OSCE Flashcards
1
Q
What are the Indications for the Insertion of Nasopharyngeal Airway (NPA)?
A
- an unconscious patient presenting with trismus where OPA cannot be oinserted
2
Q
What are the Indications for Intramuscular Injection?
A
Medications that are required to be administered via IM route as per AV CPG’s
3
Q
What are the contraindications for assembling, connecting and changing IV infusion line?
A
NONE
4
Q
What are the Indications for assembling, connecting and changing IV infusion line?
A
Indicated when IV fluid is required as per AV CPGs including dilution and administration of drugs
5
Q
What are the Clinical precautions for IV Cannula?
A
- Wherever possible do not cannulate arms which show evidence of contamination. If it is necessary all attempts must be made to clean site
- wherever possible do not cannulate patients with renal failure in the same arm as their arteriovenous fistula
6
Q
What are the Indications for the use of Magils forceps?
A
Foreign body airway obstruction with altered conscious state
7
Q
What are the clinical precautions for the insertion of a Nasogastric tube?
A
- History of coagulation abnormality
- Oesophageal varices or recent banding of varices
8
Q
What are the contraindications for the use of Y suction catheter?
A
NONE
9
Q
What are the clinical precautions for the use of Laryngoscope?
A
- Croup
- Epiglottis
10
Q
What are the steps for the Insertion of Oropharyngeal Airway (OPA)?
A
Prepare Oropharyngeal airway:
- select size (angle of jaw to the middle of incisors)
- Lubricate with water of patients saliva
Insert airway:
- Hold by flange
- natural curve upside down
- pass tip first and insert half way
- rotate 180 whilst continuing to insert
- remove if patient gags
- > > > > Not for Paed insertion:
- do not rotate on insertion, insert with curve in final position
- A laryngoscope can be used to help guide the OP airway over the tongue
Final position:
- Insert until flange rests against patients lips
- Ensure lower lip is not pinched between teeth and OPA
Check:
- Check for gag reflex
- Maintain triple airway manouvre
- Maintain position of OPA
- Look listen and feel for air movement
11
Q
What are the steps for assembling, connecting and changing IV infusion line?
A
Prepare patient:
- Explain the procedure to the patient, gain concent if possible
- Check indications, contraindications and precautions for fluid therapy
- Identify correct fluid, dose and route chosen for clinical practice guideline
- Double check with second paramedic if available
Prepare soft-pack:
- Remove outer pouch
- Check clarity of solution and use by date
- Check volume
Prepare infusion set:
- Check correct set
- Open pack
- Move drip regulator towards drip chamber and turn off
- do not remove protecting caps from line
Insert IV infusion set into soft pack:
- Remove soft pack seal
- Remove protective cover from needle (do nto touch needle)
- support pack holding insert tube between index finger and thumb
- Twist IV infusion set needle slightly during insertion
Hang pack on IV stand:
- Hold IV pack and line in one hand if unable to hang
Charge IV line to exclude air:
- Gently squeeze drip chamber until half filled
- Gently turn on regulator to fill line
- Turn off regulation when air excluded
- Do not remove protective cap
Connecting and securing IV line:
- prepare tape
- Cut appropriate strips of tape approx 15cm in length
Secure IV line with tape:
- tape one tape over line at hub connection
- loop IV line along arm and secure with tape
Turn on regulator:
Select drip rate - TKVO for medical cardiac arrest or 20ml/kg for some PEA arrests
- Visualise and count drip rate
Check:
- maintain correct drip rate
- Check infusion site for swelling or discomfort
- monitor for and exclude any air bubbles in the line
- ensure IV line is appropriately labeled
12
Q
How do you measure the size of the NPA?
A
measure from corner of nose to the earlobe (external meatus)
13
Q
What are the clinical precautions for the use of Yankaur Rigid sucker?
A
- Croup
- Epiglottis
- Upper airway obstruction
14
Q
What are the steps for the insertion of a Nasogastric tube?
A
Preparation:
- Select appropriate size tube
- Position patient supine
- Measure tube for correct length - tip held at xiphoid process, looped around ear back to nostrol or igel opening
- Hold and identify at that mark with hand or noted with a small piece of tape
Using Igel gastric channel: - Select appropriate size duodenal tube for igel Size 1.5 = 10 tube Size 2, 2.5, 3, 4 = 12 tube Size 5 =14 tube
- Place small amount of lubricant over gastric insertion hole on igel
- Measurement for length as per above
- push duodenal tube a few cm down gastric channel through gel
- move tube up and down to ensure lubricant spreads over tip
- push duodenal tube downward until in stomach
Confirm tube placement:
- Withdraw syringe plunger and connect 50ml syringe with appropriate tip to end of tube
- Place stethoscope over the epigastrium
- Inject 20ml of air and listen for air bubbling in the stomach using a stethoscope
Secure tube:
- Tape tube securely to patients upper lip and cheek to prevent dislodgement
Ensure effective drainage:
- Gently pull back on 50ml syringe to aspirate stomach content and assist in correct placement confirmation
- Continue to aspirate until gastric content can no longer be withdrawn
- Attach suitable drainage bag to duodenal tube
15
Q
What are the steps for Insertion of Supraglottic Airway SGA?
A
Prepare patient:
- position self behind patients head
- attempt manual airway clearance
- ensure airway is not obstructed
- pre-oxygenate patient during preparation
- if necessary place pillow under head
- Ensure external meatus is inline with suprasternal notch
Assess adequate airway opening:
- Pull down lower jaw to ensure an opening of atleast 3 fingers is possible
- If unable to open patients mouth 3 fingers, use OP or NPA
Select and prepare i gel supraglottic airway:
- Select appropriate size following estimation of pateints weight
- remove Igel from packet
- remove igel from frame
- apply lubricant onto green handle
- smear it on to igel
- ensure no excessive gel in bowl of igel airway
- PLace igel back into frame if not for immediate use
Insert igel:
- ensure igel is removed from frame
- grasp firmly in bite block area
- maintain appropriate pressure to lower jaw to allow passage of igel - use jaw thrust
- advance mask over top of tongue pushing back of mask against hard palate
- Glide I gel downward and backward along hard palate until resistence is felt
- if resistance felt early, a slight twist may help
Confirm position:
- Teeth should be in line with marker
- auscultate anterior chest to ensure equal and adequate air movement. Auscultate abdomen to confirm correct placement
16
Q
What are the Indications for the insertion of a Nasogastric tube?
A
- A nasogastric tube may be inserted in a patient who has undergone endotracheal intubation or where an I-GEL laryngeal mask airway (LMA) has been inserted
17
Q
What are the contraindications for the insertion of a Nasogastric tube?
A
- Severe middle facial trauma
- Recent nasal surgery
18
Q
What are the steps for the use of Y suction catheter
A
Prepare equipment:
- Position suction device convieniently
- Select appropriate size Y suction catheter
- Attach Y suction to suction tubing
–»> No larger than half the diameter of the airway/adjunct
Introduce catheter into patients mouth:
- Turn on suction control device
- Open patients mouth
- Insert catheter into lower corner of mouth
Apply suction:
- Occlude catheter control hole for no greater than 5 seconds, slowly withdraw catheter
- move tip of catheter within oral cavity to remove secretions as required
- Flush line with water, if possible, to keep sucker patent
Check:
- Airway clearance
- Maintain patients posture
19
Q
What are the clinical precautions for the use of IPPV with a Bag Valve Mask - adult and paed?
A
NONE
20
Q
What are the Indications for Insertion of Supraglottic Airway SGA?
A
ALS cardiac arrest or ventilation requiring >10 minutes
21
Q
What are the Indications for the use of IPPV with a Bag Valve Mask - adult and paed?
A
- Apnoea or significant hypoventilation
- Ventilation of adult patients with cardiac output should generally include use of positive end-expiratory pressure (PEEP) valve where accredited
22
Q
What are the contraindications for the use of Laryngoscope?
A
NONE
23
Q
What are the Indications for the use of Laryngoscope?
A
- Patient in an altered conscious state, without gag reflex, requiring inspection of airway
24
Q
What are the steps for the Insertion of Nasopharyngeal Airway (NPA)?
A
Prepare equipment:
- Select appropriate size - corner of nose to earlobe. The diameter should be slightly smaller than nostril opening
- lubricate distal end with KY jelly to reduce risk of mucosal injury on insertion
Insert NPA:
- Inspect nostrils for obstruction
- Select widest nostril
- Push tip of nose gently towards eyes
- Insert gently with NP pointing posteriorly along floor of nose
- If resistance felt, stop and do not force
- Gently rotate clockwise and anticlockwise 45 degrees whilst continuing to insert
- If further resistance felt, re-lubricate and try other nostril or smaller airway device
- Insert to measured length
Check patient:
- Check for gag reflex
- Maintain triple airway manouvre
- maintain position of NPA
- Look listen and feel for air movement
- If required, suction pharynx by passing an appropriate sized suction catheter down airway
- In NPA becomes obstructed and obstruction remains after suctioning, remove and insert new NPA
25
What are the steps for the use of Magils forceps?
Inspect upper airway with Larygoscope:
as per laryngoscope CWI
Foreign body sighted - prepare Magil forceps:
- Pick up forceps in right hand
- > grip with thumb and third or ring finger
- > index finger to steady forceps
Introduce forceps:
- Place tip of forceps in groove of laryngoscope blade
- Ensure bend of Magil forceps follows the natural curve of Laryngoscope blade. Maintain view
- Advance tips of forceps along blade with tips closed
Remove visualised impacted foreign body:
- Keep foreign body in sight
- Move tips of forcips to within 2cm of the foreign body
- open tips carefully
- manouvre tips around body
- carefully grip and remove
Check:
- Re-inspect airway
- Visualise upper airway, down to vocal cords if possible, ensuring that no visable foregn material remains
Assess:
- Check respiratory status
- Perform vital sign survey
26
What are the steps for the use of Laryngoscope?
Position patient:
- Pt positioned appropriately. Pt's suprasternal notch inline with external meatus - 2cm town under head
Prepare equipment:
- Check laryngoscope
- > check light secure and tight
- > check it's working
- Place laryngoscope alongside LEFT of patients head
- Place suction equipment on RIGHT of patients head
Prepare patient:
- Elevate patients head using small pillow, folded towel or equivalent
- Gently apply moderate extension of the head and jaw support
- Maintain 'neutral' or 'sniffing' position to improve direct visualisation of the larynx
Insert laryngoscope:
- Right hand supporting and steadying patients head
- pick up and hold laryngoscope lightly by the handle with the left hand, thumb along handle
- Gently insert laryngoscope blade down extreme right side of mouth
Inspect upper airway:
- Check for foreign body in oropharynx
- >use suction if required
27
What are the contraindications for Drawing up drug (glass ampule?
NONE
28
What are the contraindications for the use of IPPV with a Bag Valve Mask - adult and paed?
- PEEP values are contra'd in paeds and patients in cardiac arrest
29
What are the contraindications for IV Cannula?
NONE
30
What are the clinical precautions for the use of Magils forceps?
NONE
31
What are the clinical precautions for the use of Y suction catheter?
- Croup
- Epiglottis
- Upper airway obstructions
32
What are the clinical precautions for Insertion of Supraglottic Airway SGA?
- Inability to prepare patient in sniffing position
- Pts who require high airway pressures eg. advanced pregnancy, morbid obesity, decreased pulmonary compliance, sever asthma
- Pts <14 years old due to enlarged tonsils (MICA only)
- Significant volume of vomit in airway
- Correct placement of igel does not prevent passive regurgitation or gastric distension
33
What are the Indications for the use of Yankaur Rigid sucker?
- Suction may be required when a patient is in an altered conscious state and is unable to protect their own airway from secretions, vomit, blood etc.
34
What are the clinical precautions for assembling, connecting and changing IV infusion line?
- Ensure aseptic technique is practiced at all times
| - Do not re-spike fluid bags
35
What are the contraindications for the Insertion of Oropharyngeal Airway (OPA)?
- Trismus
- Gag Reflex
- Any patient suspected of having neurological injury out of concern for inducing gag response
36
What are the clinical precautions for the Insertion of Nasopharyngeal Airway (NPA)?
- Basal skull fractures and any CSF from Nares and Ears
| - NPA may need to be removed during intubation attempts as it can interupt view of glottis
37
What are the clinical precautions for Intramuscular Injection?
Safety - ensure correct technique for administration, anatomical location and disposal of sharps technique is used at all times
- Larger volumes may be painful, dilution should be avoided
38
What are the contrandications for the Insertion of Nasopharyngeal Airway (NPA)?
- Middle third facial fractures
- Significant nasal trauma
- traumatic brain injury or neurological event where airway is patent and tidal volume is adequate despite trismus
39
How do you measure the size of OPA?
Angle of jaw to middle of incisors (teeth)
40
What are the Indications for Drawing up drug (glass ampule?
NONE
41
What are the Indications for the use of Y suction catheter?
- Suction may be required when a patient is in an altered conscious state and is unable to protect their own airway for secretions, vomit and blood etc
42
What are the clinical precautions for the Insertion of Oropharyngeal Airway (OPA)?
- ensure correct measurement to ensure correct application and avoid damaging soft posterior structures
- An OP does not provide protection against aspiration
43
What are the steps for the use of IPPV with a bag valve mask?
Prepare patient:
- position patient appropriately
- Clear airway: Perform triple airway manoeuvre if required
- Insert OPA if indicated
Prepare equipment:
- Select appropriate mask size
- Assemble BVM
- Attach to oxygen source providing flow rate >8 L/min. Ensure flow rate is sufficient to keep reservoir bag filled.
Apply mask:
- Place mask such rthat the narrow end is seated over the bridge of nose and manipulate mask to obtain best fit
- Masked should be gripped so that:
- > EC grip
- Maintain grip on lower jaw with 5th, 4th and 3rd fingers
- Ensure adeqaute seal. If unable to achieve this with a single hand - move to double handed technique with thumbs securing the mask onto the face and fingers behind the mandible to achieve jaw thrust
- > get second paramedic to squeeze bag
Ventilate patient:
- Gently squeeze self inflating bag to deliver appropriate volume
- Observe chest and abdominal movement
- Ventilate at appropriate rate
- Continually reassess mask seal, airway position, chest wall movement and any spontaneous respiratory effort.
44
What are the steps for Intramuscular Injection?
Prepare patient:
- Explain the procedure to the patient, gain consent if possible
- Check allergies including chlorhexidine
- Check indications, contraindications and precautions for the medication.
- Identify correct medication, dose and route chosen for clinical practice guideline
- Double check with second paramedic
Prepare equipment:
- Select and draw up drug for administration as per CWI, ensure appropriate labelling
- Select suitable length needle for injection - typically 23g but may be smaller gauge for children
- Place suitable sharps container ready for use
Prepare insertion site:
- Select appropriate site ie. Deltoid in upper arm, upper outer quarter gluteus medius of buttock, vastus lateralis of lateral thigh
- Position patient with site easily accessible - patient clothing may need to be removed
- Identify landmarks for injection site
- Thoroughly clean injection site to cover a 5cm x5cm area with swap for 10 seconds with light friction. Repeat
- Allow to air dry
Re-check drug:
- Identify correct drug, dose and route chosen for clinical practice guideline
- Confirm expiry date
- Double check with second paramedic
Insert needle:
- Remove plastic cap from needle
- With free hand stretch skin around point of anticipated entry. Ensure they are far enough apart to avoid needle prick injury
- Hold needle approx above inject site holding syringe barrel and plunger away from patient
- Pull back syringe and quickly insert into site at 90degree angle
- Depth approx 2/3 needle length
Confirm needle position:
- With needle still in muscle, release skin stretch and grasp barrel of syringe
- Gently pull backl on syringe plunger 0.5ml and inspect for any flashback
- if blood appears, withdraw needle 2-3mm and repeat
Administer drug:
- whilst holding barrel of syringe push down on plunger
Withdraw needle:
- Release hand holding syringe steady and move hand safely clear
- identify to others that you have a contaminated sharp
- withdraw needle quickly
- Immediately drop into sharps container
Post injection management:
- Cover wound with an adhesive dressing
- Observe Pt for effects and reassess
- Document time and drug administration
45
What are the steps for the use of Yankaur suction?
Prepare equipment:
- Position suction device convieniently
- Attach Yankeur sucker to suction tubing
Introduce sucker into patients mouth:
- Turn on suction control device
- open patients mouth
- Insert sucker into lower corner of mouth with care
Apply suction:
- Occlude catheter control hole for no greater than 5 seconds whilst slowly withdrawing catheter
- Move tip of catheter within oral cavity to remove secretions as required
- Flush line with water, if possible, to keep sucker patent
- Repeat as required
Check:
- Airway clearance
- Maintain patients posture
46
What are the contraindications for Insertion of Supraglottic Airway SGA?
- intact gag reflex or resistance to insertion
- Strong jaw tone or trismus
- Suspected epiglottis or upper airway obstruction
- The use of sedation to either assist placement of, or maintain placement of i-gel is contraindicated
47
What are the clinical precautions for Drawing up drug (glass ampule?
What are the Indications for Drawing up drug (glass ampule?
48
What are the contraindications for the use of Yankaur Rigid sucker?
NONE
49
What are the contraindications for Intramuscular Injection?
NONE
50
What are the Indications for the Insertion of Oropharyngeal Airway (OPA)?
- Unconscious patient where there is a need to actively maintain airway patency by displacing the tongue anteriorly
- Bite block to support ETT placement
51
What are the contraindications for the use of Magils forceps?
NONE
52
What are the Indications for IV Cannula?
When intravenous medication administration is required in line with AV CPG's
