Intermediate skills Flashcards
Laryngoscopy & Magills
Indications
- To identify and remove a suspected foreign body from the hypopharynx that is preventing ventilation.
- In order to create a patent airway and an ability to achieve adequate ventilation
Laryngoscopy & Magills
Contraindications
- Conscious patient or Gag reflex intact
- Do not use Magill forceps if obstruction below the vocal cords.
- SpO2 reading of 90% and ventilation is achievable
- Suspected epiglottitis.
Laryngoscopy & Magills
Precautions
- Damage to upper respiratory tract, lips and teeth/dentures.
- Further impaction or crumbling of the foreign body
- Vagal stimulation
- Exacerbation of hypoxia / hypercapnia.
- Spinal injury.
SGA
Indications
To manage and maintain a compromised airway in the patient with absent pharyngeal and laryngeal reflexes.
SGA
Contraindications
Intact gag reflex
SGA
Precautions
- Stabilise patient’s head and neck to avoid flexion, rotation or traction during placement
- Confirm placement every time the patient is moved
- Consider gentle use of laryngoscope blade as tongue depressor in infants
- EtCO2 monitoring MUST be applied when available
- Adopt a 30:2 regime during cardiac arrest with mechanical CPR device
Peripheral/EJ IV Access
Indications
Intravenous access for fluid or drug administration.
Peripheral/EJ IV Access
Contraindications
Directly over or distal to:
Burns
Cellulitis
Infection
Injury
Patients with chlorhexidine sensitivity/allergy, use 10% povidone-iodine swab
Peripheral/EJ IV Access
Precautions
MAXIMUM of 2 attempts prior to transport (only 1 vascular (IV/IO) attempt in traumatic cardiac arrests)
EJ - High risk of pneumothorax or lung injury
Intraosseous Access
Indications
Cannulation of the intraosseous space using EZ-IO:
* Cardiac arrest:
* First line cardiac arrest management for paediatrics
* Consideration for first line access in traumatic cardiac arrest
* Second line cardiac arrest management for adults following at least one failed intravenous (IV) access attempt.
All other circumstances:
* Where immediate medication administration is required following at least one failed intravenous (IV) access attempt when unable to administer via any other appropriate route.
Intraosseous Access
Contraindications
- Fracture to the targeted bone.
- IO within last 48 hours in the targeted bone.
- Inability to locate landmarks or excessive tissue.
- Prosthetic limb or joint (near insertion point).
- Patients with chlorhexidine sensitivity/allergy, use 10% povidone-iodine swab
Intraosseous Access
Precautions
- Existing trauma at the insertion site.
- Infection at the insertion site/in targeted bone.
- Use on limbs with possible proximal fractures.
- Previous orthopaedic procedure to targeted limb.
Prehospital bloods
Indication
The acquisition of pre-hospital phlebotomy has proven to result in shorter ED times by having the bloods sent to the lab earlier.
Prehospital bloods
Contraindication
- Any patient whose clinical condition does not warrant IV cannulation.
- Children <16 years old.
Prehospital bloods
Precautions
- If blood fails to draw, assume an unsuccessful cannulation and re-attempt at a new site. Do not attempt to troubleshoot by flushing prior to blood draw.
- If blood flow appears slow or restricted, loosen tourniquet gradually to increase flow.
- Complete the following fields on the pathology request form: ‘clinical notes’ – case number and chief complaint i.e. chest pain, receiving ED and endorse with signature and AP number in ‘collection details’ field. Ensure the Unit No. is left blank and the patient details have been entered correctly.