IV Cannulation, anaphylaxis and airway management CCS

Question 1

Outline considerations for IV cannulation

Answer 1

Allergies
Condition of veins, type of IV fluid, estimated duration of IV access
Site contraindications, bleeding disorders and hand dominance

Question 2

Complications with LMA

Answer 2

Aspiration of gastric contents
Local irritation
Upper airway trauma
Mild SNS response

Question 3

After vein identification, what is the next step in IV cannulation?

Answer 3

Lighting and clean trolley

Wash hands prior to assembling equipment

Question 4

List some relative contraindications for LMA

Answer 4

Increased risk of aspiration
- morbid obesity
- prolonged BVM ventilation
- 2/3 pregnancy
- non fasted
- upper GIT bleed

Need for high airway pressures

Known abnormalities in supraglottic anatomy

Question 5

Contraindications for endotracheal intubation

Answer 5

Awake patient
Less invasive alternative

Question 6

List 11 steps of IV cannulation

Answer 6

1 introduction and consent
2 considerations
3 vein identification
4 assembly
5 insertion
6 needle withdrawal and bung
7 check patency (consider blood withdrawal)
8 secure site
9 label
10 post procedure cleaning
11 documentation

Question 7

After introduction and considerations, what is the first step in IV cannulation?

Answer 7

Identify appropriate vein and provide rationale

• tourniquet
• appropriate = round, firm and engorged and straight
• release tourniquet

Question 8

Indications for endotracheal intubation (6)

Answer 8

Cardiorespiratory arrest
Respiratory failure (hypercapnia, hypoxaemia)
Upper airway obstruction
Protection of airway if aspiration is a risk
Need for hyperventilation e.g. raised intracranial pressure
Anaesthesia

Question 9

What is the appropriate rate for bag-valve-mask (BVM) ventilation?

Answer 9

12 per minute

Question 10

Indications for laryngeal mask airway (LMA)?

Answer 10

Elective ventilation - day procedures

Cardiac arrest: especially prehospital setting (minimizes interruptions to CPR)

Conduit for intubation

Question 11

Complications with endotracheal intubation (5)

Answer 11

• Oesophageal intubation
• R main bronchus intubation
• Damage to teeth and oropharynx or airway
• Laryngospasm
• Hypoxia

Question 12

Common adult size - endotracheal intubation blades for curved and straight

Answer 12

Curved - 3 and 4

Straight - 2 and 3

Question 13

Outline main steps when hand hygiene is required?

Answer 13

Before equipment assembly

Before insertion

Post procedure cleaning after glove disposal