MODULE 9 - CWIs

Question 1

059
Bag Valve Mask
Indications & Contras?

Answer 1

Indications:

• Apnoea
• Inadequate ventilation

Contras:
- NONE

Question 2

059
Bag Valve Mask
Equipment?

Answer 2

• BVM
• O2
• PEEP valve (as req’d.)
• Bacterial / viral filter

Question 3

059
Bag Valve Mask
Procedure?

Answer 3

1. PREPARE PT
   - positioning (airway), mask size, BVM circuit + filter,
   O2 attached > 8L/min
2. APPLY MASK
   - good fit to face, appropriate grip for good seal
   (VE, CE, double CE)
3. VENTILATE PT
   - squeeze at appropriate vol. & rate,
   note chest rise & fall,
   continue reassessing all of above
   and spontaneous resp. effort

Question 4

190
Airway manoeuvres & positioning
Indications & Contras?

Answer 4

Indications:
- Pt that requires airway mx

Contras:
- NONE

Question 5

190
Airway manoeuvres & positioning
Equipment?

Answer 5

towel / sheet / blanket

Question 6

190
Airway manoeuvres & positioning
Background&raquo_space; In an unconscious pt, which muscles relax? What can this lead to?

Answer 6

Pharyngeal muscles relax.

Can lead to obstruction of airway by soft tissue (e.g. soft palate, tongue, +/- epiglottis

Question 7

190
Airway manoeuvres & positioning
Overview&raquo_space; Neutral pos. points?

Answer 7

• For initial ax and airway mx

- Maintains neutral alignment for pts w/ susp. cervical spine injury

Question 8

190
Airway manoeuvres & positioning
Overview&raquo_space; Sniffing pos.?

Answer 8

• For pts requiring airway mx
• Optimises airway patency
• Optimises anatomical pos. for ETT / SGA
• NOT appropriate for spinally immobilised pts

Question 9

190
Airway manoeuvres & positioning
Overview&raquo_space; Lateral pos.?

Answer 9

• Pts w/ Alt CS, not requiring active airway mx

- Reduced risk of aspiration

Question 10

190
Airway manoeuvres & positioning
Overview&raquo_space; Head tilt / chin lift

Answer 10

• Initial ax and airway mx

- Combined w/ neutral pos. during initial ax and mx

Question 11

190
Airway manoeuvres & positioning
Overview&raquo_space; Triple airway manoeuvre

Answer 11

• airway mx and troubleshooting

- Combined w/ sniffing or neutral pos.

Question 12

190
Airway manoeuvres & positioning
Neutral pos. for:
Adult?
Paed?

Answer 12

Adult:
- supine, elevate head 2-5cm to bring ear canal to the level of mid-clavicle

paeds:
- due to prominent occiputs and short necks in paeds, use blankets / towels to achieve thoracic elevation
as per Adult

Question 13

190
Airway manoeuvres & positioning
Sniffing pos.?

Answer 13

• supine, elevate head to bring ear canal to level of sternum
• req. upper neck extension - face parallel w/ ceiling
• elevate head of stretcher if req’d. to achieve this pos.

Question 14

190
Airway manoeuvres & positioning
Lateral pos.?

Answer 14

• neutral head / spine (if susp. spinal inj.)
• extend one arm perpendicular to body
• place other arm across chest
• flex hip + knee (same side as arm across chest)
• roll pt to their side ensuring hip + knee stay flexed
• extend neck (use towel / blanket if req’d.) to achieve neutral spine

Question 15

190
Airway manoeuvres & positioning
Airway manoeuvres?

Answer 15

1. Head tilt / chin lift
2. Triple airway manoeuvre
   * Susp. spinal injury: DO NOT tilt head

Question 16

188
Soft Cervical Collar
Indications & Contras?

Answer 16

Indications:
- as per CPG A0804 Spinal Injury

Contras:

• surgical airway
• penetrating neck trauma
• unable to achieve neutral pos. *
• unwilling / non-compliant pt, disease, pain, anatomical deformity

Question 17

188
Soft Cervical Collar
Indications&raquo_space; 804 Spinal Injury?

Answer 17

• susp. SCI
• major trauma w/ blunt
  force to head / trunk
• neurological changes / deficits

Question 18

188.
Soft Cervical Collar
Modified NEXUS criteria?

Answer 18

I.I.BR.A.V.E.

• Intoxication
• Injury +++ (significant distracting)
• Bone / muscle weakening disease / inj.
• ROM < 45 deg. L & R
• Alt CS
• Vertebrae midline POP/tender
• Elderly > 64