OSCE Prep - Cardiac/Airway

Question 1

Nasopharyngeal airway insertion

Answer 1

Size NPA from the tip of the nose to the earlobe
Lubricate and insert with bevel facing septum until flange rests against the nostril
Precautions - suspected base of skull fracture

Question 2

Oropharyngeal insertion

Answer 2

Size OPA from the mouth to the angle of the jaw
Insert with the concavity facing the roof of the mouth
Rotate 180 degrees over the tongue once 1/3 has been inserted
Precautions - severe oral trauma or occlusions that must be suctioned

Question 3

Suctioning

Answer 3

Suction pressure - 80-120 mmHg
Insert suctioning tube into the oral cavity and withdraw with the side port occluded
Hope to god you can remember how to hook it up to the oxygen tank

Question 4

Triple airway manoeuvre

Answer 4

Head tilt - mouth open - jaw thrust

If there is a suspected C-spine injury eliminate head tilt

Question 5

Bag Valve Mask ventilation

Answer 5

Indicated for respiratory distress, respiratory arrest, or hypoventilation <10
Don’t forget the green disposable filter + pressure relief plug

Adjust oxygen flow to 15L/min
Use syringe to fill the air cushion to achieve a tight seal
Press firmly over the mouth and nose (C+E grip) in a rolling motion
Compress and release the bag to provide Positive Pressure Ventilation

Question 6

Cardiac monitoring

Answer 6

Indicated for unconscious/recently unconscious patients, chest pain, poor perfusion, abnormal vital signs, cardiac arrest etc
Lead placement: Smoke over fire, snow over trees, throw the snow with your right hand cos your righthanded
Make sure the skin is clean and dry to adhere sticky dots and attach leads

Question 7

CPR

Answer 7

Indicated if no pulse can be felt
Get the BVM on
30 compressions to 2 breaths
100 BPM (sing stayin’ alive in your head)

Question 8

Defibrillation - semiautomatic

Answer 8

Shockable rhythms:
Ventricular tachycardia (updownupdownupdown)
Ventricular fibrillation (laskfdjgkjh heart goes all over the place)
Non-shockable rhythms:
Pulseless electrical activity (organised ECG output but no pulse - give CPR)
Asystole (heart goes ‘fuck it I’m out’ - give CPR)

Make sure skin is clean and dry and place pads
Make sure no conductive material is around
Fuck around with the corpuls until it cooperates and press Analyse
Hopefully you get back to normal sinus rhythm

Question 9

ECG strips

Answer 9

Small boxes (1mm) 0.04 seconds
Large boxes (5mm) 0.2 seconds
Top notches - 3 seconds

P wave: Atrial excitation (depolarisation)
P-R interval: Impulse delay at atrioventricular junction
QRS complex: Ventricular excitation (depolarisation)
T wave: Ventricular repolarisation

Atrial repolarisation is hidden in the QRS complex

Question 10

Five step method

Answer 10

Regularity, rate, P waves, P-R interval, QRS width

1. Regular or irregular? Any patterns?
2. No. of beats in a 6 second strip times by 10 OR 300 divided by large squares between 2 peaks OR 1500 divided by small squares between two peaks
3. Are they regular, one in front of each QRS?
4. Is the interval within normal range? (0.12-0.2 seconds = 3-5 small boxes)
5. QRS complex width? (at or under 0.12 seconds/3 small boxes) Are they alike? Any abnormalities?