Enhanced Care skills

Question 1

Indications for Ketamine

Answer 1

To provide effective pain relief of severe traumatic pain as part of a balanced analgesia regime in:
- multiple or significant fractures
- significant soft tissue injury
- dislocations
- burns

• or where morphine is contraindicated

Question 2

Characteristics of Ketamine dissociation

Answer 2

• airway reflexes maintained
• normal or enhanced muscle tone
• substantial or complete analgesia
• total amnesia is typical
• cardiovascular stability

Question 3

Ketamine inclusion criteria

Answer 3

Adults and children over 12 years old

Question 4

Ketamine exclusion criteria

Answer 4

• Children under 12
• Patients with current airway compromise where securing the airway will be difficult
• known previous adverse reaction / hypersensitivity
• GCS <12
• Uncontrolled hypertension >180SBP, or >110DBP
• Suspected acute ACS
• Known raised ICP or intraoccular pressure
• Acute porphyria
• Concurrent administration or theophylline
• Eclampsia or Pre-eclampsia

Question 5

Ketamine onset, peak and duration

Answer 5

Onset: 30secs
Peak: 2 mins
Duration: up to 40 mins

Question 6

Ketamine: minimum monitoring

Answer 6

• SPO2
• 3 lead ECG
• BP
• ETCO2

Question 7

Ketamine dose

Answer 7

0.5mg/kg
10mg increments

Question 8

Ketamine: Side effects

Answer 8

Anxiety, behavioral abnormalities, diplopia, nystagmus, nausea, vomiting, tachycardia, hallucination, increased muscle tone

Question 9

Ketamine treatment of emergence

Answer 9

• reassurance & calming
• diazepam 2.5mg aliquots up to 10mg (10 min intervals)

Question 10

Airway: Anticipated difficult BVM

Answer 10

Mask seal
Obesity
Age
No teeth
Stiff lungs

Question 11

Difficult airway: change something significant

Answer 11

Oxygenation is king
Head position
ELM
Laryngoscope
Pal/person

Question 12

Quadrangle of Trauma

Answer 12

Coagulopathy
Metabolic Acidosis
Hyocalcaemia
Hypothermia

Question 13

Indications for Finger Thoracostomy

Answer 13

Treatment of Tension pneumothorax in cardiac arrest:
- SCUBA
- Asthma
- TCA
Must be positively pressure ventilated

Question 14

Indications for Surgical Airway

Answer 14

Can’t Intubate, Can’t Oxygenate

Question 15

Complications of Surgical Airway

Answer 15

Bleeding
Insertion in soft tissue

Question 16

Complications of Finger Thoracostomy

Answer 16

Sharps
Damage to organs, vessels and nerves
Bleeding
Open Pneumothorax
Damage to long thoracic nerve
Infection / Empyema
Retained Foreign Body

Question 17

Kit required for Intubation

Answer 17

Laryngoscope blade/handle
Bougie
ET tube
Syringe
Catheter mount
Filter
ETCO2
Thomas Tube Holder
Magills forceps
Suction
Back-up airway
Lube

Question 18

Kit required for surgical airway

Answer 18

Scalpel
Trachael dilators
Bougie
Size 6 pre-cut ET tube (cuffed)

Question 19

Kit required for Finger thoracostomy

Answer 19

Chloraprep
Scalpel
Spencer wells forceps

Question 20

Landmarks for finger thoracostomy

Answer 20

4th intercostal space just anterior to the mid axilla line

Question 21

Triangle of safety

Answer 21

Lateral border of the pectoralis major
Anterior border of the latissimus dorsi
5th intercostal space

Question 22

Landmarks for FONA

Answer 22

Cricothyroid membrane
- inferior to the thyroid cartilage
- superior to the cricoid cartilage

Question 23

Airway Assessment

Answer 23

Look externally
Evaluate the 332
Mallampati score >3
Obstruction
Neck mobility

Question 24

Prior to Ketamine administration, you need to…

Answer 24

Have performed an airway assessment
Have monitoring on

Question 25

Breaking laryngosasm

Answer 25

Larsons Point
Positive pressure - BVM

Question 26

What %O2 does a BVM deliver when used well?

Answer 26

85%