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BCAS CCP Program > CCP 106 - Critical Care Skills And Equipment > Flashcards

CCP 106 - Critical Care Skills And Equipment Flashcards

1
Q

What dose parameters are available on the Alaris Medsystem III

A

Measure - Gm, mg, mcg, Ng, mMol, mEq, nUn, Un Weight - Kg Time - min, hour, day

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2
Q

On the Zoll X series monitor how do you “hard silence” alarms and how long will they be silenced for?

A
  • 2nd page menu, bell icon, select bell with cross through it for temporary alarm suspend or select x2 for permanent - will silence for 4 min by default
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3
Q

How do you set alarms on the Zoll X series monitor? - Standard alarm setting -“Stat set”

A

Standard alarm setting: select desired channel and press select -OR- access 2nd page menu/alarms menu/set desired alarm “Stat set”: access 2nd page menu/alarms menu/“Stat set” - will set all alarms by preset values +/- the current patient values.

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4
Q

List common sites of Arterial Line placement

A

Radial artery, femoral artery, brachial artery, carotid artery

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5
Q

Describe the procedure and what a “positive” finding is from a Modified Allens Test

A
  • Compress the radial and ulnar artery of the selected arm, if the patient is alert have the patient clench their fist or raise the patients arm and observe for blanching, release the ulnar artery (non-thumb side) and observe for return of circulation (3-5 seconds) - Positive test = return of circulation from the ulnar artery
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6
Q

What is the battery life for the Alaris Medsystem III pump?

A

6-8 Hours with 3 channels running at 125 ml/hr

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7
Q

What is the TKVO rate for the Alaris Medsystem III pump?

A

3 mL/hr

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8
Q

What are the steps for calculating RASS?

A

1) Observation - passive observation of the patient, ratings of 0 to +4 2) Voice - directive verbal communication, ratings -1 to -3 3) Touch - physical touch, rating -4 to -5

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9
Q

The _______ virus is not killed by alcohol hand sanitizers but washing with soap and water will.

A

C. Difficile

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10
Q

On the Zoll X series monitor pressing the “Audio pause/reset” button will do?

A
  • Acknowledge and cancel all “Alerts” (yellow flashing light) - Silence and current “Alarms” for 90 seconds (red flashing light)
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11
Q

Order of donning and doffing PPE

A

Donning: Gown/Mask or Respirator/Goggles or face shield/Gloves Doffing: Gloves/Goggles or face shield/Gown/Mask or respirator

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12
Q

EEG wave frequencies

A
  • BATD (Beta/Alpha/Theta/Delta waves) - Beta wave: ≥ 13Hz (spindles/sec) - Alpha wave: 8-12 Hz (spindles/sec) - Theta wave: 4-8 Hz (spindles/sec) - Delta wave: 0.5-4 Hz (spindles/sec
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13
Q

What are the fluid delivery rates for the Alaris Medsystem III pump?

A

0.1 - 999 mL/hr

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14
Q

With the Alaris Medsystem III pump what minimum height must a secondary set be above the primary set?

A

8 inches

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15
Q

With the Alaris Medsystem III pump what is the maximum flow rate that will not result in concurrent flow from the primary set?

A

275 mL/hr

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16
Q

What drug concentration parameters are available on the Alaris Medsystem III pump?

A

Grams (Gm), milligrams (mg), micrograms (mcg), millimoles (mMol), milliequivilents (mEq), milliunits (mUn), and units (Un)

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17
Q

1) Label and describe the waveform
2) Describe where to measure the mean pressure

A

1) a - RA contraction (RA systole)

c - Tricuspid buldge (early ventricular systole)

x - RA relaxation

v - RA filling (Late ventricular systole)

y - Tricuspid valve opening (passive RA emptying)

2) measured midway down “x” descent at end of exhalation

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18
Q

What is the average CVP and when might it be higher than normal?

A

Measure from distal CVC port (brown)

2-6 mmHg

8-12 mmHg in mechanicly ventilated patients

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19
Q

Contraindications for Starting an Arterial Line

A

Failed modified Allens Test

Reynaud’s disease

Buerger’s disease

Trauma/Infection at target site

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20
Q

Where is the correct placement of the transducer for ICP monitoring?

A

Tragus of the Ear (if patient is supine)

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21
Q

What is this Tube, what is it used for and how do you manage it?

A
  • Disposable tracheal tube
  • Used for patients with neck/mouth injuries or paralysis
  • Placed between 2nd and 3rd tracheal rings, seated 2-3 cm above corina
  • Has inner and outer tube, some inner lumens disposable and some reusable
  • Care and maintenance: Clean inner lumen, DO NOT reintroduce disloged tubes - use ETT if needed
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22
Q

What is this Tube, what is it used for and how do you manage it?

A
  • Swan-Ganz catheter/Pulmonary Artery catheter
  • Blind placement device for measuring pulmonary wedge pressure
  • Can provide the following pressures: RA/RV pressure, CVP, PA pressure
  • Can provide the following sampling/measurements: Thermodilution, LVEDP, Temperature, SvO2 sampling
  • Ensure the Swan-Ganz is completly deflated and retracted for transport and confirm tube dapth
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23
Q

What is this Tube, what is it used for and how do you manage it?

A
  • Cordis
  • Central line access and intriducer for other devices
  • Allows rapid infusion of fluid and medication not appropriate for peripheral IV (vasopressors, chemotherapy, parenteral nutrition)
  • Complications: Infection/Air embolis
  • No flow? Aspirate then flush with N/S
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24
Q

What is this Tube, what is it used for and how do you manage it?

A
  • Feeding tube
  • Used to introduce nutrition or medication to the gut
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25
Q

What is this Tube, what is it used for and how do you manage it?

A
  • Peripherally Inserted Central Catheter (PICC) line
  • Used for medication administration
  • Can measure CVP through line
  • Maybe heparinized - aspirate prior to medication administration
26
Q

What is this Tube, what is it used for and how do you manage it?

A
  • Transesophageal balloon cetheter
  • Used for measurment of transesophageal pressure (analog for transpleural pressure)
  • Indication: ARDS, ALI, VILI, Lung protective ventilator stratagies
  • Contraindications: esophageal rupture, tumors, diverticulitis, bleeding varacose veins
27
Q

What is this device, what is it used for and how do you manage it?

A
  • Turkel thoracic decompression needle
  • Used for decompression of a tension pneumothorax
  • Can be used for hemothorax but will likely occlude
  • Placement 5th intercostal space/midaxilary line (prefered) -OR- 2nd intercostal space/midclavicular line
28
Q

What is this Tube, what is it used for and how do you manage it?

What other tubes are related?

A
  • Blakemore esophageal tube
  • Used for massive upper GI bleeds
  • Have patient intubated first
  • Contraindications:
  • Steps for use: check balloon, lubricate, insert, inflate gastric baloon (do not inflate esophaheal balloon), apply 1 Kg traction and secure.
  • Other related tubes: Minnesota Tube, Linton Tube
29
Q

What is this Tube, what is it used for and how do you manage it?

A
  • Vas Cath/permacath
  • Used for dialysis
  • Not normally used by CCP’s but can be used in emergency
30
Q

What is this Tube, what is it used for and how do you manage it?

A
  • Orogastric/Nasogastric tube
  • Used for gastric decompression, suction, medication administration
  • Masured from mouth to epigastrum
  • DO NOT REMOVE IN PED PYLORIC STENOSIS - doing so lead to complete closure and inabiltiy to feed
31
Q

What is this Tube, what is it used for and how do you manage it?

How do you troubleshoot it?

A
  • Transvenous pacing wire
  • Introduced through Cordis
  • Connected to TVP controller
  • Troubleshooting loss of capture: Check patient, check site for displacement, check connections to controller, check battery, roll/change patient position, withdraw or insert wire
32
Q

What settings does a TVP controller have and what must you bring with you prior to transport?

A
  • Settings: Rate, Sensitivity, Milivolts (mV), syncronized/mandatory
  • Bring spare batteries (usually 9V)
33
Q

What is this device, what is it used for and how do you manage it?

What other devices are also seen?

A
  • Hemovac surgical drain
  • Active non-powered suction used post operation
  • Tube placed by surgeon, secured with sutures
  • Other devices: Jackson-Pratt bulb suction
34
Q

What is this Tube, what is it used for and how do you manage it?

A
  • Chest Tube
  • Used for the evacuation of hemo or pneumothroax, pleural effusion, empyema, chylothorax or introducing medication (pleurodesis)
  • Placed between 4th or 5th intercostal space midaxilary line
35
Q

Which direction will you angle a chest tube for the following conditions:

Phenumothorax

Hemothorax

A

Pneumothorax: Apically

Hemothorax: Basally

36
Q

What sizes of chest tubes are used?

A
  • 16-22fr: Large Pneumothorax
  • 22-28fr: Chronic ling disease, Mechanical ventilator, Risk of large air leak
  • 28-32fr: Draining hemothorax or patients on mechchanical ventilation with large air space
37
Q

What is this Tube, what is it used for and how do you manage it?

A
  • Invastive Temperature Probe
  • Used for esophageal or rectal temperature monitoring
38
Q

What is this Tube, what is it used for and how do you manage it?

A
  • Pig Tail Catheter
  • Used in drinage of Air and Clear fluid from pleural space
  • Sizes: 6-12fr
  • Inserted with Seldinger technique and ultrasound guidence
39
Q

What is this Tube, what is it used for and how do you manage it?

A
  • Central Venous Catheter (CVC)
  • Can be placed through Cordis or independantly
  • Ideal placement in Inferior Vena Cava at level of right atrium
  • Used for Medicaion/Fluid administration, venous sampling (SvO2/SvCO2), dialysis, and pressure monitoring (CVP)
  • Ideal for administration of vasopressors
  • USE DISTAL PORT FOR PRESSURE MONITORING
40
Q

What are the contraindications for placing a CVC?

A
  • Coagulopathy
  • Thrombocytopenia (low platelets)
41
Q

How do you confirm a patent CVC?

A
  • Dark venous bloodflow
  • Transduced pressures between 2-6mmHg
  • Placement confirmed with ultrasound or X-Ray
  • Pulsitile flow or transduced pressure >30mmHg indicate arterial placement
42
Q

What is the order of anatomical structures found when completing a radial or femoral puncture? (medial to lateral)

A

Vein, Artery, Nerve

“The VAN drives out”

-or-

Dyck VAN Dyke (femoral punctures)

43
Q

What to we as CCP’s use Arterial lines for?

A
  • Arterial pressure monitoring
  • Continual arterial blood gas assay’s
44
Q

What is different with the syringe used for ABG collection?

Can you use a normal syringe? If so what will it change?

A
  • Vented/heparinized syringe - allows passive collection of a arterial sample and prevents coagulation of the sample
  • Yes, but without heparin you cannot use the EPOC to calculate a ionized calcium (Ca+) as it will cause errors
45
Q

List the steps for initiating an Arterial line

A
  • Prepair equipment: prime pressure tubing, inflate pressure infuser, collect catheter, opsite, retention clip or sutures, tape, gauze, chlorahexadine wipes
  • Preform modified Allens test
  • Prepare skin
  • Insert catheter at 45* angle, once flash obtained advance guide wire, slide catheter off needle into artery, remove catheter
  • DO NOT LET GO OF CATHETER
  • Attach pressure tubing
  • Secure catheter
  • Transduce and zero
46
Q

What is this Tube, what is it used for and how do you manage it?

A
  • Foley Catheter
  • Normal Size: 14-18fr
  • Gross Hematuria: 22-24fr
  • < 14fr narrow strictures
  • Special Catheters: Coude Tip (for BPH), Straight or in/out, Tripple lumen (for bladder irrigation)
47
Q

Can you use a syringe with the Alaris Medsystem III pump?

A
  • Yes, using a 20-60ml syringe and a “half set”
48
Q

Can the Medtronic LP15 monitor all of the same pressures as the Zoll X Series?

A

Yes, but only 2 at a time insead of 3

49
Q

How long will the Zoll X Series monitor oporate on battery power?

A

>6 hours

50
Q

What is the difference between “VAMP” tubing and “non-VAMP” tubing?

A
  • VAMP = Venous Arterial blood Managment Protection
  • VAMP tubing: closed system to ease the collection of blood samples and reduce blood wastage
  • non-VAMP: required to withdraw and discard blood prior to collecting sample, risk for contamination
51
Q

Label and describe components of the waveform

A
  • Arterial pressure waveform
  • Systolic: rapid increase in pressure to a peak, followed by a rapid decline. Begins with the opening of aortic valve = left ventricular ejection
  • Diastolic: represents movement of blood into peripheral circulation
  • Pulse Pressure: the difference between the systolic and diastolic pressure resulting in forward blood flow
  • Mean Arteral Pressure (MAP): measured as half the “area under the curve” or calcuated as “systolic + (2 x diastolic) / 3 = MAP”
  • Dicrotic Notch: represents the closure of the aortic valve
52
Q

What are the prefered sites for CVC placement?

A
  • Internal jugular
  • Subclavian Vein
  • Femoral Vein
53
Q

What are the indications for initiating a CVC?

A
  • IV access (especially if difficult peripheral access)
  • CVP monitoring
  • ScvO2 monitoring/sampling
  • Infusions of irritant substances (e.g. vasoactive agents, chemotherapy or TPN administration)
  • Renal replacement therapy, olasmapheresis and apheresis
  • Transvenous pacing
54
Q

Label and describe components of these waveforms

A
  • Pulmonary Artery Catheter waveforms

A) CVP/RA pressure waveform: see CVP waveform for labeling

B) RV pressure waveform: 1) ventricular contraction, 2) blood flows to pulmonary artery, 3/4) ventricular relaxation, 5) passive filling from RA, 6) RA contraction

C) Pumonary Artery Waveform: increase and decrease in pressure due to forward flow of blood from RV contraction

D) Pulmonary Capillary Wedge Pressure Waveform: labeling is the same as CVP waveform

55
Q

What are the inciations for Intercranial Pressure (ICP) monitoring?

A
  • monitoring ICP for increased pressures or to guide therapy
  • pressure releif of cerebrospinal fluid (CSF)
56
Q

Label and describe the waveform

A
  • Intercranial Pressure (ICP) waveform
57
Q

Describe and list the RASS scoring system

A
  • Richmond Agitation and Sedation Scale
58
Q

How long do you have to insert a sample into the EPOC after calibration

A

7.5 minutes

59
Q

How much blood is required for the EPOC to sample?

A

92 mcL

60
Q

What is the operating temperature and pressure for the EPOC?

A
  • 15 - 30*c
  • 400 - 850 mmHg
61
Q

What is the normal range for Intercranial Pressure?

A

Normal ICP: ≤ 15 mmHg

Pathological ICP: ≥ 20 mmHg

62
Q

When monitoring a Pulmonary Artery (PA) catheter what are the common pressure ranges?

A
  • Right Atrial: 0 - 6 mmHg (same as CVP)
  • Right Ventrical = 25/0 mmHg
  • Pulmonary Aartery = 15-30/5-15 mmHg
  • Pulmonary Aartery Wedge Pressure = 2-10 mmHg at 40-50 cm distance (if SCV/ IJ insertion)

BCAS CCP Program (13 decks)

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