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Nurse 1 > REBOA > Flashcards

REBOA Flashcards

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1
Q

What does REBOA stand for?

A

Resuscitative Endovascular Balloon Occlusion of the Aorta

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2
Q

Where does Zone 1 extend from for REBOA?

A

Origin of the left subclavian artery to the coeliac artery

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3
Q

Where does Zone 2 extend from for REBOA?

A

The coeliac artery to the most caudal renal artery

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4
Q

Where does Zone 3 extend from for REBOA?

A

From most caudal renal artery to the aortic bifurcation

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5
Q

What is the external landmark for Zone 1 landing zone?

A

Mid sternum

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6
Q

What is the external landmark for the Zone 3 landing zone?

A

Immediately cranial to the umbilicus

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7
Q

Where does the REBOA trolley live?

A

In resus bay 8

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8
Q

What needs to be prepared in addition to the standard preparation for a Code Red patient that also has a REBOA?

A

Double pressure transducer line from the REBOA trolley

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9
Q

What is the priority for a REBOA patient?

A

Expedite their transfer to theatre

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10
Q

What is contained in the drawer 1 in the REBOA trolley?

A

Sterile gowns
Sterile gloves

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11
Q

What is contained in the drawer 2 in the REBOA trolley?

A

Femoral angio drape
ER-REBOA convenience pack
ER-REBOA catheter

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12
Q

What is contained in the drawer 3 in the REBOA trolley?

A

10ml syringe
Blunt drawing up needles
Sterile gauze
Clear film dressings
Chloraprep
Chlorhexadine
Double transducer
Pressure bag
Double transduce connector
Arterial line transducer
500ml bag of saline

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13
Q

What is contained in the drawer 4 in the REBOA trolley?

A

Femoral cutdown kit
Sterile scissors
Scalpel
4 Fr femoral catheter
8 Fr femoral catheter
18 gauge percutaneous entry needle
Suture

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14
Q

What injuries are associated with rapid exsanguination and mortality rates nearing 50%?

A

Pelvic, abdominal, thoracic and junctional vascular injuries

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15
Q

What is the recommended approach to the management of exsanguinating patients in extremis?

A

A resuscitative thoracotomy and clamping the descending aorta which is associated with poor outcomes

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16
Q

What does the REBOA procedure involve?

A

The placement of an endovascular balloon in the aorta to gain proximal control of exsanguinating haemorrhage

17
Q

What can be used as an alternative to performing a resuscitative thoracotomy in traumatic arrest or as an adjunct for
temporising intra-thoracic, abdominal, pelvic or junctional haemorrhage?

A

REBOA

18
Q

As distances and diameters are variable in every patient, when inserting the REBOA catheter what is essential?

A

Measurement of surface anatomy and careful feel for the balloon abutting the aortic wall

19
Q

What is the indications for a patient needing REBOA?

A

Adult trauma patient (over 16 years old) with blunt or penetrating injuries and suspected exsanguinating sub diaphragmatic haemorrhage indicated by:
- mechanism compatible with causing injuries resulting in exsanguinating haemorrhage
- identifiable injuries
- appropriate timescale
- hypotension/unrecordable BP
- pale, clammy
- absence of peripheral venous filling
- air hunger
- low/falling end tidal CO2

20
Q

Is recent hypovalaemic cardiac arrest a contra indication to REBOA?

A

No, but common femoral artery cannulation is likely to be challenging

21
Q

What essential investigations should be done for REBOA patients?

A

Blood gas
Essential pharmacotherapy e.g. TXA FAST scan
Chest and pelvic X-ray
Abdo X-ray to check balloon locations
An attempt a P-REBOA

22
Q

If a patients has had a REBOA where should the balloon be seen in zone 1 or zone 3 on an X-ray?

A

Zone 1-just above the diaphragm
Zone 3- overlying the L2-L4 vertebrae

23
Q

To prevent the need to re-transduce the lABP lines for a patient who has had a REBOA pre-hospital what should be done in resus?

A

Patient should remain on the
HEMs monitor

24
Q

What should happen to REBOA patients who remain haemodynamically unstable and any patient with hemoperitoneum on FAST scan?

A

Transfer to theatre without delay

25
Q

If a REBOA patient is responding well to blood transfusion what could be considered?

A

Attempt P-REBOA with a view to undertaking CT and subsequent angioembolisation in the IR suite

26
Q

Why would you attempt at P-REBOA?

A

In order to minimise the ischaemic and reperfusion associated with prolonged complete occlusion is reasonable stability has been achieved

27
Q

What is P-REBOA?

A

When you partially deflate the
REBOA balloon

28
Q

How do you know what your ‘baseline’ occlusion pressure is if your patients has had REBOA?

A

The arterial pressure reading from the side arm of the sheath downstream of the balloon will read a low number e.g. 5-10 mmHg, not usually zero

29
Q

How do you achieve P-REBOA?

A

Remove 0.5ml of saline from the balloon and observe the response. If there is no critical deterioration the balloon should be deflated a further 0.5ml and then repeat until either the baseline pressure rises to 10 mmHg above the baseline pressure or a degree of pupsitility is seen to return to the downstream IABP trace

30
Q

What is the aim of P-REBOA?

A

To transition to partial occlusion by allowing enough flow through to raise the baseline occlusion pressure by 10mmHg

31
Q

Why during deflation of the REBOA balloon is it likely that the blood pressure will fall?

A

It is secondary to reinstitution of distal flow, reduced after load and reperfusion of tissues and progression towards a ‘partial occlusive’ state

32
Q

What is the aim of P-REBOA?

A

To strike a balance between maintaining an adequate aortic blood pressure, haemostatsis and distal organ perfusion

33
Q

If the catheter migrates when deflating the REBOA balloon, what should be considered before re-inflating if needed?

A

Consider deflating and re-inserting to the initial pre-determined depth before re-inflating

34
Q

What should happen if a patients haemodynamic a fall beyond antolerable level during P-REBOA?

A

The balloon should be re-inflated and transferred to theatre with aggressive volume resuscitation

Nurse 1 (24 decks)

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