after discharges
()(
)
1.(1 mA)( 1 mA)
EEG after discharges
2. after discharges
-
51
Cortical Stimulation for Brain Function Mapping
15 mA
()()
1. EEG after discharges
0.5-1 mA
2. after discharges 15 mA
()
1./
2.EEG after discharges
3. 15 mA/
()
1.
2.
3.()
()
()
()
-
52
1. Hans Luders. Epilepsy Surgery. 2nd ed. Ravens Press 2001.
2. American Clinical Neurophysiology Society. Guideline on Electrocorticography and Intraoperative Cortical Srimulation. 2000, sep.
-
53
Sphenoidal Electrode Recording
Sphenoidal Electrode Recording
(video-EEG
monitoring)
()()
()
()
(disposable)
:
( 70-75%)
-
54
(
)
3X3
()
(2% Lidocaine)
1
2 5c.c.
()
()
()
()
()( 4% Chlorhexidine gluconate)
( 70-75%)
2
()(zygomatic archintertragus2.5 incisura
intertragus )
()( Lidocaine)
()() 10
10
-
55
Sphenoidal Electrode Recording
() 4~5
()
() 1~2
()
() 3~5
()(Jack
box)
()()()
()
()
1. King DW. So EL. Marcus R. Gallagher BB. Techniques and applications of sphenoidal recording. J Clin Neurophysiol 1986;3(1):51-65.
2. Klass DW, Daly DD, eds. Current practice of clinical EEG. New York: Raven Press, 1979.
3. Niedermeyer E, Lopes Da Silva F, eds. Electroencephalography: basic principles, clinical applications, and related fields. Baltimore: Williams and Wilkins, 1999:725-6.
-
56
-
57
Intracarotid Sodium Amytal Test or Wada Test
Intracarotid Sodium Amytal Test or Wada Test
()
()(
)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
()
1.
2.
-
58
(disposable)
:
( 70-75%)
()
()
()
()
( 70-75%)
2
()( 4% Chlorhexidine gluconate)
-
59
Intracarotid Sodium Amytal Test or Wada Test
()
(cross-over)
()
() 3 ml sodium amytal 100 mg 3~5
()
()
3+58+5100-7
()
8
()
()()
()
()
()
-
60
1. Hans Luders. Epilepsy Surgery. 2nd ed. Ravens Press 1992.
2. Simkins-Bullock J. Beyond speech lateralization: a review of the variability, reliability, and validity of the intracarotid amobarbital procedure and its nonlanguage uses in epilepsy surgery candidates. Neuropsychol Rev 2000;10(1):41-74.
3. Silfvenius H. Fagerlund M. Saisa J. Olivecrona M. Christianson SA.Carotid angiography in conjunction with amytal testing of epilepsy patients. Brain Cognition 1997;33(1):33-49.
4. Dodrill CB. Preoperative criteria for identifying eloquent brain. Intracarotid amytal for language and memory testing. Neurosurg Clin N Am 1993;4(2):211-6.
5. Jones-Gotman M. Neuropsychological techniques in the identification of epileptic foci. Epilepsy Res 1992;5:87-94.
6. Rausch R. Role of the neuropsychological evaluation and the intracarotid sodium amobarbital procedure in the surgical treatment for epilepsy. Epilepsy Res 1992;5:77-86.
7. Jones-Gotman M. Localization of lesions by neuropsychological testing. Epilepsia 1991;5:41-52.
8. Nilsson LG, Christianson SA, Silfvenius H. The accuracy of the dichotic, the visual half-field, and the intracarotid sodium amytal memory tests in preoperative neuropsychological investigation of epileptic patients. Acta Neurol Scand 1988;117:73-8.
-
61
Nerve Biops
Nerve Biopsy
(sural nerve)
()
()
()
()
()
()
()
()
()
(disposable)
:
( 70-75%)
-
62
(3c.c.5c.c. 1 )
( 70-75%)
2
0.5% lidocaine Achilles (Achilles tendon)
1 8 10
(sural nerve)(saphenous
vein) 1
(mm) 5 14
-
63
Nerve Biops
lidocaine
3-4
(neuroma)
(whole nerve biopsy)
(fascicular nerve biopsy) 11
( 3-4 )
()
24
1. Asbury AK, Johnson PC. Pathology of Peripheral Nerve. Philadelphia: W.B. Saunders, 1978:268-71.
2. Swash M, Schwartz MS. Muscle and nerve biopsy. In: Swash M, Schwartz MS,
-
64
eds. Neuromuscular Disease: A Practical Approach to Diagnosis and Management. 3rd ed. Cambridge, Chapman & Hall Medical 1987:15-62.
3. Dyck PJ, Giannini C, Lais A. Pathologic alternations of nerves. In: Dyck PJ, Thomas PK, Griffin JW, Low PA, Poduslo JF, ed. Peripheral Neuropathy, Vol. 1, 3rd ed. Philadelphia: W.B. Saunders, 1993:514-95.
4. Midroni G, Bilbao JM. Peripheral neuropathy and the role of nerve biopsy, In: Midroni G, Bilbao JM, eds. Biopsy Diagnosis of Peripheral Neuropathy. Newton Butterworth-Heinemann, 1995:1-11.
5. Vital C, Vallat JM. The peripheral nerve biopsy. In: Vital C, Vallate JM, eds. Ultrastructural Study of the Human Diseased Peripheral Nerve. 2nd ed. Amsterdam Elsevier, 1987:3-4.
-
65
Muscle Biopsy
Muscle Biopsy
()
()
(disposable)
:
( 70-75%)
-
66
1% xylocaine without
epinephrine
10c.c.
3
15
/
/
/
/
3
1 /2
1 /2
-
67
Muscle Biopsy
1
()
()
()
()
()
()
()
()
()
-
68
()( 70-75%)
2
()(Steri-Drape)
()( 1% xylocaine
without epinephrine)
() 4~8
()
() 2~2.5 X 0.5 X 0.5
()
()
()
()
()
()
()
()
()
()()
1.
-
69
Muscle Biopsy
2.(muscle hernination)
3.
1. Pamphlett: Muscle biopsy. In: Mastaglia FL, Walton L, eds. Skeletal Muscle Pathology. 2nd ed. London: Churchill Livingstone, 1992;95-121.
2. Edward RHT, Jackson MJ, Helliwell TR, et al. Muscle biopsy technique. Im: Lane RJM ed. Handbook of Muscle Disease. New York: Marcel Dekker, 1996;53-9.
3. Edward RHT, Jones DA. Disease of skeletal muscle. In: Peachey LD, Adrian RH, Geiger SR, ed. Handbook of physiology, Section of Skeletal Muscle. Bethesda: American Physiological Society, 1983;637.
4. Kokulas BA, Adams RD. Obtaining and preparing muscle tissue for microscopic study. In: Kokulas BA, Adams RD, eds. Diseases of Muscle: Pathological Function of Clinical Myology. 4th ed. Philadelphia: Happer & Row Publishers, 1985;772-5.
5. Swash M, Schwartz MS. Muscle and nerve biopsies. In: Swash M, Schwartz MS, eds. Neuromuscular diseases: A Practical Approach to Diagnosis and Management. 2nd ed. Berlin: Sprlinger Verlage, 1988;37-62.
6. Dubowitz V. The procedure of muscle biopsy. In: Dubowitz V, ed. Muscle Biopsy: A Practical Approach. 2nd ed. Eastbourne: Bailliere Tindall, 1985;3-18.
7. Swash M, Schwartz MS. The muscle biopsy: techniques and laboratory methods. In: Swash M, Schwartz MS, eds. Biopsy Pathology of Muscle. 2nd. London: Chapman & Hall Medical, 1991;15-37.
8. Sage FP. Inheritable progressive neuromuscular disease. In: Crenshaw AH, ed. Compbells Operative Orthopaedics. 8th ed. St. Louis: Mosby Year Book, 1992;2466-8.
9. Brown JR, MacEwan GD. Muscle and nerve disorders in children. In: Chapman MW, ed. Operative Orhtopedics. 2nd ed. Philadelphia: JB Lippincott, 1993;3729.
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71
Needle Electromyography
Needle Electromyography
(needle electrode)(electric
activity)(needle electromyography)
(conventional EMG)(monopolar needle)
(concentric needle)(single-fiber EMG)
(macro EMG)(scanning EMG)
90%
(EKG)(EEG)
430
(motor unit)
-
72
(myotonia)(myokymia)
(neuromyotonia)
(axonopathy)
(myelinopathy)
()
(disposable)
(AIDS)Creutzfeldt-Jakob
:
-
73
Needle Electromyography
(
4% Chlorhexidine gluconate)
()
(Tension pneumothorax)
-
74
1. Emeryk B, Hausmanowa-Petrusewicz I, Nowak T. Spontaneous volleys of bizarre high frequency potentials in neuromuscular diseases. Electromyogr Clin Neurophysiol 1974;14:339-54.
2. Daube JR. AAEE Minimonograph No. 11: Needle Examination in Electromyography. Rochester, MN, USA, American Association of Electromyography and Electrodiagnosis (renamed American Association of Electrodiagnostic Medicine), 1979.
3. Wiechers DO. Electromyographic insertional activity in normal limb muscles. Arch Phys Med Rehabil 1979;60:359-63.
4. Stlberg EV, Antoni L. Electrophysiological cross section of the motor unit. J Neurol Neurosurg Psychiatry 1980;43:469-74.
5. Brown WF, Varkey GP. The origin of spontaneous electrical activity at the end-plate zone. Ann Neurol 1981;10:557-60.
6. Roth G. The origin of fasciculations. Ann Neurol 1982;12:542-7.
7. Goodgold J, Eberstein A. Electrodiagnosis of Neuromuscular Diseases, 3rd ed. Baltimore: Williams & Wilkins, 1983:65-103.
8. Litchy WJ. A practical demonstration of EMG activity, in AAEM Course C: Standard Needle Electromyography of Muscles. Rochester, MN, USA, American Association of Electrodiagnostic Medicine, 1988:23-33.
9. Kimura J. Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice. 3nd ed. Philadephia: FA Davis, 2001:249-74.
10. Kraft GH. Fibrillation potential amplitude and muscle atrophy following peripheral nerve injury. Muscle Nerve 1990;13:814-21.
11. Mayo Clinic and Mayo Foundation. Mayo Clinic Examinations in Neurology. 6th ed. St. Louis: Mosby Year Book, 1998:385-418.
12. Petajan JH. AAEM Minimonograph No. 3: Motor unit recruitment. Muscle Nerve 1991;14:286-98.
13. Patten J. Neurological Differential Diagnosis. 2nd ed. London: Springer,
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75
Needle Electromyography
1996:352-4.
14. Buchthal F, Rosenfalck P. Spontaneous electrical activity of human muscle. Electroencephalogr Clin Neurophysiol 1996;20:321-36.
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77
Cornea Scraping Test
Cornea Scraping Test
()
()
()
()
:
1
15 64 1
0.5% Alcaine 1
()
-
78
()( 4% Chlorhexidine gluconate)
Alcaine
() 15
()
()
()
()
1. Kenyon KR. Recurrent corneal erosion: pathogenesis and therapy. Int Ophthalmol Clin 1979;19:169-76.
2. McLean LB, MacRae SM, Rich LF. Recurrent erosion. Treatment by anterior stromal puncture. Ophthalmology 1986;93:784-8.
3. Arey LB, Cavode WM. The method of repair in epithelial wounds of the cornea. Anat Rec 1943;86:75-82.
4. Matsuda M, Ubels JL, Edelhauser HF. A larger corneal epithelial wound close at a faster rate. Invest Ophthalmol Vis Sci 1985;26:897-900.
5. Khodadoust AA, Silverstein AM, Keynyon KR. Adhesion of regenerating corneal epithelium: the role of the basement membrane. Am J Ophthalmol 1968;65:339-48.
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79
Photorefractive Keratectomy
Photorefractive Keratectomy
() 18
()(-2.0D)
()()
()
() 0.5
() 100
()
()
()
()
()
()
()
()
()
()
()
() 1.0 (
-
80
)
(disposable)
:
( 10%)
1% mydriacyl eye drop
1.3% gentamycin eye drop
0.5% Alcaine
64#
2x2
Healon
0.9%
-
81
Photorefractive Keratectomy
()
1.
2.
3.
()
1.
2.
()
1.( 4% Chlorhexidine gluconate)
2.
3.
()
1.
() 2 1% pilocarpine2 0.5% Alcaine eye drop
() 10%(1/4 )
()
()3M sticker
() 64# PRK
() 6-6.5mm 0.1mm
() 1 1% mydriacyl
-
82
()
1% mydriacyl antibiotic eye drop
0.1% Fluoromethalone ---- 1
0.1% Fluoromethalone ---- 2
0.1% Fluoromethalone ---- 3
Topography 3
()
()
()
()95% 0.5 1.0
60% 77%
()PPK
()PRK ( 75 )
()
()
-
83
Photorefractive Keratectomy
1. Machat JJ. Eximer Laser Refractive Surgery (Practice and Principle) 1996. by SLACK Incorporated, 6900 Grave Rood, Thorofare, NJ 08086-9447.
2. Elander R, Rich LF, Robin JB. Principles and Practice of Refractive Surgery, 1997. W.B. SAUNDERS Company. A Division of Harcourt Brace E. Company Philadelphia London Toronto Montreal Sydney Tokyo.
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85
Indocyanine Green Scanning Laser Ophthalmoscopy
Indocyanine Green Scanning Laser Ophthalmoscopy
(Indocyanine Green)
()
()
()
()
()
()
()
()
()
()
()
:
(70-75%)
-
86
Indocyanine green dye(ICG)
(10c.c.)
(1 mydriacyl)
()
() 1% Tropicamide
() SLO
()( 4% Chlorhexidine gluconate)
(70-75%)
25
( 5c.c.) 5c.c.
ICG SLO
VHS
() 3 510152030
()
10~30
-
87
Indocyanine Green Scanning Laser Ophthalmoscopy
Atropine 0.6~0.8mg
()
()Epinephrine 11000 0.1-0.5ml
()
()
() 20
Aminophylline 5.6mg/kg
() Dopamine 400mg 500ml
D5W 5~15ug/Kg/min
() Corticosteroid antihistamine
()
1. Flower RW. Extraction of choriocapillaris hemodynamic data from ICG fluorescence angiogram. Invest Ophthal Vis Sci 1993;34:2720-9.
2. Destro MC, Puliafito CA. Indocyanine green videoangiography of choroidal
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88
neovascularization. Ophthalmology 1989;96:846-53.
3. Guyer DR, Yannuzzi LA, Slakter JS. Digital indocyanine green videoangiography of occult choroidal neovascularization. Ophthalmology 1994;101:1727-35.
4. Sorenson JA, Yannuzzi LA. A pilot study of digital ICG videoangiography for recurrent occult choroidal neovacularization in age-related mascular degeneration. Arch Ophthalmol 1994;112:473-84.
5. Slakter JS, Yannuzzi LA. A pilot study of ICG videoangiography-quided laser photocoagulation of occult choroidal neovascularization in age-related mascular degeneration. Arch Ophthalmol 1994;112:465-72.
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89
Eye Fundus Fluorescein Angiography
Eye Fundus Fluorescein Angiography
()
()
()
()
()
()
()
()
()
()
()
()
()
()
(disposable)
-
90
:
(70-75%)
10% sodium fluorescein 5ml
(10c.c.)
Canon
Kodack Ektachrome ASA 400
(1% Tropicamide)
()
() 1% Tropicamide
() Topcon
()( 4% Chlorhexidine gluconate)
(70-75%)
10% sodium fluorescein
5ml
() 1-2 22-24
-
91
Eye Fundus Fluorescein Angiography
() 10 15 30
()
10-30
Atropine 0.6~0.8mg
()
()Epinephrine 11000 0.1~0.5ml
()
()
() 20
Aminophyline 5.6mg/kg
() Dopamine 400mg 500ml
D5W 5~15ug/Kg/min
() Corticosteroid antihistamine
()
-
92
1. Bron AJ, Easty DL. Fluorescein angiography of the globe and anterior segment. Trans Ophthalmol Soc UK 1970;90:339-67.
2. Amalric P. Circulation choroidienne. C. R. Symp. Int. Angiographic fluoresceinique, Albi 1969, Karger, Basel 1971:193-203.
3. Justice JJ, Paton D, Beyer CR, Seddon GG. Clinical comparison of 10% and 25% intravenous sodium fluorescein solution. Arch Ophthalmol 1977;95:2015-6.
4. Flower RW. Injection techniques for indocyanine green and sodium fluorescein dye angiography of the eye. Invest Ophthalmic 1973;12:881-2.
5. Benson RC, Kues HA. Fluorescence properties of indocyanine green as related to angiography. Phys Med Biol 1978;23:159-63.
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93
Electroretinography
Electroretinography
()
()
()
()
()
(disposable)
:
(70-75%)
1% Mydriacyl
0.5% Alcaine
2% Methylcellulose
-
94
()
()( 4% Chlorhexidine gluconate)
()
()
()
() 2% MCNS
() Ganzfeld
() 30
1.
2.
3.
()
1.
2.
()
-
95
Electroretinography
1. Marmor MF. Arden GB, Nilsson SE. Standard for clinical electroretinography. Arch Ophthalmol 1989;107:816-9.
2. Burian HM, Allen L. A speculum contact lens electrode for electroretinography. EEG Clin Neurophysiol 1954;6:509-11.
3. Murayama K. Sieving PA. Different rates of growth of human and monkey photopic ERG suggests two sites of light adaptation. Clin Vis Sci 1992;7:385-92.
4. Marg E. Development of electrooculography. Arch Ophthalmol 1951;45:169-85.
5. Berson EL. Electrical phenomena in the retina. In: Moss RA, Hart WM, eds. Alders physiology of the eye: clinical application. St Louis: CV Mosby 1987:506-67.
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97
Nasolacrimal Duct Probing
Nasolacrimal Duct Probing
()
()
()
()
()
()
(disposable)
:
23
26
(5c.c.)
10ml
-
98
0 (Bowman probe)
00 (Bowman probe)
2
()
()
()
()
()( 4% Chlorhexidine gluconate)
()
()
()
()
()
()
()
()
-
99
Nasolacrimal Duct Probing
()
()
()
(False passage)
1. Jones LT. The lacrimal secretory system and its treatment. Am J Ophthalmol 1966; 62:47-64.
2. Jones LT. An anatomical approach to problems of the eyelids and lacrimal apparatus. Arch Ophthalmol 1961;66:111-20.
3. Linberg JV, McCormick SA. Primary acquired nasolacrimal duct obstruction; A clinical pathological report and biopsy technique. Ophthalmology 1986;93:1055-62.
4. Hurwitz JJ. Diseases of the sac and duct; The lacrimal system. Philadelphia: Lippincott-Raven Publishers. 1996:117-48.
5. Norn MS. Tear secretion in normal eyes. Acta Ophthalmol 1965;43:567-77.
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101
Electrocochleography
Electrocochleography
()
()
()
()
()
()
(disposable)
:
( 70-75%)
-
102
2
2
1
1
1
(Jelly) 1
2 ( 1
2 4 )
1 ( 2
4 1
1 )
(2% xylocaine)5c.c.
(24 ) 2
1
()
()(
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103
Electrocochleography
)(A )
()
()
()
()
()
() 0.5c.c.(2%
xylocaine)
()
()
()
(promontory)
()
()
()
-
104
()()()
()
()
10 20
()
1. 199352(5)319-24
2. SchuknechtHarold F 198621(1)138-46
3. Eggermont JJ, Odenthal DW. Methods in electrocochleography. Acta Oto-Laryngologica-Supplement 1974;316:17-24.
4. Odenthal DW, Eggermont JJ. Clinical electrocochleography. Acta Oto-Laryngologica-Supplement 1974;316:62-74.
-
105
Electrocochleography
5. Hooper R. Electrocochleography. J Laryngol Otol 1973;87(10):919-27.
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107
Myringotomy
Myringotomy
()
()
()
()
()
()
()
*
()
()
()
()
(disposable)
-
108
:
()
2x2
2c.c. 25
(10% xylocaine)2c.c.
Epinephrine(11000)
Rubber suction tube
Middle ear fluid aspiration collector
Anaerobic culture tube
Ventilation tube insertion instruments
Ear set.
1 4 1
1
-
109
Myringotomy
()
()
()
() 10% xylocaine 2c.c. 30
()
()
()
()
()
()
()
()
()
()
1. Myringotomy for Otitis Media with Effusion in School-Aged Children 199934(3)207-11
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110
2. 1986
-
111
Rhinomanometry
Rhinomanometry
()
()
()
()
(disposable)
:
(70-75%)
2% Glutaraldehyde (Cidex)
-
112
()
()
()( 4% Chlorhexidine gluconate)
()
() 1
()
()
()
()
70-75%
cidex 20
1. Clement PA, Gordts F. Standardisation Committee on Objective Assessment of the Nasal Airway, IRS, and ERS. Consensus report on acoustic rhinometry and rhinomanometry. Rhinology 2005;43(3):169-79.
2. Huang ZL, Ong KL, Goh SY, Liew HL, Yeoh KH, Wang de Y. Assessment of nasal cycle by acoustic rhinometry and rhinomanometry. Otolaryngol Head Neck Surg 2003;128(4):510-6.
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113
Rhinomanometry
3. Cole P. Acoustic rhinometry and rhinomanometry. Rhinology Suppl 2000;16: 29-34.
4. Carney AS, Bateman ND, Jones NS. Reliable and reproducible anterior active rhinomanometry for the assessment of unilateral nasal resistance. Clinic Otolaryngol 2000;25:499-503.
5. Silkoff PE, Chakravorty S, Chapnik J, Cole P, Zamel N. Reproducibility of acoustic rhinometry and rhinomanometry in normal subjects. Am Rhinology 1999; 13:131-5.
6. Panagou P, Loukides S, Tsipra S, Syrigou K, Anastasakis C, Kalogeropoulos N. Evaluation of nasal patency: comparison of patient and clinician assessments with rhinomanometry. Acta Oto-Laryngologica 1998;118:847-51.
7. Naito K, Iwata S. Current advances in rhinomanometry. Eur Arch Oto-Rhino-Laryngol 1997;254:309-12.
8. Clement PA. Rhinomanometry. Allergy 1997;52(Suppl):26-7.
9. Fernandes FR, Sole D, Naspitz C, Munoz-Lopez F. Diagnostic value of nasal provocation testing and rhinomanometry in allergic rhinitis. J Invest Allergol Clinic Immunol 1996;6:184-8.
10. Maranta CA, Scherrer JL, Simmen D. The mask: style and volume do not influence rhinomanometry. Rhinology 1995;33:84-5.
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115
Rigid Nasal Sinuscope
Rigid Nasal Sinuscope
()
()
()
()
()
()
()
(disposable)
:
(70-75%)
-
116
(03070120 )
1
CCD 1
1
4% xylocaine 5c.c.
180000 Bosmin 5c.c.
2% xylocaine
2% Glutaraldehyde (Cidex)
1
1
1
()
1
() 1
laryngoscope 2
()
()
() 4% xylocaine
-
117
Rigid Nasal Sinuscope
2% xylocaine E 10
()
()( 4% Chlorhexidine gluconate)
()
()
()
()
()
()
() Endozime 10 (
) Cidex 20
70-75%
() 30
()
()
1:100 Cidex
-
118
20 70-75%
2% xylocaine
1/80000 Bosmin surgicelfuracine
merocel
()
()
()
atropine
1. Bailey BJ, et al. Chapter 344: Nasal Cavity Examination with Nasal Biopsy or Foreign Body Removal Atlas of Head & Neck Surgery-Otolaryngology Second Edition 2001:900-901.
2. Rudman DT, Stredney D, Sessanna D, Yagel R, Crawfis R, Heskamp D, et al. Functional endoscopic sinus surgery training simulator. Laryngoscope 1998;108(11 Pt 1):1643-7.
3. Christmas DA Jr., Krouse JH. Powered instrumentation in functional endoscopic sinus surgery. 1: Surgical technique. Ear, Nose, & throat Journal 1996;75(1):33-6, 39-40.
4. Prasanna A. Murthy PS. Sphenopalatine ganglion block under vision using rigid nasal sinuscope. Reg Anesth 1993;18(2):139-40.
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119
Transnasal Puncture and Irrigation of Maxillary Sinus
Transnasal Puncture and Irrigation of Maxillary Sinus
(cystic fibrosis)
(immotile cilia syndrome)
()
()
(disposable)
:
-
120
Tilley-Litchwitz trocar and cannula
2% epinephrine + xylocaine
4% xylocaine 180000 Bosmin
() 2% epinephrine + xylocaine 10
4% xylocaine 180000 Bosmin
()12
X
( 4% Chlorhexidine gluconate)
Tilley-Litchwitz trocar and cannula
1 2
(trocar)
(cannula)
-
121
Transnasal Puncture and Irrigation of Maxillary Sinus
37
500 1000c.c.
xylocaineepinephrine
5-10
()
1. Bailey B J, et al. Chapter 350: Intranasal antrostomy through the inferior meatus. Atlas of Head & Neck Surgery-Otolaryngology Second Edition 2001:916-7.
2. 1993191-4
-
123
Laryngeal Electromyelography
Laryngeal Electromyelography
()(
)
()(Jacob-Creutzfeldt )
()
()
(disposable)
:
(70-75%)
-
124
()1
1
1
4% Xylocaine 2c.c.
2% Xylocaine + E
1c.c.
()
()
()
()
()(Bipolar concenter electrode)
()
()( 4% Chlorhexidine gluconate)
()(4% Xylocaine)(70-75%)
1c.c. 2% Xylocaine + E
()
()
-
125
Laryngeal Electromyelography
()
(Thyroaytend muscles)(Circothyroid muscles)
()
()
()
()
15
1. Gay T, Hirose H, Strome M, Sawashima M. EMG of the intrinsic laryngel muscles during phonation. Ann Otolarygol 1972;81:401-9.
2. Blair RL, Berry H, Briant TD. Laryngeal electromyography: techniques and application. Otolaryngol Clin North Am 1978;11:325-46.
3. Bevan K, Morgan MH, Griffiths MV. The role and techniques of laryngeal electromyography. Clin Otolaryngol Allied Sci 1988;13:299-305.
4. Koufman JA, Postma GN, Whang CS, Rees CJ, Amin MR, Belafsky PC, et al. Diagnostic laryngeal electromyography: The Wake Forest experience 1995-1999. Otolaryngol Head Neck Surg 2001;124(6):603-6.
-
127
Rigid and Flexible Laryngoscopy
Rigid and Flexible Laryngoscopy
()
()
()
()
()
()
()
()
()
()
(disposable)
-
128
:
(70-75%)
1
1
1
1
(myostate) 1
1
1
1
4% Cocaine 3-5c.c.
4% Xylocaine 3-5c.c.
70-75%
2% Glutaraldehyde(Cidex)
2x2
1
()
1
() 1
() 1
-
129
Rigid and Flexible Laryngoscopy
()
()
() 4% cocaine
100mg/70kg 4% xylocaine 200mg/70kg
() 2% cidex 20
70-75%
70-75%
()
1. 5~10 ( 4%
Chlorhexidine gluconate)
2.
3.
4.
5.
6.E
7.(Trumpet Maneuver)
8.
-
130
9.
()
1.( 4% Chlorhexidine
gluconate)
2. 2x2
3.
4.
5.
6.
7.
()
()
() Endozime 10
Cidex 20
70-75%
() 0.5~1
()
() cocaine
TCAA surgicel furacin
-
131
Rigid and Flexible Laryngoscopy
()
1.
2.
3.
atropine
1. John M. Lone: An atlas of head and neck surgery, WB Saunders company. 1988:888-9.
2. Dedo: surgery of the Larynx and Trachea, BC Deck, INC. 1990:3-12.
3. Ballerger: Otorhinolaryngology, Head and Neck surgery, waverly company,15th ed., 1996:1189-208.
-
133
Flexible Laryngovideostroboscopic Surgery
Flexible Laryngovideostroboscopic Surgery
()
()
()
()
()()
()
()
()
()
()
()
()
()
()
(disposable)
-
134
:
(70-75%)
1 (
)
CCD 1
1
storz Teflon
1
(Nagashima)(storz)
1
Nagashima 2
1
1
1
4% Xylocaine
2% Glutaraldehyde(Cidex) 1L
2x2
()
()
-
135
Flexible Laryngovideostroboscopic Surgery
() 4% cocaine
100mg/70kg 4% xylocaine 200mg/70kg
() cidex 20
70-75%
() 5~8c.c. 4% xylocaine
A-E fold
() 5~10
()( 4% Chlorhexidine gluconate)
70-75%
()
()
()
()()
()()
()
()
()
() Endozime 10 (
-
136
)Cidex 20
70-75%
() 0.5~1
()
() cocaine
TCAA surgicel furacin
()
1.
2.
3.
atropine
1. Dedo HH, Urrea RD, Lawson L. Intracordal injection of Teflon in the treatment of 135 patients with dysthonia. Ann Otol Rhinol Laryngol 1973;82:661-7.
2. Teflon 198419141-6
3. Lone JM. An atlas of head and neck surgery. WB Saunders company. 1988:888-9.
4. Dedo. Surgery of the Larynx and Trachea. BC Deck, INC. 1990:3-12.
-
137
Flexible Laryngovideostroboscopic Surgery
5. Crumley RL. Teflon versus thyroplasty versus nerve transfer: A comparison. Ann Otol Rhinol Laryngol 1990;99:759-63.
6. Mahieu HF, Dikkers FG. Indirect microlaryngostroboscopic surgery. Arch Otolaryngol Head Neck Surg 1992;118:21-4.
7. Dedo HH. Injection and removal of Teflon for unilateral vocal cord paralysis. Ann Otol Rhinol Laryngol 1992;101:81-6.
8. Gould WJ, Sataloff RT, Spiegel JR. Voice surgery. St. Louis, Mosby 1993:227-67.
9. Dikkers FG, Sulter AM. Suspension microlaryngoscopic surgery and indirect microlaryngostroboscopic surgery for benign lesions of the vocal folds. J Laryngol Otol 1994;108:1064-7.
10. Benninger MS, Crumley RL, Ford CN, Gould WJ, Hanson DG, Ossoff RH, et al. Evaluation and treatment of the unilateral paralyzed vocal fold. Otolaryngol Head Neck Surg 1994;111:497-508.
11. Ballerger. Otorhinolaryngology, Head and Neck surgery, waverly company, 15th
ed., 1996:1189-208.
-
139
Nasopharyngofiberoscopy
Nasopharyngofiberoscopy
()
()
()
()
()
()
()
()
(disposable)
-
140
:
(70-75%)
1
1
1
1
4% Cocaine 3-5c.c.
4% Xylocaine 3-5c.c.
2% Glutaraldehyde(Cidex)
2x2
()
()
() 4% cocaine
100mg/70kg 4% xylocaine 200mg/70kg
() cidex 20
70-75%
70-75%
-
141
Nasopharyngofiberoscopy
() 5~10 ( 4%
Chlorhexidine gluconate)
()
()
()
()
()E
()Trumpet maneuver
()
()
()
Endozime 10 (
)Cidex 20
70-75%
0.5~1
cocaine
(Vasovagal collapse)
-
142
1. Butter CT. Endoscopy of the Upper Airways. Amsterdam. Excepta Medica 1976.
2. Croft CB. Endoscopy of the nose and sinuses. In: Mackay IS, Bull TR. Rhinology. Kerr AG: Scott-Browns Otolaryngology, Vol 4, 5th ed. London: Butterworths, 1987:31-9.
3. Herberbold C. Endoscopy of the maxillary sinus. Maxillofacial Surg, 1:125-8.
-
143
Swan-Ganz Catheterization
Swan-Ganz Catheterization
()
()
()
()
()
()
()
()
()
(critical items)
(steam sterilization)
(guide-wire)
-
144
:
( 70-75%)
(Guidewire)
( 70-75%)
2
-
145
Swan-Ganz Catheterization
2% Xylocaine (Seldinger puncture needle)
(Guidewire) 11 0.3
(dilator)(sheath)
15 20 0.8mL
1.5mL
()
()(
)
1. Gore JM, Alpert JS, Benotti JR, et al. Handbook of Hemodynamic Monitoring. Boston: Little, Brown, 1985.
2. Joseph SA, Gary SF. Handbook of Coronary Care. Boston: Little, Brown, 1993.
3. Swan HJC, Ganz W, Forrester J, et al. Catheterization of the heart in man with the use of a flow-direct balloon-tipped catheter. N Engl J Med 1970;283:447-51.
4. Falicov RE, Resnekov L. Relationship of the pulmonary artery end diastolic pressure to the left ventricular dysfunction. Circulation 1970;42:65-78.
5. Patel C, Laboy V, Venus B, et al. Acute complications of pulmonary catheter
-
146
insertion in critically ill patients. Crit Care Med 1986;14:195-7.
6. Putterman C. The Swan-Ganz catheter: a decade of hemodynamic monitoring. J Crit Care 1989;4:127-46.
-
147
Insertion of Temporary Pacemaker
Insertion of Temporary Pacemaker
()
()
()/
()
()
() QT
()
(disposable)
-
148
:
( 70-75%)
2 10 1 2 2 x 2 46 x 46 9 5 5 / 3 3 4.5
-
149
Insertion of Temporary Pacemaker
X
( 70-75%)
2
X Internal jugular vein Subclavian vein
Femoral vein
()
X 24
3 X
1. Bartecchi CE. Temporary cardiac pacing. Chicago: Precept Press, 1990:268.
2. Goldberger J, Kruse J, Ehlert FA. Temporary transvenous pacemaker placement: what criteria constitute an adequate pacing site? Am Heart J 1993;126:488.
3. Fitzpatrick A, Sutton R. A guide to temporary pacing. Br Med J 1992;304:365.
-
150
4. Hynes JK, Holmes DR Jr., Harrison CE, et al. Five-year experience with temporary pacemaker therapy in the coronary care unit. Mayo Clinic Proc 1983;58:122-6.
5. Donovan KD, Lee KY. Indication for and complications of temporary transvenous cardiac pacing. Anaesth Intensive Care 1985;13:63-70.
-
151
Insertion of Permanent Pacemaker
Insertion of Permanent Pacemaker
2 Slow junctional
rhythm/
QT
(disposable)
:
( 70-75%)
-
152
5
5
/
5
3
U
9
2
10
1
-
153
Insertion of Permanent Pacemaker
11 ()
Sofra-Tulle
Tagaderm
2-0 Dexon
2-0 Dexon
2-0
2-0 Plain Cat Gut
Needle holder 7
Straight Kelly
Self-Rentaion Reactor
Aneurgarm Reactor
20c.c.
19#, 23# needle3-0
1% xylocaine
3x3
( 70-75%)
2
-
154
X
()
EKG X (posteroanterior left lateral view)
1. Kusumoto FM, Goldschlager N. Medical process: cardiac pacing. N Eng J Med 1996;334:89-97.
2. Barold SS. Indication for permanent pacemaker: 1991 ACC/AHA guidelines Progress In Clinical Pacing 1992;439-503.
3. Dreifus LS, Frisch C, Griffin JC, et al. Guidelines for implantation of cardiac pacemakers and antiarrhythmia devices: a report of American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic procedures. J Am Coll Cardiol 1991;18:1-13.
4. Hayes DL, Vliestra RE. Pacemaker malfunction. Ann Intern Med 1993;119:828-35.
5. Gastle LW, Cook S. Pacemaker Radiography: Clinical Cardiac Pacing. Philadephia: W.B. Saunders, 1995:538.
-
155
Pericardiocentesis
Pericardiocentesis
(pericardiocentesis) Pericardial tapping
(
)()
()
()
(Pulse paradoxus)
10
-
156
(disposable)
:
( 70-75%)
-
157
Pericardiocentesis
()
20 Gauge cannular (Arterial line)
(Lead II & V Leads)
2%
10
2
24G 10c.c. 2% xylocaine 5-10ml
(subxiphoid)() 11
2mm
18 Gauge Pressure transducer
(3-way stopcock) 2%
-
158
xylocaine 10c.c.
ST-T
()
J 45 80
0.035-0.038
Drainage catheter 6F/15cm 8F/30cm
30-50c.c.
250c.c.
()
-
159
Pericardiocentesis
1. Eugene Braunwald, et al. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 7th ed., 2005.
2. Donald S. Baim, William, M.D. Grossman. Grossman's Cardiac Catheterization, Angiography, and Intervention, 6th ed. Williams & Wilkins, Baltimore, Maryland.
3. Valentin Fuster, R. Wayne Alexander, Robert A. O'Rourke, Robert Roberts, Spencer B. King, Eric N. Prystowsky, Ira Nash. Hursts, The Heart, 11th ed McGraw Hill, New York 2005.
-
161
Transesophageal Echocardiography (TEE)
Transesophageal Echocardiography (TEE)
()
()
()
()
()
()
()
()
()
()
()
-
162
(disposable)
:
8% Xylocaine spray
Xylocaine jelly
S-VHS Tape
(Electrode lead)
Cida-Dars Solution
(BP monitor)
(ECG monitor)
()
()
()(Prothrombin time)
-
163
Transesophageal Echocardiography (TEE)
() 4-6
()
()
()
() lidocainecetacaine benzocaine base
()
()
()
()
()
()( 4% Chlorhexidine gluconate)
()
()
()
()
()
() 30
()
() 10c.c.
-
164
()
()
()
()
()
()
()
()
()
()
1. Transesophageal echocardiography: Basic principles and clinical Applications Edited by Arthr J. Labovitz, Anthony C. Pearson. Lea & Febiger, 1993.
2. Basic of Transesophageal Echocardiography. Edited by Terence D. Rafferty, Churchill, Livingstone.
-
165
Coronary Angiography
Coronary Angiography
()
()
()
()
()
()
()
()
()
()
()
()
()
()(Prothrombin time 18 sec.)
()
()
(disposable)
-
166
:
( 70-75%)
(Guide wire) (sheath) (100cm 3 45cm 2 ) ( 1 )
(xylocaine) (heparin)
-
167
Coronary Angiography
(pigtail)
(guidewire)
(sheath)
(100cm 3 45cm 2 )
(xylocaine) heparin
( Cidex)
()
-
168
()
() 6~8
()
()
()
()
1. X
2.
3.
4.
()
()
()
()()
( 70-75%)
2
()()
()(Set iv line)
()
-
169
Coronary Angiography
()(sheath)
() X
()
()
()
()()
2
()
()
()
()(VT)
-
170
atropine
()
()
()
atropine
()
() heparin
()
()
()(Pyrogenic
endotoxin)
1. John VB, Philip SB. Hospital Infections. Library of Congress, USA, 1992:925-6.
2. Kern MJ. The Interventional Cardiac Catheterization Handbook. Mosby-Year Book, inc. USA. 1996.
-
171
Coronary Angiography
3. From Scanlon PJ, Faxon DF, Auden AM, et al. ACC/AHA guidelines for coronary angiography: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Coronary Angiography). Developed in collaboration with the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol 1999;33(6):1756824.
-
173
Left Ventriculography
Left Ventriculography
()
()
()
()(Ventricular aneurysm)
()
()
()
()
()
()
()
()
()
()(Prothrombin time 18 sec.)
()
()
()
()
-
174
()
(disposable)
:
( 70-75%)
(pigtail)
(guidewire)
(sheath)
(100cm 3 45cm 2 )
( 1
)
-
175
Left Ventriculography
(xylocaine)
(heparin)
()
()
() 6~8
()
()
()
()
1. X
2.
3.
4.
()
-
176
()
()
()()
( 70-75%)
2
()()
()(Set iv line)
()
()(sheath)
() X
()
()
()
-
177
Left Ventriculography
()()
2
() 6
()
() hydrocortisone + antihistamine (
vena)
()
()(VT)
atropine
()
()
()
atropine
()
-
178
() IV heparin
()
guidewire
()
()(Pyrogenic
endotoxin)
1. Kern MJ. The Interventional Cardiac Catheterization Handbook. Mosby-Year Book, inc. USA. 1996.
2. John VB, Philip SB: Hospital Infections. Library of Congress, USA, 1992:925-6.
-
179
Right Ventriculography
Right Ventriculography
()
()
()(shunt)
()(RV dysplasia for
arrhythmia)
()
()
()
()
()
()
()
()
()
()
()
()
()
-
180
()
()
(disposable)
:
( 70-75%)
(guidewire)
(sheath)
(100cm 2 45cm 1 )
( 1 )
-
181
Right Ventriculography
(xylocaine)
(heparin)
()
()
() 6~8
()
()
()
()
1. X
2.
3.
4.
-
182
()
()
()
()()
( 70-75%)
2
()()
()(Set iv line)
()
()(sheath)
() X
()
()
()
-
183
Right Ventriculography
()
()
(sheath)
()
()
()
()(ventricular tachycardia)
atropine
()
()
atropine
()
()
Guidewire
()
-
184
()(Pyrogenic
endotoxin)
1. Kern MJ. The Interventional Cardiac Catheterization Handbook. Mosby-Year Book, inc. USA. 1996.
2. John VB, Philip SB: Hospital Infections. Library of Congress, USA, 1992:925-6.
-
185
Chest Tube Insertion
Chest Tube Insertion
( pneumothorax)
( hemothorax)( pyothorax)( chylothorax)
( hydrothorax)
(chest tube insertion)
()
()
()
()
()
()
()
()
()
(disposable)
-
186
:
( 70-75%)
()
10 ml
(informed
consent) X
PTPTT 1.5 50,000/mm3
() 18 40
-
187
Chest Tube Insertion
()
()
()
()(localized)
()( 4% Chlorhexidine gluconate)
()( 70-75%) 15
2
() 2
(blunt dissection)
()(blunt
dissection)
-
188
() kelly sarrot
sarrot
(
)
()
()
()
(under water sealed bottle)
X
1. Iberti TJ, Stern PM. Risk of pneumothorax in CT-guided transthoracic needle aspiration biopsy of the lung. Crit Care Clin 1992;8:879-95.
2. Kazerooni EA, Lim FT, Mikhail A, et al. Chest tube thoracostomy Radiology
-
189
Chest Tube Insertion
1996;198:371-5.
3. Ravitch MM. Diagnostic and therapeutic procedures. In: Ravitch MM. ed. Philadelphia W.B. Saunders company, 1988:164-7.
4. Wisner DH. Trauma to the chest. In: Sabiston DC, Jr ed. Surgery of the Chest. 6th ed. New York: New York University, 1994:464-5,530-1.
5. Gregoire J, Deslauriers J. Closed drainage and suction system. In: Pearson FG. ed. Thoracic Surgery. New York: Churchill Livingstone 1995,1121-33.
6. Joob AW, Hartz RS. General principles of postoperative care. In: Shields TW ed. General Thoracic Surgery 4th ed. Baltimore: Williams & Wilkins, 1994:341-2, 705-6,668-70.
7. Closed Drainage and Suction Systems in Thoracic Surgery, ed: FG Pearson, J Deslaurier, RJ Ginsberg, CA Hiebert, MF McKneally, HC Urschel, Churchill Livingstone, 1995:1121-33.
8. Miller KS, Sahn SA. Chest tubes. Indications, technique, management and complications. Chest 1987;91:258-64.
-
191
Pleural Biopsy
Pleural Biopsy
(parietal pleura)
()
()
()
()
()
()
(disposable)
Cope Abrams
ethylene oxide(EO)
-
192
:
( 70-75%)
Cope Abrams
Heparin
(informed consent)
( 4% Chlorhexidine gluconate)
(
70-75%)
2 22
(lidocaine)
-
193
Pleural Biopsy
X
Cope
Abrams
Cope Abrams
Abrams
()
5
-
194
1. Light RW. Thoracentesis and Pleural biopsy. In: Wang KP, ed. Biopsy Techniques in Pulmonary Disease. New York: Raven press, 1989:29-44.
2. Yucel AE, Calguneri M, Ruacan S. False positive pleural biopsy and high CA125 levels in serum and pleural effusion in systemic lupus erythematosus. Clin Rheumatol 1996;15:295-7.
3. Kumar ND, Bhatia A, Misra K, et al. Comparison of pleural fluid cytology and pleural biopsy in the evaluation of pleural effusion. J Indian Med Assoc 1995;93:307-9.
4. Kirsch CM, Kroe DM, Jensen WA, et al. A modified Abrams needle biopsy technique. Chest 1995;108:982-6.
5. Pearson FG. Thoracic Surgery. New York: Churchill Livingstone, 1995:988-9.
6. Sabiston DC, Jr Surgery of the Chest. 6th ed. Ch 16, The Pleura 1994:544.
7. Shields TW. In: Shields TW, ed. General Thoracic Surgery 4th ed. Invasive diagnostic procedures. Baltimore: Williams & Wilkins, 1994:273.
8. Fraser RS. Methods of roentgenologic and pathologic investigation. In: Fraser RS. ed. Synopsis of Disease of The Chest. 2nd ed. Philadelphia: W.B. Saunders, 1994:133-4.
9. P.N. Mathur, R. Loddenkemper, Eur Respir Mon, 2002;22:120-130.
-
195
Bronchoscopy
Bronchoscopy
(lower airways)
X
X
()
()(transbronchial lung biopsy)
()
()
()
()
()
()
()
()
()
()
()
(disposable)
-
196
:
( N95 )
(2% xylocaine)
Atropine
2% Glutaraldehyde
2% glutaraldehyde
2% glutaraldehyde
20
B
-
197
Bronchoscopy
EO
2% glutaraldehyde
() X
(informed consent)
()
()
15-30 0.5
mg atropine
35-70 mgmeperidine
2% xylocaine
xylocaine 400 mg
( 4% Chlorhexidine gluconate)
( N95 )
xylocaine
mouth piece
-
198
2% xylocaine
()
4
2
aminophylline
1. Denis AC. Flexible Bronchoscopy. In: Pearson FG. ed. Thoracic Surgery. New York: Churchill Livingstone, 1995:200-9.
2. Arthur DB. Endoscopy: Bronchoscopy and Esophagoscopy In: Sabiston DC, Jr, ed. Surgery of the Chest. 6th ed. New York: New York University, 1994:69-84.
3. William HW, Faber LP. Bronchoscopic Evaluation of The Lungs and Tracheobronchial tree. In: Shields TW, ed. General Thoracic Surgery 4th ed. Baltimore: Williams & Wilkins, 1994:250-62.
4. Fraser RS. Methods of Clinical laboratory and Functional investigation. In: Fraser RS. ed. Synopsis of Disease of The Chest. 2nd ed. Philadelphia: W.B. Saunders, 1994:149.
5. Dweik RA, Mehta AC, Meeker DP, et al. Analysis of the safety of bronchoscopy after recent acute myocardial infarction. Chest 1996;100:825-8.
-
199
Bronchoscopy
6. Shennib H, Baslaim G. Bronchoscopy in the intensive care unit. Chest Surg Clin North Am 1996;6:349-61.
7. Colt HG. Laser bronchoscopy. Chest Surg Clin North Am 1996;6:277-91.
8. Borchers SD, Beamis JF Jr. Flexible bronchoscopy. Chest Surg Clin North Am 1996;6:169-92.
9. Oho K. Instrumentation and technique. In: Oho K, Amemyia R, ed. Practical Fiberoptic Bronchscopy. 2nd ed. Tokyo: Igaku-shoin, 1984:5-26.
10. Stradling P. Diagnostic Bronchoscopy. 6th ed. London: Churchill Livingstone, 1991:9-22.
11. Dikensoy O, Usalan C, Filiz A. Foreign body aspiration: clinical utility of flexible bronchoscopy. Chest 2002;78;399-403.
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201
Analysis of Arterial Blood Gases
Analysis of Arterial Blood Gases
(arterial blood gas ABG)
ABG
pHPaCO2PaO2HCO3- base excess(BE)
()
()()
() ABG (hypercapnia)
()
()
()
()
()
()
(disposable)
-
202
:
( 70-75%)
()
()
(heparin)
25
(2% xylocaine)
25~19 ()
(syringe1~5 ml )
()
()
()
()( 4% Chlorhexidine gluconate)
()
() Allens
-
203
Analysis of Arterial Blood Gases
1.
2.
3.
4.()
15
5. 15 Allens Allens
()( 70-75%)
2 (
)
()(
)
()
()
(
)
() 1~4c.c.()
()
-
204
()
()
1.
2.
()
()
1.
2.
()(arterial occlusion)
1.
2.
3.
1. 1998COM 3-5123-4
-
205
Tracheostomy
Tracheostomy
()
()
()
()
()
()
()
()
(disposable)
-
206
:
( 70-75%)
Y
PTPTT 1.5 100,000/mm3
-
207
Tracheostomy
30 60
(chin)
( 70-75%)
2
(tracheal ring) 2-3
(thyroid isthmus)
plastysma
(sucker)
2 4
Y
()
-
208
()
()
()-
()
()
()
()
()(atelectasis)
5
4
1. Durbin CG Jr. Indications for and timing of tracheostomy. Respir Care 2005;50:483-7.
2. Durbin CG Jr. Techniques for performing tracheostomy. Respir Care 2005;50:488-96.
3. Epstein SK. Late complications of tracheostomy. Respir Care 2005;50:542-9.
4. Lee KJ: General procedure. In: Comprehensive Surgical Atlas in Otolaryngology and Head and Neck Surgery. Vol 1, New York: Grune & Stratton, 1983:10-9.
5. Wright D: Tracheostomy and laryngology. In Rob C, ed: Operative surgery, Vol 2. 3rd ed. London, Butterworth, 1976:242-8.
6. Lulenski GC. Long-term tracheal dimensions after flap tracheostomy. Arch
-
209
Tracheostomy
Otolaryngol 1984;107:114-6.
7. Lulenski GC, Batsakis JG. Management of the flap trachestomy. Arch Otolaryngol 1979;105:260-3.
-
211
Thoracentesis
Thoracentesis
(thoracentesis)
(pleural space)
(ultrasound-guided)
()
()
()
()
()
()
()
()
(disposable)
-
212
:
( 70-75%)
(Lidocaine)
3-way stop cock
(informed consent) X
(decubitus)
X
-
213
Thoracentesis
( 4% Chlorhexidine gluconate