Medical Director Operations

Question 1

Needle Cricothyrotomy Indications

Answer 1

INDICATIONS: Must meet all criteria

1: ) The pt is in imminent danger of death
2: ) No alt airway device/maneuver has been successful
3: ) The pt can not be oxygenated/ventilated by any other means

Note: Needle Cricothyrotomy is a standing order

Question 2

Needle Cricothyrotomy Procedure

Answer 2

Procedure:
1.) Assemble equipment, O2 source meet be able to deliver >/= 50 psi at the nipple

2. ) Place pt in sitting position
3. ) Assemble a #12 or 14 g, 8.5 cm, over the needle catheter to a 6-12 mL syringe
4. ) Clean the neck
5. ) Palp cricothyroid membrane, then stabilize the trachea w/ the thumb and forefinger
6. ) Punture the skin midline (needle/syringe) into membrane
7. ) Direct needle at 45 degree angle caudally, while applying negative pressure to syringe as you insert it further
8. ) Aspiration of air signifies entry into the trachea
9. ) Remove syringe, w/draw stylet while gentle advancing the catheter downward into position, being careful not to perforate posterior wall.
10. ) Attach O2 tubing over the catheter needle hub (may need to use a 4 ET tube connector) and secure the catheter to the neck
11. ) Intermittent ventilation can be acheived by occluding open hole in tube and then removing it in a 1:4 second ratio.
12. ) Monitor lung inflation and auscultate the chest

Note: adequate PaO2 can be maintained only for 30-45 min.

Question 3

Selective Spinal Assessment Objective

Answer 3

Long board is NOT the standard of care but can be considered. Instead collar and cot will suffice in most cases. Exception can be made with pt who can not be logrolled or risk of resp/airway compromise.

Question 4

Selective Spinal Assessment Concerning Mechanisms

Answer 4

• fall from over 3 feet, including adult fall from standing, or 5+ stair steps
• MVC at 30+ mph, rollovers and/or ejections
• motorcylce, bicycles, other conveyance, or pedestrian vs MVC
• Axial loading
• Electric shock

Question 5

Selective Spinal Assessment Symptoms

Answer 5

• Posterior neck/back pain/tenderness
• Paresthesias or loss of sensation in extremities
• Weakness or parlysis of extremities

Question 6

Selective Spinal Assessment Unreliable Pt

Answer 6

• AMS
• Inability to adequately communicate
• Hx of C-spine injury/abnormality or condition of fragile bones
• Distracting injury
• Very young and >65 y.o.