Level A Module 3

Question 1

What are the Indications for the insertion of an OPA?

Answer 1

• Unconscious patient where there is a need to actively maintain airway patency by displacing the tongue anteriorly
• Bite block to support an ETT (not SGA placement)

Question 2

What are the contraindications for the insertion of OPA?

Answer 2

• Trismus
• Gag reflex present
• Any patient suspected of having neurological injury out of concern for inducing a gag response

Question 3

What are the Indications for the insertion of an NPA?

Answer 3

•Unconscious with trismus (where an OPA cannot be inserted

Question 4

What are the contraindications for the insertion of NPA?

Answer 4

• Middle third facial fractures -possibility of intrusion into brain tissue
• Significant nasal trauma -May induce undesirable gag increasing ICP so use must be essential
• TBI & neurological event where airway is patent and tidal volume is adequate despite trismus -May induce undesirable gag reflex increasing intracranial pressure

Question 5

What are the precautions for the insertion of the NPA?

Answer 5

• Basal skull fractures
• Cerebrospinal Fluid from nares or ears
• NPA may need to be removed during intubation attempts as it can interrupt the view of the glottis

Question 6

How does the triple airway manoeuvre enhance the assessment of the airway?

Answer 6

• To pull the tongue & soft tissues from the back of the throat to achieve & maintain an open airway

Question 7

Outline the difference between the ‘neutral position’ & the ‘sniffing position’.

Answer 7

• The neutral position can be achieved by placing a 2-5cm towel under the occiput & is aimed at opening the airway.
• The sniffing position is useful for maximizing the potential view of the vocal cords. Though this can be used for normal airway care & ventilation. It can be achieved by placing more padding beneath the occiput that is required to obtain the neutral position

Question 8

Why is it important to avoid hyper-extension of the head?

Answer 8

• Hyper-extension can flatten the trachea

Question 9

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

Answer 9

• Small children have a relatively larger occiput than adults proportional to their body size. As a result,they do not need to have their head elevated in the same fashion.

A medium child (primary school aged to 11) is likely best managed supine with their head on the same surface plane as their body.

Question 10

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

Answer 10

• The infant and smaller child (pre-school) has a relatively larger occiput than adults proportional to their body size. They are best managed with a small pad (2cm approx.) underneath the shoulders.
  If a supine position is opted for, the occiput can push the chin down towards the chest, potentially occluding the airway

Question 11

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

Answer 11

• When QRS complexes are present indicating a potentially perfusing rhythm at the end of a CPR cycle

Question 12

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

Answer 12

• Hypoxia
• Exsanguination
• Asthma
• Tension pneumothorax
• Anaphylaxis
• Upper airway obstruction

Question 13

In accordance with AV’s CPGs How does the management of a hypothermic cardiac arrest patient differ to that of a norm thermic cardiac arrest patient?

Answer 13

• ≥30°C–•Standard cardiac arrest
• <30°c•Double the interval for adrenaline administration.
• Primary goal of managing moderate to severe hypothermia should be the prevention of further heat loss prior to ROSC or transport. Significant improvement in temperature from prehospital intervention is unlikely.
• Greater than 3 shocks are unlikely to be successful while patient remains severely hypothermic. Where resources do not allow for further management e.g. AAV, mechanical CPR, continue DCCS as per standard cardiac arrest
• For patients in cardiac arrest where hypothermia is clearly the cause, mechanical CPR to hospital may be appropriate in consultation with the clinician and receiving hospital.

Question 14

In what circumstances should external cardiac compressions (ECC) be performed on a paediatric patient?

Answer 14

• No palpable pulse (carotid, brachial or femoral)
• HR <60bpm (infants)
• HR <40bpm (children)

Question 15

What actions need to be performed when ROSC is achieved?

Answer 15

• 12 lead ECG –Consider Pre-Hospital Thrombolysis (PHT)
• VF/VT arrest OR suspected cardiac cause OR post PHT
• Transport to 24-hour PCI facility
• Consider AAV
• Suspected non-cardiac cause Transport to closest appropriate hospital with notification.

Question 16

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

Answer 16

Infant

• Two finger or two thumb technique
• The hands encircle the chest and the thumbs compress the sternum

Small child
- One handed technique otherwise similar to that for adults

Medium child
- Two handed technique similar to that for adults

Question 17

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

Answer 17

Two rescuers:
- 15 compressions to 2 ventilations -

One rescuer:
- 30 compressions to 2 ventilations •

Aim for 100 –120 compressions per minute
- Pause for ventilations.

Question 18

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

Answer 18

ETT/SGA

• Aim for 100 –120 compressions per minute
• 10 ventilations per minute
• No pause for ventilations

Question 19

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

Answer 19

• Appearance
• Pulse
• Grimace
• Activity
• Respiratory Effort

Question 20

What are the compression and ventilation rates for Newborn?

Answer 20

3: 1 Achieve 90 compressions and 30 ventilations per minute with a 0.5 second pause for ventilation. (120 events per min or two per second)
- There is no pause for ventilation post intubation

Question 21

What are the 5 ECG rhythm criteria for Ventricular Fibrillation (VF)?

Answer 21

• Ventricular Rate Nil discernible - Ventricular Rhythm: Bizarre, chaotic, amplitude > 0.1mV •
• P Waves: Nil discernible
• PR Interval: Nil discernible
• QRS Duration: Nil discernible

Question 22

In accordance with AV’s CPGs, what are the common causes of cardiac arrest in a paediatric patient?

Answer 22

(HHAD CUTSS)

• Hypoxaemia,
• Hypotension
• Trauma,
• Drowning,
• Septicaemia,
• SIDS,
• Asthma,
• Upper airway obstruction
• Congenital heart abnormalities

Question 23

n accordance with AV’s CPGs, list the 6 clinical elements in the ‘determinants of death’??

Answer 23

• No palpable carotid pulse
• No heart sounds heard for 2 mins
• No breath sounds heard for 2 mins
• Fixed (non-responsive to light) and dilated pupils (may be varied from underlying illness)
• No response to centralized stimulus (supraorbital pressure, mandibular pressure,or sternal pressure)
• No motor (withdrawal) response or facial grimace to painful stimulus (pinching inner aspect of elbow or nail bed pressure).
• ECG strip that shows asystole over 2 min is an optional finding that may be included.

Question 24

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

Answer 24

• Sinus Tachycardia
• Supra-ventricular Arrhythmia’s
• Ventricular Arrhythmia’s
• Hypertension
• Dilated pupils
• May increase size of AMI
• Feelings of anxiety/ Heart Palpitations.

Question 25

What are the benefits of administering adrenaline for a cardiac arrest?

Answer 25

Alpha Effects (Main Reason)

Causes peripheral vasoconstriction leading to:

• An increase in peripheral vascular resistance
• Increased venous return and eventually cardiac output and increased coronary perfusion pressures
• Along with effective CPR, this aids in perfusing the myocardium and providing us with a shock-able rhythm

Beta Effects
- Increases the irritability of the ventricles and myocardial contractility