Operation indications contraindications and data that must be remembered 1. Thoracentesis: Indications: (3) clarify the nature of pleural effusion; puncture for fluid extraction or suction decompression; thoracentesis for drug administration. Contraindications: (4) severe cardiopulmonary insufficiency, extremely debilitated patients who cannot cooperate; severe cough that is difficult to locate; local skin inflammation at the puncture site; patients with hemophilia. [7 to 8 intercostal spaces in the scapular line or posterior axillary line, 6 to 7 intercostal spaces in the mid-axillary line, and 5 intercostal spaces in the anterior axillary line. First time 600, later <1000, diagnostic 50-100] 2, abdominal puncture: indications (3) to clarify the nature of the abdominal fluid; puncture and fluid extraction to reduce the symptoms of abdominal distension and dyspnea; abdominal puncture injection. Contraindications (3): those with precursors of hepatic encephalopathy; tuberculous peritonitis with adherent masses; non-peritoneal effusion patients (including giant ovarian cysts, etc.). Xu Jiang, Department of Internal Medicine, Qinhuangdao Orthopedic Hospital [first urinate, measure abdominal circumference and blood pressure, take the left anterior iliac spine at the intersection of the outer middle 1/3 of the umbilical cord, the umbilicus at the midpoint of the pubic symphysis line 1cm, 1!1.5cm to the left or right, or take the umbilicus horizontal line at the intersection of the anterior axillary line and the extension of the mid-axillary line. Staggered needle, 20-100 delivery, 3000-4000,] 3, bone aspiration: indications: (3) diagnosis of various leukemias, differential diagnosis, and treatment follow-up; diagnosis of unexplained fever, differential diagnosis, bone marrow culture and smear to find parasites; unexplained increase or decrease in red blood cells, white blood cells, platelets and morphological abnormalities. Contraindications (2): Patients with hemophilia; local inflammation of the skin at the puncture site. [1~2cm above the posterior superior iliac spine, posterior superior iliac spine, sternal stalk, lumbar spine spine. 1~1.5cm,dry syringe 0.1~0.2ml, 6~8 smears, bone marrow culture 2~3ml] 4, lumbar puncture: Indications: (3) Diagnosis and differential diagnosis of inflammatory diseases of the central nervous system; diagnosis and differential diagnosis of cerebrovascular accidents; diagnosis and treatment of neoplastic diseases. Contraindications (3): those with elevated intracranial pressure; those with inflammation at the puncture site; those in shock, failure or near death. [Posterior superior iliac spine line in the posterior midline intersection, that is, the 3rd, 4 lumbar spine gap, or the upper or lower vertebral space, adults 4 ~ 6cm, children 2 ~ 3cm, normal lateral position pressure 70 ~ 18.mmhg or 40 ~ 50 drops / min, to the pillow lying flat 4 ~ 6 hours] 5, catheterization: indications (4): urinary retention; retention of urinary catheter or meter hourly urine volume changes; retention of urine to do bacterial Culture; preparation for pelvic surgery, cystography for pressure measurement and detection of urethral strictures. 0.5% iodophor or 0.1% chlorhexidine, catheter 14, male 15-20cm, female 6-8cm, 10-15ml water fixed,] 6. Tracheal intubation: indications: (3) general anesthesia; cardiac arrest; respiratory failure, respiratory muscle paralysis or respiratory depression requiring mechanical ventilation. Contraindications: (2) laryngeal edema, acute inflammation of the trachea, pharyngeal abscess; thoracic aortic aneurysm compressing the trachea, severe bleeding quality. [Pillow cushion 10cm high, spray the surface of the larynx with 2% lidocaine] 7, gastric intubation: indications (6): gastric dilatation, pyloric obstruction and food poisoning; gastric fluid examination; gastrointestinal decompression; oral and laryngeal surgery need to keep the surgical site clean; coma, extreme anorexia intubation for nutritional therapy; barium examination or preparation before surgical treatment. Contraindications: (5) severe esophageal varices; corrosive gastritis; nasal obstruction, esophageal or cardia stenosis or obstruction; severe respiratory distress. [Paraffin oil lubrication, nostril to pharynx about 14 ~ 16m swallowing, total length 45 ~ 55cm, equivalent to hair to the glabella, gastric lavage fluid 5000ml, pour into funnel 300 ~ 500. * Gastric tube lavage indications: (3) emetic gastric lavage method is ineffective or uncooperative with impaired consciousness; need to retain gastric fluid specimens sent to toxic analysis; where oral poisoning within 6 hours and no contraindications] 8, Gastrointestinal decompression: Indications (5): acute gastric dilatation; gastric and duodenal perforation; after larger abdominal surgery; mechanical and paralytic intestinal obstruction; acute pancreatitis. Contraindications (4): esophageal stricture; severe esophageal varices; severe cardiopulmonary insufficiency, bronchial asthma; corrosive injury to the esophagus and stomach. 【Insert 50～75cm】 9, cardiopulmonary resuscitation: Indications: (2) circulatory arrest due to various causes (including cardiac arrest, ventricular fibrillation, and extremely weak heartbeat) or respiratory arrest (caused by brain herniation, brainstem injury) Contraindications: (5) open chest wall injury; thoracic deformity; pericardial pressure wallow; rib fracture; where it is clear that the heart, lungs, brain and other important organ failure can not mud brick. Resuscitation may not be performed. Such as advanced cancer, etc. [Look at the morphology, facial color, pupils, feel the femoral artery strong arterial pulsation, listen to the heart sound, hard board bed, go to the pillow and lie flat. Normal human tidal volume 500～600ml, blowing 12～20 times/min, compression 80～100 times/min, frequency 5:1 for two people, 15:2 for single person, compression: relaxation time = 0.6:0.4, sternal depression 4～5cm for adults, 3cm for 5 to 13 years old, 2cm for infants and children. effective signs: systolic pressure >60mmhg when the aorta starts to beat, face color, lip color, nails and skin turns red; dilated pupils narrow (normal 3 to 4mm, “2 narrowed,” 5 dilated) appear to breathe on their own; mental recovery. 10, the clinical application of ventilators: indications (4): severe hypoventilation (such as chronic obstructive pulmonary disease caused by respiratory failure, asthma persistent state, various causes of central respiratory failure and respiratory muscle paralysis); severe ventilatory dysfunction (acute respiratory distress syndrome, severe pulmonary infection or acute pulmonary edema where medical treatment is ineffective); cardiopulmonary resuscitation; decreased respiratory function (chest and cardiac surgery, severe chest trauma). Indications for application: clinical indications: shallow, slow, 0 irregular breathing, extreme dyspnea, respiratory arrest or cessation, impaired consciousness, respiratory rate greater than 35 breaths/min. Indications for blood gas analysis: blood ph <7.20~7.25; pco2>70~80mmhg; po2 inhalation fio20.40,30 minutes after still <50mmhg. relative contraindications: (5) severe pulmonary maculopathy, pulmonary cyst; moderate amount of hemoptysis or more; undrained tension pneumothorax, mediastinal emphysema; hypovolemic shock before replenishment of blood volume; acute Myocardial infarction. [Mask oxygenation is suitable for clear consciousness, short-term or intermittent application for 1 to 2 hours; tracheal intubation: comatose or semi-comatose patients, retained for 72 hours; tracheotomy for long-term mechanical ventilation. Regulation: Ventilation volume: 600 ml for general, 500 ml for slow obstructive pulmonary, 800 ml for acute respiratory distress syndrome; inspiration/exhalation time: 1:2 to 2.5 slow frequency for slow obstructive pulmonary; 1:1.5 fast frequency for restrictive ventilation; ventilation pressure: 15-20 cmh2o for light lesions, 20-25 cmh2o for moderate, 25-30 cmh2o for severe giving oxygen concentration: 24% for low concentration ~ 28% not more than 40%, moderate 40% ~ 60% for hypoxia and carbon dioxide retention, high concentration: 60% or more for carbon monoxide poisoning, cardiogenic shock, inhalation of high concentration of oxygen should not exceed 1 to 2 days] 11, emergency hemostasis: indications: (3) peripheral vascular traumatic bleeding; reduce bleeding in the surgical area; some special sites of trauma or pathological vascular rupture bleeding (liver rupture, esophageal variceal rupture). Contraindications: (3) need to perform amputation replantation without tourniquet; special infected amputation without tourniquet, such as gas gangrene amputation; where there is atherosclerosis, diabetes, chronic kidney disease renal insufficiency, caution with tourniquet or shock pants. [Tourniquet location: upper limb for the upper 1/3 of the upper arm, the lower limb for the junction of the middle and lower 1/3 of the femur. Inflatable tourniquet upper extremity 300kpa lower extremity 500kpa, time about 1 hour, maximum not more than 3 hours] 12.Electric suction aspiration purpose: to use the principle of negative pressure, the patient's respiratory tract viscous sputum or misabsorbed foreign body aspiration, to clean the airway, improve the function of ventilation. The purpose of oxygen nebulization inhalation: purpose: to use high-speed oxygen airflow to blow the medicine into mist and inhale the patient's respiratory tract to achieve therapeutic purposes. [Oxygen flow 5 to 10 liters of inhalation solution plus 5 ml of distilled water to dissolve or dilute. General 10 to 15 minutes.] 13, spinal injury site handling principles: the application of hardboard or wooden board as a tool, three people to assist in carrying the patient, keeping the patient's trunk in a straight position to avoid spinal torsion. 14, the purpose of wearing surgical gowns and gloves: to avoid prolonged surgery, bacteria hidden deep in the skin migrate to the skin surface and rapidly multiply and grow, contaminating the surgical area. 15.Clear suturing: Indications: fresh traumatic wounds. Contraindications: suture is not suitable for septic infected wounds. 16.Stitch removal: Indications: (2) sterile surgical incisions, no abnormal local and systemic manifestations, the time for stitch removal has come, and the incision is healing well. 4-5 days for head and neck, 6-7 days for lower abdomen and perineum; 7-9 days for upper abdomen, chest, back and buttocks, 10-12 days for extremities, and 14 days for some extension and reduction of tension sutures at joints. Wounds with obvious infections such as redness, swelling, heat and pain after surgery should be removed earlier. Contraindications: (4) The removal of stitches should be delayed: severe anemia, wasting, mild cachexia; severe water loss or water-electrolyte disorders have not been corrected; elderly patients and infants; when cough is not controlled, the removal of stitches should be delayed for thoracoabdominal incisions. 17, dressing change: purpose: to check the wound, remove wound secretions, remove foreign bodies and necrotic tissue in the wound, smooth drainage, control infection and promote wound healing. No special 3 to 5 days to change once, infected wounds secretions more than 1 day 1 time, fresh granulation trauma every 1 to 2 days, serious infection depending on the amount of drainage flow to determine the number of drug changes. 18, wear isolation clothing purpose: (2) to protect patients, protect medical personnel, to avoid cross-infection and self-infection. Avoid the spread of pathogenic bacteria. Indications: Enter infectious diseases or areas that may cause infection. 19. Electroshock defibrillation: Indications: Various arrhythmias and cardiac arrests. [Synchronous defibrillation except for ventricular fibrillation tuned to asynchronous. Electrode location: 5th intercostal space in the left anterior axillary line, 2nd intercostal space next to the right sternum, coated with conductive paste or padded with wet saline gauze pad, charged for the first time 300j, not more than 360j, failed to resuscitate for 3 consecutive times, stop defibrillation. Note: When defibrillating, make sure that the patient is not lying on a metal bed and no bystanders are touching the patient. Remember to register ECG changes for recording].