Airways, ETCO2 & IV Cannulation/Infusion Flashcards
Airway
Example Essay Question: List the known risks and complications of using supraglottic airway devices as per the Resuscitation Council UK Guidelines (2015) and the Intersurgical i-gel guidelines (2018). (14 marks)
- Laryngospasm
- Sore throat
- Trauma to the pharyngo-laryngeal framework
- Gastric insufflation
- Regurgitation and inhalation of the gastric contents
- Nerve injuries
- Vocal cord paralysis
- Tongue numbness
- Cyanosis
- Airway obstruction by folding down of the epiglottis
- Hypoventilation with high airway pressures
- Hypoventilation with poor lung compliance
- Barotrauma with high airway pressures
- Uninterrupted chest compressions likely to cause gas leak
Airway
Example Essay Question: You are dealing with the airway of a patient in cardiac arrest. Whilst attempting to intubate the patient with a bougie, you are having difficulty visualising the vocal cords.
a) What procedure could you ask another colleague to perform to help enhance visualization of the vocal cords during endotracheal intubation? (3 marks)
b) You successfully manage to intubate the patient, what checks would you make to confirm endotracheal tube placement? (12 marks)
a) Backwards (Pt’s Back), Upwards, Rightwards (Pt’s Right) Pressure (BURP)
b) Visualisation of adequate bilateral chest rise, auscultation of the lungs for breath sounds, auscultation over the stomach – no gurgling sounds, clinical improvement of the patient, capnography (ETC02) boxed waveform.
ETCO2
Example Exam Question: Identify the elements A-E of the waveform capnography graph (see photo) ensuring you write your answers in the answer booklet provided, and not on the exam paper. (5 marks)
A – End of inspiration/Post inspiratory phase
B – Exhalation
C – Expiratory plateau
D – End tidal value
E – End of inspiration/Post inspiratory phase
Vascular Access
Example Exam Question: Briefly discuss key sites and key parts in relation to Intravenous Cannulation as per the latest aseptic non-touch technique guidelines (2018). (3 marks)
- Key-sites are open wounds, including insertion and puncture sites
- Key-parts are the parts of the procedure equipment that come into direct or indirect contact with any liquid infusion, key-sites or with any active key-parts connected to the patient already
- If contaminated they present a very high risk of infection to the patient.
ETCO2
Example Exam Question: Discuss the physiological factors affecting increases in ETC02 capnography readings. (12 marks)
- Increased muscular activity (Shivering)
- Malignant hypothermia
- Increased cardiac output
- Tourniquet release
- Effective drug therapy for bronchospasm
- The decreased minute ventilation
ETCO2
Example Exam Question: Discuss the physiological factors affecting decrease in ETC02 capnography readings. (18 marks)
- Decreased muscular activity
- Hypothermia
- Decreased cardiac output
- I-Gel/ ET tube misplaced/ wrong size
- Pulmonary embolism
- Bronchospasm
- The increased minute ventilation.
- Apnoea
- Hypovolaemia
ETCO2
Example Exam Questions: In a healthy adult, what is the normal range of end tidal ETCO2 readings? (2 marks)
35-45mmHg and or 4.0 to 5.7 KPA
ETCO2
Example Exam Question: You attend a 65 male presenting with difficulty in breathing. Your initial assessment is that this patient’s condition is not life threatening. You obtain this capnography reading during examination.
a) Name one common condition that is responsible for this reading. (3 marks)
b) Having assessed your patient please discuss your interventions with reference to this reading. (20 marks)
a) Asthma or COPD
- b) Oxygen 4 litres per minutes with venturi mask (28%)
- (6 minutes only for COPD patients, target saturations 88-92%, 94- 98% non COPD)
- Salbutamol dose 2.5/5 mcg depending on severity (Repeat after 5 minutes if symptoms persist)
- Ipratropium bromide (Once Only)
- Monitor respiratory rate
- 12 lead ECG
Vascular Access
Example Essay Question: List the contraindications for the use of the EZ-IO device as per the latest Teleflex guidelines (2017). (6 marks)
- Fracture in target bone
- Excessive tissue (severe obesity) and/or absence of adequate anatomical landmarks (e.g. may also be due to muscularity or variations in body habitus or an under-developed humerus in an infant/small child)
- Infection at area of insertion site
- Previous, significant orthopaedic procedure at the site
- Prosthetic limb, or joint
- IO access (or attempted IO access) in targeted bone within past 48 hours
