ACCS Special Procedures Flashcards
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.
80-150 miles.
30 miles.
When transporting a patient, (use / do not use) an ambubag.
Don’t use an ambubag.
Always use a ventilator but keep the BVM in case of emergency.
How do you calculate tank duration?
PSIG x Factor / Flow
What’s an E cylinder tank factor?
0.3
What’s an H cylinder tank factor?
3
Note: H cylinders last ten times longer than E cylinders.
VAP is usually (Bacterial / Viral)
Bacterial.
What’s the most common cause of VAP?
Aspiration of secretions or gastric contents.
How do you determine if someone has VAP?
Get a sputum specimen.
CXR
What kind of sputum indicates VAP?
Purulent
What is a protected specimen brush?
Catheter with sealed plug. Put it down the trachea, instill fluid, then suction fluid back up.
What test is usually done rule out VAP?
Mini-BAL.
What is a BBS?
How does it work?
Blind Bronchial Sampling.
Blindly wedging catheter into a distal bronchus, instill fluid, then suction it out right away.
What is the minimum and maximum SBT time?
30 min - 2 hours
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).
Bronchioalveolar Lavage (BAL).
Flexible
Carlens tube
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.
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.
What kind of procedure is used to visualize the trachea and bronchi?
Broncoscopy
When would you use a rigid bronchoscope?
For therapeutic indications.
When would you use a flexible bronchoscope? x2
It has an outer diameter of ___.
For diagnostic indications.
Can also be used to intubate patient with Cspine injury.
5 mm
The minimum size ET tube you can use with a flexible bronchoscope is size ___.
Size 8.
What does it mean if you see lots of black spots on the bronchoscope?
That means there’s a broken optic fiber.
How do you prepare a patient for a bronchoscope?
First give a topical anesthetic (Lidocaine, benzocaine, any “-caine”)
Assemble monitoring equipment, including pulse ox and EKG
Give a sedative
Give a narcotic (morphine).
Why do you want to give a narcotic to a bronchoscope patient?
Give morphine for analgesic and antitussive effects.
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?
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.
How do you treat acute hemorrhaging during a bronchoscopy?
Give iced saline or epinepherine
During a bronchoscopy, how can you treat severe hemoptysis?
Insert a double lumen endobronchial tube to protect the healthy lung.
During a bronchoscopy, what should you do if there’s an obstruction of the suction channel?
Irrigate with saline.
What four things should you do following a bronchoscopy?
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)
How do you disinfect a bronchoscope?
How do you sterilize one?
Immerse in glutaraldehyde for 15-20 min
Immerse in glutaraldehyde for 10+ hours.
