Feedback - Practical

Question 1

Learning Point x 3

Answer 1

Call for backup earlier

Question 2

A patient stops breathing suddenly. Response?

Answer 2

Primary survey again.

R - Response - 4, 5 6 GCS

A - Check airway - No soiled? Move on

B - Check breathing - Count rate - Too low ?

• Insert OPA / i-gel -> Get BVM attached and provide up to 10 per min breaths if needed.

C - Check circulation. If no radial pulse -> begin compression’s.

• > Charge and check ect.

Question 3

Learning point x 2

Answer 3

Going too fast. Slow…it…down. You have all the time in the world.

Question 4

Learning point x 1

Answer 4

You dont have to consult for fluids in asthma

Question 5

Learning point x 1

Answer 5

When providing a neb -> Always have the patient postured upright.

Question 6

On-road observation - Mucus influenza patient

Answer 6

When dealing with a patient with propensity for respiratory decline. Use capnography if possible

Question 7

On-road observation - Mucus influenza patient

Answer 7

If you have a patient with significant mucus in the upper respiratory tract…you should consider suction even if they are conscious. You saw this done in resus by the doctors.

Question 8

On-road observation - Mucus influenza patient

Answer 8

A patient with severe mucus in the upper respiratory tract is a severe aspiration risk. This is the key thing you are worried about.

Question 9

On-road observation - Mucus influenza patient

Answer 9

When doing a notification ‘paint the picture’ of how sick the patient is, desribing the respiratory presentation in detail if nessecary.

Question 10

On-road observation - Mucus influenza patient

Answer 10

posture upright immediately in respiratory patients.

Question 11

On-road observation - Mucus influenza patient

Answer 11

You panicked with you saw 80 sats and rising respiratory rate.

you needed to LOOK at the patient. Is he stable? At this stage yes. Next step. troubleshoot the sats probe and try different fingers to get a good pleth wave.

If nessecary - > consider a primary survey. If passed. Continue.

Question 12

A patient with a siezure in a shopping centre. Passes primary survey…next step? GCS 14

Answer 12

Extricate. Get on a bed and in an ambulance for assessment.

Question 13

Any patient who is disorientated, post ictal is?

Answer 13

GCS 14. Confused.

Question 14

Never use what size cannula?

Answer 14

Size 24.

Question 15

You go for cannulation on a patient. It fails. Your aim is to give ondansatron. Next step?

Answer 15

IM. Dont mess around anymore with it.

Question 16

You come to a patient with no radial pulse, sitting on the couch, currently GCS 15. Do what?

Answer 16

Put them on the ground. Feet Up - POSTURE patient!!

Question 17

When someone is GCS 15 -> has NO RADIAL pulse and has already been postured, what should you do next?

Answer 17

Oxygen because the patient is in a ‘shocked state’

Question 18

Why must you ALWAYS make sure the monitor is on at the start of any scenario?

Answer 18

Because they will pin you with a declining patient that you ‘didnt notice’ where as if you have a monitor on, you will be prompted that the monitor is beeping. This is your clue for declining/arresting patients.

Question 19

What should always be a part of your primary survey>

Answer 19

1. Doing an auscultation/breathing assessment. You often miss this.

Question 20

How should you correctly do a paerdiatric arrest compression, you damn idiot?

Answer 20

With only one arm at a time.

Question 21

You have a patient who is maintaining an airway, breathing at an adequate rate, and is unconcious with a head injury. How should you manage their breathing/airway?

Answer 21

The least invasive method.

Do MANUAL jaw thrust with head tilt. Do not poke the bear by putting in an airway device even with a low GCS unless airway is an issue and airway device indicated. If nessecary, think about going naso first.

Question 22

You are doing compressions, the person on the airway wants to do an advanced airway, do you stop?

Answer 22

No. Keep going. Doesnt affect an advanced/any airway management.

Question 23

Doing a scenario, and you are not attending…you are the supporting clinican. What do you do?>

Answer 23

SHUT UP. Do NOT make ANY sort of clinical decision, or suggest anything. Just take obs and report them. If you see somthing important, communicate it to your attending clinican and make sure they hear you/good communication/attention.

Question 24

When managing a paed airway should you go no OPA?

Answer 24

No. Just go for advance airway.

Question 25

What way is the correct way for pad placement in cardiac arrest?

Answer 25

White in the clavical, red at the mid auxillary line.

Question 26

You go to a car accident and the patient is trapped….What should be a first priority?

Answer 26

• go spinal straight away in MVA. Get a firey back seat for manually stabilisation
• call MEDSTAR right away for MVA with compression

Question 27

You attend a scenario involving a MVA. What key info do you need situationally?

Answer 27

Ask about windshield break pattern (star pattern = hit head)

Are airbags deployed

How damaged is the vehicle.

Question 28

You have the potential for a pneumo (reduced air entry in one lung field). When should you decompress?

Answer 28

• not all pneumo tension. Wait for gcs and other changes such as loss of radial pulse before decompress check CpG week notes

Question 29

Made the same mistake as usual, what was it?

Answer 29

Not completing a FULL primary survey.

Question 30

Key points for you to improve your compressions?

Answer 30

• Go deeper and faster on compressions. Watch for hand placement

Question 31

Explain the difference between fluid administration in arrest for an adult with obstructive cause vs post-ROSC patients guideline.

Answer 31

• Fluids in resus - > its 20 ml per kilo and REASSESS every 500 ml and provide fluid ONLY in OBSTRUCTIVE arrest. If you use that, and then get to post rosc. the fluid limit resets.
• Fluid limit in post rosc - 10 ml per kilo. Aim is to get above 100 systolic. Reassess every 250 ml aliquots checking for APO.