OSCE technical skills Flashcards
What pressure should be applied in cricoid pressure when patient is awake and asleep
Awake: 10N of force
Asleep: 30N of force
When is cricoid pressure used
RSI
How would you explain what 30N of pressure is
…
how might cricoid pressure cause problems
May make intubation more difficult if too much pressure applied or displace larynx laterally
If patient vomits can cause oesophageal rupture - must be released
some studies show its ineffective and aspiration still occurred despite cricoid pressure
can be uncomfortable for patient if inadequately sedated
when might cricoid pressure be released despite patient not being intubated
obscuring view of larynx
active vomiting
in CICV when inserting an LMA/BMV
When would IO be used
in emergency situations where IV access is not available/difficult
where can IO be done
proximal Tibia
head of humerus
How do you give drugs down a IO
Flush immediately with 5-10ml of saline to create a cavity within the medullary space
in awake patients very painful so can give LA down the IO initially
Level needed for spinal for TURP
up to t10
Contraindications for spinal
Coagulopathy
On blood thinners/clopidogrel
infection over skin in that area
Patient refusal
Increased ICP
allergy to drugs used in spinal
What are the landmarks for a chest drain
Pectoralis major
Lat dorsi
5th intercostal space - at level of nipple
How would you position a patient for a chest drain
Lying on back with arm up
Sat up and leaning onto table
lying on side
How would you identify a tension pneumothorax
silent chest on one side
deviated trachea to unaffected side
desaturation/cyanosis
reduced chest wall movement on side of ptx
hyperresonance
jugular vein distension
Where would you place a needle decompression
2nd intercostal space mid clavicular line and listen for hiss
at what level does the spinal cord end in an adult
L1-2
Which structures will you pass through when inserting a spinal needle
skin
subcutaneous tissue
supraspinous ligament
interspinous ligament
ligamentum flavum
epidural space (potential space)
dura mater
sub dural space
arachnoid mater
sub arachnoid space - where CSF is
How much CSF is produced by the body
500ml a day
CSF is 150ml at one time
where is the CSF reabsorbed
Arachnoid villi
Why head down in CVC insertion
Increases size of IJV
decreases incidence of venous air embolism
Talk through change of tracheostomy tube
Ensure patient has been fasted for last 6 hours
Suctioned trache and oropharynx
Preoxygenate with 100% oxygen
check which tube is in place and check previous trache change or trache insertion for any complications
check laryngoscopy grade and check drugs and equipment ready for tracheal intubation
Check trache and check cuff inflates and deflates
Remove trache ties
remove trache tube and insert new one
remove obturator
inflate cuff
Check can ventilate and then connect to ventilator and check ETCO2
What should cuff pressure be in tracheostomy
20-25cmm H20
At which level should sa tracheostomy be sited
between 1st and 2nd tracheal rings
or 2nd and 3rd tracheal rings
by how much does a tracheostomy reduce anatomical deadspace by
75-100ml
When would you use a variable flange tracheostomy
Obese patient or unusual anatomy
Oedema (actual or anticipated following surgery)
