Advanced Life Support Flashcards
What is SBARD? State the components
Strutured approach/framework for communicating information about a patient:
* Situation: who you are, where you are, what you are calling about and the urgency
* Background: info about patient e.g. age, gender, what admitted with, when, relevant PMH
* ** Assessment:** EWS, A-E asssement
* Recommendations: what interventions you think are appropriate (e.g. given oxygen, fluids, antibiotics) AND what you would like them to do
* Decisions: repeat the decisions that have been made in a summary at the end of your SBARD so that both parties are fully aware of plan
An obstruction to an airway is an emergency and you should take immediate steps to manage the airway and call 2222 to summon expert help; true or false?
True
Explain why an unconcious patient may not be able to maintain their own airway
When unconscious, or have reduced conscious levels, muscle tone is reduced and patients will not have complete control of their muscles. If the patient is lying on their back their tongue will drop back and occlude the airway.
State 2 airway manoeuvres- state when you would use one over the other
- Head tilt chin lift
- Jaw thrust (use if suspected C spine injury)
State 2 types of simple airway adjuncts
- Nasopharyngeal
- Oropharyngeal
Who would you use nasopharyngeal airway in?
Who would you not use a/use a nasophargyneal airway with caution in?
Explain how to insert a nasopharyngeal airway
- Use in those who are semi-conscious as wont tolerate oropharyngeal
- Use in caution in those with basal skull fractures
- Ensure the airway is lubricated (lower 1/3), insert into a nostril and using a twisting motion advance until the flange is at the opening of the nostril. Bevel should be facing/towards the septum. If resistance is felt remove and try the other nostril.
Describe how to measure and insert an oropharyngeal airway
- Measure: place the oropharyngeal airway next to patients face and find the one that fits from incissors to angle of mandible
- Insertion: check airway is clear and open airway with head tilt chin lift manoevure (if no C spine injury). Insert with curve upwards, advance along the hard pallet until the junction of the hard and soft pallet is felt then rotate the airway 180 degrees. The flange should be flush with the lips.
State two types of advanced airway adjuncts
- Igel
- Endotracheal tube
What kind of airway is an igel?
Supraglottic airway
State three advantages of inserting an igel
- Once the iGEL has been inserted you can commence asynchronous ventilations and chest compressions i.e. continuous chest compression and ventilations 1 every 5/6 seconds
- The iGEL may be considered to be a “sealed circuit” and therefore the** BVM could be left attached during defibrillation** however if you are unsure of the seal it should be disconnected from the iGEL as part of the safety checks prior to defibrillation
- Reduce the risk of gastric inflation that can be caused by bag valve mask ventilation.
If igel can be inserted without delay it is preferable to bag valve mask ventilation
How do you determine what size igel to use?
Based on weight (e.g. sixe x for weight Y-Z)
Explain how to insert an igel
- Remove from casing and lubricate the distal end of igel/insertion end (mostly on curved side)
- Open airway using head tilt chin lift (if not contraindicated)
- Insert with curve downwards/how it would sit it in airway (oropharyngeal only one inserted upside down)
- Attach bag-valve ventilation
Who can insert an endotracheal tube?
Like igels, what advantage do they have?
- Trained specialist (e.g. anaesthetist)
- Once inserted you can commence asynchronous ventilations and chest compressions. i.e. continuous chest compressions and ventilation 1 every 5/6 seconds. During defibrillation, oxygen can remain attached.
What should you do if suction isn’t immediately available?
Put patient in recovery position (left lateral recumbent position)
Explain how to suction if there are airway secretions
- Only suction what you can see never do it blind
- Put in recovery position or turn patients head to side to allow postural drainage
- Turn on the suction device,
- Insert the “Yankauer” suction catheter gently into the patient’s mouth until it reaches the pouch of the cheek, once in place begin to suction, gently sweep over the arch of the tongue to the pouch of the opposite cheek, repeat this process until the airway is cleared.
- Suction for short period of time 5-10 seconds then allow a rest/break, then go again
What is difference between Yankeur type 1 and type 2 suction catheter?
- Type 1 has small hole and will only suction when you occlude the hole
- Type 2 will suction immediately when turned on
Describe how to manage a choking adult
- Ask patient if they are choking. If they are able to speak, cough and breathe it indicates mild obstruction and you should encourage them to cough.
- If unable to speak, has weakening cough or unable to breath summon for help, call 2222, start backslaps and abdominal thrusts.
- Continue until obstruction clears, if loses consciousness/collapses start CPR
What can be attached to igel or endotracheal tube to assess adequecy/effectiveness of ventilation?
Waveform capnography measures the concentration of carbon dioxide expired from the lungs. Assists in identifying:
* Confirmation of tube placement
* Assessment of the quality of chest compressions
* Return of spontaneous circulation
* Poor prognosis in a resuscitation attempt
* Rate of ventilations
Systolic BP below what may indicate shock?
<90 mmHg
If you can’t get IV access, what access could you get?
Intraosseous
State some common causes of reduced consciousness
- Profound hypoxia. (lack of oxygen)
- Hypercapnia. (retention of carbon dioxide)
- Recent administration of sedatives or analgesic drugs.
- Trauma / head injuries
- Seizures
- Drugs
- Hypoglycaemia (low blood sugar)
State 3 ways you can assess if your patient responds to pain
- Trapezius squeeze
- Supraorbital pressure
- Sternal rub
What are you looking for during exposure of A-E?
- Is there any evidence of trauma / bruising or deformity of bone?
- Does the patient have any evidence of internal or external bleeding. e.g. from the rectum or vagina. Do they have surgical wounds or drains? Is the abdomen distended?
- Does the patient have any rashes, bites or stings or skin / mucosal changes?
- Does the patient have any swelling around the eyes, mouth or nose?
- Do the patient’s calves appear swollen or painful?
- Does the patient’s breath or odour give any clues to aid your assessment e.g alcohol, recreational drugs, pear drop breath (ketones)?
- Old injuries or scars
Outline the adult tachycardia alogrithm
If narrow complex tachycardia is regular and is not atrial flutter then do adenosine.
Describe three vagal manoevures
-
The Valsalva Manoeuvre - there are a number of ways to do this. Commonly take a 20 ml syringe and get the patient to create a tight seal around the tip with their lips and blow forcefully as if they are trying to expel the plunger.
** A Modified Valsalva Manoeuvre **- as above but with the patient in the semi-recumbent position, followed by supine repositioning with 15 seconds of passive leg raise at a 45-degree angle
*** Carotid Sinus Massage - **Massaging the Carotid Artery. Undertake this procedure with caution having listened at the carotid artery for a Bruit. However, given the tachycardia it may be difficult to hear a bruit. This should only be performed by those clinicians trained to do this.
Describe the standard pad placement for defibrillators
Describe the anterior postieor pad placement for defibrillators
Outline the adult bradycardia periarrest alogrithm
Atropine 500mcg every 3-5 mins up to max of 3mg
Explain how to do percussion pacing
Outline advanced life support alogrithm
Outline difference in responsibilities betweeen team member and team leader in ALS
What are the 8 reversible causes of cardiac arrest?
What are the 8 reversible causes of cardiac arrest?
What safety checks should person who is delivering shock perform before shocking?
Summarise the COVID changes to CPR
How do you assess whether needle for IO access is correct size?
Describe where to place leads in 3 lead cardiac monitor
