ACCS Special Procedures

Question 1

If a patient is traveling between __ and __ miles, fly them with a helicopter.
Exception: if pt is critical, then use an ambulance only if distance is less than ___ miles.

Answer 1

80-150 miles.

30 miles.

Question 2

When transporting a patient, (use / do not use) an ambubag.

Answer 2

Don’t use an ambubag.

Always use a ventilator but keep the BVM in case of emergency.

Question 3

How do you calculate tank duration?

Answer 3

PSIG x Factor / Flow

Question 4

What’s an E cylinder tank factor?

Answer 4

0.3

Question 5

What’s an H cylinder tank factor?

Answer 5

3

Note: H cylinders last ten times longer than E cylinders.

Question 6

VAP is usually (Bacterial / Viral)

Answer 6

Bacterial.

Question 7

What’s the most common cause of VAP?

Answer 7

Aspiration of secretions or gastric contents.

Question 8

How do you determine if someone has VAP?

Answer 8

Get a sputum specimen.

CXR

Question 9

What kind of sputum indicates VAP?

Answer 9

Purulent

Question 10

What is a protected specimen brush?

Answer 10

Catheter with sealed plug. Put it down the trachea, instill fluid, then suction fluid back up.

Question 11

What test is usually done rule out VAP?

Answer 11

Mini-BAL.

Question 12

What is a BBS?

How does it work?

Answer 12

Blind Bronchial Sampling.

Blindly wedging catheter into a distal bronchus, instill fluid, then suction it out right away.

Question 13

What is the minimum and maximum SBT time?

Answer 13

30 min - 2 hours

Question 14

What is used to diagnose and treat alveolar filling disorders? Can be used for diagnostic lavage, but when used for therapeutic lavage, use a (rigid or flexible) bronchoscope. You must lavage one lung at a time, so you must use a ___ (specific type of airway).

Answer 14

Bronchioalveolar Lavage (BAL).
Flexible
Carlens tube

Question 15

To do a Mini-BAL, insert the mini-BAL catheter into the airway past ___ centimeters. Then slightly withdraw because ___. Next, QUICKLY deliver ___ml of normal saline. Aspirate ___ mL into specimen container, then suction all remaining lavage fluid.

Answer 15

Insert catheter into airway up to 56 cm.
You have to allow inner catheter to advance.
QUICKLY deliver 2 20 ml syringes of saline
Aspirate 3-4 ml into specimen container.

Question 16

What kind of procedure is used to visualize the trachea and bronchi?

Answer 16

Broncoscopy

Question 17

When would you use a rigid bronchoscope?

Answer 17

For therapeutic indications.

Question 18

When would you use a flexible bronchoscope? x2

It has an outer diameter of ___.

Answer 18

For diagnostic indications.
Can also be used to intubate patient with Cspine injury.
5 mm

Question 19

The minimum size ET tube you can use with a flexible bronchoscope is size ___.

Answer 19

Size 8.

Question 20

What does it mean if you see lots of black spots on the bronchoscope?

Answer 20

That means there’s a broken optic fiber.

Question 21

How do you prepare a patient for a bronchoscope?

Answer 21

First give a topical anesthetic (Lidocaine, benzocaine, any “-caine”)
Assemble monitoring equipment, including pulse ox and EKG
Give a sedative
Give a narcotic (morphine).

Question 22

Why do you want to give a narcotic to a bronchoscope patient?

Answer 22

Give morphine for analgesic and antitussive effects.

Question 23

Before doing a bronchoscopy on a patient who is being ventilated, you have to attach a ___. Why?
What other three things do you need to do?

Answer 23

Bodai adaptor. It allows a patient to keep receiving positive pressure during procedure.
Give topical anesthetic via ET tube
Increase FiO2 to 100%
Increase high pressure alarm setting.

Question 24

How do you treat acute hemorrhaging during a bronchoscopy?

Answer 24

Give iced saline or epinepherine

Question 25

During a bronchoscopy, how can you treat severe hemoptysis?

Answer 25

Insert a double lumen endobronchial tube to protect the healthy lung.

Question 26

During a bronchoscopy, what should you do if there’s an obstruction of the suction channel?

Answer 26

Irrigate with saline.

Question 27

What four things should you do following a bronchoscopy?

Answer 27

Wipe the exterior surface
Irrigate and flush the suction channel and port with detergent
Rinse entire instrument with tap water
Immerse the scope in glutaraldehyde (Cydex)

Question 28

How do you disinfect a bronchoscope?

How do you sterilize one?

Answer 28

Immerse in glutaraldehyde for 15-20 min

Immerse in glutaraldehyde for 10+ hours.