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PAR2011 - ALS > OSCE > Flashcards

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
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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

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3
Q

What are the contraindications for assembling, connecting and changing IV infusion line?

A

NONE

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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

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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
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6
Q

What are the Indications for the use of Magils forceps?

A

Foreign body airway obstruction with altered conscious state

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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

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8
Q

What are the contraindications for the use of Y suction catheter?

A

NONE

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9
Q

What are the clinical precautions for the use of Laryngoscope?

A
  • Croup

- Epiglottis

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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
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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
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12
Q

How do you measure the size of the NPA?

A

measure from corner of nose to the earlobe (external meatus)

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13
Q

What are the clinical precautions for the use of Yankaur Rigid sucker?

A
  • Croup
  • Epiglottis
  • Upper airway obstruction
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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
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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
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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
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17
Q

What are the contraindications for the insertion of a Nasogastric tube?

A
  • Severe middle facial trauma

- Recent nasal surgery

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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
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19
Q

What are the clinical precautions for the use of IPPV with a Bag Valve Mask - adult and paed?

A

NONE

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20
Q

What are the Indications for Insertion of Supraglottic Airway SGA?

A

ALS cardiac arrest or ventilation requiring >10 minutes

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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
Q

What are the steps for the use of Magils forceps?

A

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
Q

What are the steps for the use of Laryngoscope?

A

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
Q

What are the contraindications for Drawing up drug (glass ampule?

A

NONE

28
Q

What are the contraindications for the use of IPPV with a Bag Valve Mask - adult and paed?

A
  • PEEP values are contra’d in paeds and patients in cardiac arrest
29
Q

What are the contraindications for IV Cannula?

A

NONE

30
Q

What are the clinical precautions for the use of Magils forceps?

A

NONE

31
Q

What are the clinical precautions for the use of Y suction catheter?

A
  • Croup
  • Epiglottis
  • Upper airway obstructions
32
Q

What are the clinical precautions for Insertion of Supraglottic Airway SGA?

A
  • 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
Q

What are the Indications for the use of Yankaur Rigid sucker?

A
  • 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
Q

What are the clinical precautions for assembling, connecting and changing IV infusion line?

A
  • Ensure aseptic technique is practiced at all times

- Do not re-spike fluid bags

35
Q

What are the contraindications for the Insertion of Oropharyngeal Airway (OPA)?

A
  • Trismus
  • Gag Reflex
  • Any patient suspected of having neurological injury out of concern for inducing gag response
36
Q

What are the clinical precautions for the Insertion of Nasopharyngeal Airway (NPA)?

A
  • 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
Q

What are the clinical precautions for Intramuscular Injection?

A

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
Q

What are the contrandications for the Insertion of Nasopharyngeal Airway (NPA)?

A
  • 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
Q

How do you measure the size of OPA?

A

Angle of jaw to middle of incisors (teeth)

40
Q

What are the Indications for Drawing up drug (glass ampule?

A

NONE

41
Q

What are the Indications for the use of Y suction catheter?

A
  • 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
Q

What are the clinical precautions for the Insertion of Oropharyngeal Airway (OPA)?

A
  • ensure correct measurement to ensure correct application and avoid damaging soft posterior structures
  • An OP does not provide protection against aspiration
43
Q

What are the steps for the use of IPPV with a bag valve mask?

A

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
Q

What are the steps for Intramuscular Injection?

A

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
Q

What are the steps for the use of Yankaur suction?

A

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
Q

What are the contraindications for Insertion of Supraglottic Airway SGA?

A
  • 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
Q

What are the clinical precautions for Drawing up drug (glass ampule?

A

What are the Indications for Drawing up drug (glass ampule?

48
Q

What are the contraindications for the use of Yankaur Rigid sucker?

A

NONE

49
Q

What are the contraindications for Intramuscular Injection?

A

NONE

50
Q

What are the Indications for the Insertion of Oropharyngeal Airway (OPA)?

A
  • Unconscious patient where there is a need to actively maintain airway patency by displacing the tongue anteriorly
  • Bite block to support ETT placement
51
Q

What are the contraindications for the use of Magils forceps?

A

NONE

52
Q

What are the Indications for IV Cannula?

A

When intravenous medication administration is required in line with AV CPG’s

PAR2011 - ALS (11 decks)

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