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managing abc's > Knowledge Bank > Flashcards

Knowledge Bank Flashcards

1
Q

What are the indications for the insertion of an OPA?

A
  1. Unconscious pt needing active airway management by displacing the tongue anteriorly
  2. Bite block to support ETT
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2
Q

What are the contraindications for the insertion of an OPA?

A
  1. Trismus
  2. Intact gag reflex
  3. Suspected neurological injury out of concern for inducing gag response
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3
Q

What are the indications for insertion of a NPA?

A
  1. Unconscious pt with trismus (where OPA can’t be inserted)
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4
Q

What are the contraindications of insertion of a NPA?

A
  1. Middle third facial fractures (possible intrusion into brain tissue)
  2. Significant nasal trauma (may induce gag)
  3. TBI and neurological even where airway patent and tidal volume adequate despite trismus (undesirable gag)
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5
Q

What are the precautions for insertion of a NPA?

A
  1. Basal skull fractures
  2. CSF in nares or ears
  3. May need to be removed during intubation as can interrupt view of glottis
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6
Q

How does triple airway manoeuvre enhance assessment of airway?

A
  1. Displaces tongue and soft tissue away from back of throat
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7
Q

Outline the difference between neutral and sniffing position

A
  1. Neutral position achieve by placing 2-5cm towel under occiput and aims to open airway
  2. Sniffing position requires more padding and maximises view of vocal cords
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8
Q

Why is it important to avoid hyperextension of the head?

A
  1. It can flatten the trachea
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9
Q

Why should head positioning be varied when assessing the airway or a small child compared to a medium child?

A
  1. Small children have a relatively larger occiput and don’t need their head elevated in the same fashion
  2. Medium children are best managed with head and body on same plane
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10
Q

How would you position an infant’s and small child’s airway?

A
  1. Small pad (2cm) beneath shoulders
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11
Q

In the setting of a cardiac arrest, when is a carotid pulse check required?

A
  1. In presence of a potentially perfusing rhythm at the end of a CPR cycle
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12
Q

In accordance with AV CPG’s, what are the correctable causes of PEA?

A
  1. Hypoxia
  2. Exsanguination
  3. Asthma
  4. Tension pneumothorax
  5. Anaphylaxis
  6. Upper airway obstruction
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13
Q

In accordance with AV CPG’s, how does the management of a hypothermic pt in cardiac arrest vary from that of a normothermic pt in cardiac arrest?

A
  1. 30C or more = standard
  2. <30C = double interval for adrenaline administration
  3. Primary goal of managing moderate-severe hypothermia should be prevention of further heat loss prior to ROSC or transport. Significant improvement in temperature from prehospital intervention is unlikely
  4. Greater than 3 shocks is unlikely to be successful while pt remains severely hypothermic
  5. If hypothermia is clear cause for cardiac arrest, mechanical CPR to hospital may be appropriate in consultation with clinician and hospital
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14
Q

What circumstances should compressions be performed in a paediatric pt?

A
  1. No palpable pulse
  2. HR<60bpm (infants)
  3. HR <40bpm (children)
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15
Q

What actions need to be performed when ROSC is achieved?

A
  1. 12 lead ECG - consider PHT
  2. VF/VT arrest OR suspected cardiac cause OR post PHT:
    - transport to 24hr PCI facility
    - consider AAV
  3. Suspected non-cardiac cause:
    - transport to closest appropriate hospital with notification
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16
Q

How does the technique of compressions differ for the infant, small child and medium child?

A
  1. Infant:
    - 2 finger or 2 thumb technique
    - hands encircle chest and thumbs compress sternum
  2. Small child:
    - one handed technique otherwise similar to that for adults
  3. Medium child:
    - two handed technique similar to that for adults
17
Q

What are the compression and ventilation rates for infants? (No ETT/SGA)

A
  1. Two rescuers - 15:2, one rescuer - 30:2
  2. Aim for 100-120 compressions per minute
  3. Pause for ventilations
18
Q

What are compression and ventilation rates for children? (ETT/SGA insitu)

A
  1. Aim for 100-120 compressions per minute
  2. 10 ventilations per minute
  3. No pause for ventilations
19
Q

What are the five criteria used to determine a newborn’s APGAR score?

A
  1. Appearance
  2. Pulse
  3. Grimace
  4. Activity
  5. Respiratory effort
20
Q

What are the compression ventilation rates for a newborn?

A
  1. 3:1
  2. Aim for 90 compressions and 30 ventilations per minute (120 per minute or 2 per second)
  3. 0.5 second pause for ventilation. No pause for ventilation post intubation
21
Q

What are the 5 ECG rhythm criteria for VF?

A
  1. Ventricular rate: nil discernible
  2. Ventricular rhythm: bizarre, chaotic, amplitude >0.1mV
  3. P waves: nil discernible
  4. PR interval: nil discernible
  5. QRS duration: nil discernible
22
Q

In accordance with AV CPG’s, what are the common causes of paediatric cardiac arrest?

A
  1. Hypoxaemia
  2. Hypotension
  3. Trauma
  4. Drowning
  5. Septicaemia
  6. SIDS
  7. Asthma
  8. Upper airway obstruction
  9. Congenital heart abnormalities
23
Q

In accordance with AV CPG’s, list the 6 clinical elements in determinants of death

A
  1. No palpable carotid pulse
  2. No heart sounds heard for 2 mins
  3. No breath sounds heard for 2 mins
  4. Fixed and dilated pupils
  5. No response to central stimulus
  6. No withdrawal or grimace from painful stimulus
  7. ECG strip showing 2 mins of asystole is an optional finding that may be included
24
Q

As per the AV CPG pharmacology sheet, what are the side effects of adrenaline?

A
  1. Sinus tachycardia
  2. Supraventricular tachycardia
  3. Ventricular arrhythmias
  4. Hypertension
  5. Dilated pupils
  6. May increase size of AMI
  7. Anxiety
25
Q

What are the benefits of administering adrenaline for cardiac arrest?

A
  1. Alpha effects:
    - causes peripheral vasoconstriction
    - increases peripheral vascular resistance
    - increases venous return/cardiac output/coronary perfusion pressures
    - along with effective CPR, aids in perfusing myocardium to provide a shockable rhythm
  2. Beta effects:
    - increases irritability of ventricles and myocardial contractility

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