Res School Flashcards
1
Q
What are the aspects oh GCS?
A
E
4 - open spontaneously
3 - open to voice
2 - open to pain
1 - un responsive
V
5 - orientated
4 - confused
3 - Inappropriate
2 - incomprehensible
1 - unresponsive
M
6 - obeys commands
5 - localises to pain
4 - withdraws from pain
3 - abnormal flexion
2 - abnormal extension
1 - unresponsive
2
Q
What are the contraindicators of a GCS
A
Use APGAR instead of GCS for newborns
3
Q
What are the precautions for GCS?
A
- limited adaption to patients who don’t have a traumatic brain injury
- requires a modified GCS for paediatric patients
- Painful stimuli should be minimised and repeat application is rarely required
4
Q
What are the Nexus Criteria?
A
Midline tenderness
Evidence of intoxication
Any loss of consciousness
Focal neurological Deficit
Distracting injury
5
Q
What are the indications of manual inline stabilisation?
A
Stabilisation of the head and neck in a patient with a suspected cervical spine injury
6
Q
What are the contraindications for manual inline stabilisation?
A
Nil
7
Q
What are the precautions for manual inline stabilisation?
A
Difficult Laryngoscopy
8
Q
What are the different positions you can achieve manual inline stabilisation?
A
Side
Behind
Sitting up right
9
Q
What are the indications for a cervical collar?
A
Suspicion of a cervical spine injury SCI
10
Q
What are the contraindications for a cervical collar?
A
Surgical airway
Penetrating neck trauma
11
Q
What are the precautions for a cervical collar?
A
Discomfort
Anxiety
12
Q
What is the procedure for putting on a cervical collar?
A
- Align the patients head to a natural position or a position of greatest comfort
- Measure the distance from the base of the chin and suprasternal notch (notch in the middle of collar bones)
- Select the right size collar by comparing the patients neck to the width of the soft collar chin supports
- Slide the collar under the patients neck right to Kraft until the adhesive Velcro strap is clearly visible
- Secure the collar with the Velcro strap
13
Q
What are the sizes for a cervical collar?
A
XS- height - 65mm and length - 480mm
M - height - 90mm and length - 480mm
L - height - 100mm and length - 535mm
14
Q
What is the Normal resp rate?
A
12-18 BPM
15
Q
How long to count for a resp rate ?
A
No less than 30 seconds
16
Q
What is Eupnoea.
A
Normal breathing rate and pattern
17
Q
What is Tachypnoea?
A
Increased respiratory rate
18
Q
What is bradypnoea?
A
Decreased respiratory rate
19
Q
What is apnoea?
A
Absence of breathing
20
Q
What is Hyperpnoea?
A
Increase depth and rate of breathing
21
Q
What is Cheyenne-stokes
A
Gradual increases and decreases in respirations with periods of apnoea
22
Q
What is biots?
A
Abnormal breathing pattern with groups/clusters of rapid respiration of equal depth and regular apnoea periods
23
Q
What is kussmaul’s
A
Tachypnoea and hyperpnoea
24
Q
What is Apneustic?
A
Prolonged inspiratory phase with a prolonged expiratory phase
25
What are the sights of increased effort when breathing?
Intercostal retraction/accessory muscle use
Nadal flaring
Forward/tripod posturing
Paradoxical respiration Anxiety or agitation
26
What is hypoxemia?
Decreased levels of oxygen in the arterial blood
27
What is cyanoais?
Bluish discolouration of skin and mucus membrane due to a lack if oxygen
28
What are the indications for suction?
The removal of airway blockages that cannot be spontaneously cleared
29
What are the contraindications due suction?
Nil
30
What are the precautions for suction?
Hypoxia
Airway trauma
Study,ate coughing or gagging
Vagaries stimulation
31
What is the procedure for oropharyngeal suction (yankauer)?
1. Ensure the catheter is connected to the suction tubing and the tubing is connected to an appropriate suction device
2. Test for adequate suction by occluding the catheters side Oort
3. With the side port remaining open, gently insert the catheters tip into the patients oral cavity
4. Activate suctioning whist gently withdrawing the catheter from the oropharynx
5. Ensure the commencement of appropriate oxygen/ventilation, if required repeat the suction procedure
32
What is the procedure for nasopharyngeal suction (Y-Suction )?
1. Ensure the catheter is connected to the suction tubing and the suction tubing is connected to an appropriate suction device
2. Test for adequate suction by occluding the catheter’s side port
3. With the side port remaining open, gently insert the catheter’s tip into the patient’s nostril down to the back of the throat. If resistance is felt, or the patients cough reflex is stimulated remove and attempt reinsertion
4. Activate suctioning and whilst gently withdrawing the catheter in a rotating motion
5. Ensure the commencement of appropriate oxygen/ventilation. If required consider repeating using the alternative nostril
33
What are the indicators of IPPV?
Acutely respiratory distress, hypoventilation or arrest requiring positive pressure ventilation
34
What are the contraindications of IPPV?
Spontaneously breathing patients with adequate tidal volume and an appropriate respiratory rate?
35
What are the precautions of IPPV?
Gastric inflammation
Pulmonary barotrauma
Undesirable cardiovascular effects such as hypotension secondary to caval compression
36
What is the procedure for IPPV?
1. Determine need for IPPV
2. Continuously ensure the patient has a patent airway, apply basic airway management and progress to advanced airway techniques when appropriate
3. Ensure appropriate positioning of the patient
4. Test the equipment
5. If positive and expiratory pressure is required connect the PEEP valve firmly to the expiratory flow diverter
6. Connect the oxygen tubing to an oxygen source and set to 15L/min
7. Ensure the air cushion on the mask is adequately inflicted to achieve a tight seal on the farce
8. If inflation is required do so via the inflation port on the mask using a syringe
9. Create an effective seal between the cuffed mask and the face
10. Gently compress the squeeze bag to deliver a breath and observe the chest rise to confirm inspiration
11. Gauge the effort required to ventilate through the feel of the recoil bag and rise and fall of the chest
12. Release the pressure on I the squeeze bag to allow passive exhalation and re-expansion of the bag
13. During ventilation check for signs of cyanosis, adequate ventilation, airway pressure, correct functioning of all valves and tubing and continuous supply of oxygen to the resuscitator and inflation of the reservoir bag
14. The recoil bag should be squeezed to a volume corresponding to an estimated total volume of the patient
37
What are the indicators of an OPA?
Maintain airway patency
Bite block in advanced airways
38
What are the contraindications of an OPA?
Conscious patients
Patients with an intact gag reflex
39
What are the precautions of an OPA?
Airway trauma from incorrect OPA placement
Intolerance of OPA requiring removal
Precipitate vomiting or aspiration in a patient with an intact gag reflex
Incorrect size or placement can potentially exacerbate an airway obstruction
40
What is the procedure for inserting an OPA into an adult?
1. Identify the correct OPA by measuring from the centre of the patients lips to the angle of the jaw
2. Insert the OPA ensuring the cavity of the adjunct is facing the roof of the mouth
3. Once a third of the OPA has been inserted rotate it 180 degrees over the tougher
4. Gently advance the OPA until the flange is pressing against the lips
41
What is the procedure for inserting an OPA for a child?
1. Identify the correct OPA by measuring from the centre of the patients lips to the angle of the jaw
2. Insert the OPA ensuring the concavity of the adjunct is facing the floor of the mouth
3. Gently advance the OPA until the flange is pressing against the lips?
42
What are the indications for a nasopharyngeal airway?
Potential or actual airway obstruction
43
What are the contraindications for a nasopharyngeal airway?
Nil
44
What are the precautions for a Nasopharyngeal airway?
Airway fauna particularly epistaxis
Incorrect size or placement will compromise placement
Exacerbate injury in base of skull fracture with nap potentially displacing the cardinal vault
Can still stimulate a gag reflex in sensitive patients
45
What is the procedure for inserting a nasopharyngeal airway?
1. Place the patients head in a neutral position
2. Identify the correct size by measuring from the tip of the patients nose to the earlobe
3. Lubricate the end of the NOA with water soluble lubricant
4. Advance the device carefully along the floor of the nasopharyngeal following its natural curvature until the flange rests against the nostril
46
What is a normal pulse rate?
40-100 BPM
47
What is bradycardia?
A pulse rate of less than 60 BPM
48
What is tachycardia?
A pulse rate of more than 100 BPM
49
What are the different options of an irregular pulse rate?
Irregularly irregular
Regularly irregular
50
What is a normal blood pressure?
Systolic - 100-149 mmHg
Diastolic - 70-90 mmHg
51
What is hypotension
Low blood pressure
52
What is hypertension
High blood pressure
53
What are the indications for a blood pressure
Determine a patients blood pressure
54
What are the contraindications of taking a blood pressure?
Do not apply to a lump with an AV fistula, significant injury or burn or lymph node removal pose mastectomy
55
What are the precautions for taking a blood pressure
Discomfort or pain in patient
Excessive pt or vehicular movement will result in an inaccurate reading
Incorrect cuff size or incorrect p,ace ent will result in inaccurate readings
56
What is the procedure for taking a blood pressure
1. Expose arm
2. Select the appropriate cuff
3. The arm circumference range is orientated on the Bp Cuff and the artery index marker falls within the range indicator of the cuff
4. Position the cuff with a minimum of 2.5cm above the crease of the elbow
5. Wrap the cuff around the arm with the artery index maker located over
the brachial artery
6. Position the patients arm in a relaxed and supported position at
approximately the same level as the patients heart
57
What is a normal BGL?
4-8mmol/L
58
What is hypoglycaemia?
Low BGL levels
59
What is hyperglycaemia
High BGL levels
60
What are the indications of a blood analysis for glucose
Point of care glucometry analysis
61
What are the contraindications of a BGL
Routine use in newborns unless clinically indicated
62
What are the precautions of a BGL?
Nil
63
What is hypoxemia
Low oxygen in the blood
64
What is hypoxia
Low oxygen levels reaching the tissues
65
What are the indicators of a SP02
To determine a patients oxygen saturation
66
What are the contraindications of an SPO2
Nil
67
What are the precautions of an SPO2
The reliability of SPO2 reading depends on the correct sensor size and placement and adequate arterial blood pulsation through the sensor site or an in accurate reading may be caused by excessive patient movement, exposure to ambient light, dirt or nail polish or methaemoglobinaemia abs carbon monoxide
68
What is a normal temperature
36-37 degrees
69
What is normothermia?
Normal body temperature
70
What is hyperthermia?
High body temperature
71
What is hypothermia?
Low body temperature
72
What is febrile?
Having or showing symptoms of a fever
73
What is afebrile
Not marked by or having a fever?
74
What are the indications for a tympanic temperature?
The monitoring of temperature when clinically indicated
75
Hat are the contraindications of a tympanic temperature?
Blood or drainage in the ear canal
Acura or chronic inflammatory conditions pf the external ear canal
Perforated tympanic membrane
76
What are the precautions of a tympanic temperature
Nil
77
What is the basic ECG Electrode placement
White on the rights and make over fire
Ankles and wrists
78
How much time does one small block represent on an ECG?
40msec
79
What is the P wave
The first positive bump on the ECG
80
What is the P-R interval
The interval from the start of the P wave to the start of the QRS wave
81
What is the P-R segment?
The segment from the end of the P wave to the start of the QRS interval
82
What is the Q point
The first negative point on the ECG right before the R point
83
What is the R point on an ECG
The positive point after the P wave
84
What is the S point on an ECG
The first negative point after the at point
85
What is the QRS interval
The interval from the start of the Q point to the end of the S point
86
What is the S-T segment on an ECG
The segment from the end of the S point to the start of the T wave
87
What is the T wave
The positive wave after the QRS segment
88
What is the S-T interval
The interval from the end of the S point to the end of the T wave
89
What is the U wave?
The wave after the T wave
90
How long should the PR interval be?
0.12-0.2 seconds (3-5 small boxes)
91
What are the two methods of ECG rate interpretation
1. Count the number of R waves in 6 seconds and multiple it by 10
2. Count the number of large boxes between each R wave and divide that number by 300
92
What is the normal height of a P wave?
2.5mm
93
What is the normal interval for a P wave?
Less than 0.12 seconds
94
How long should a PR internal last?
Between 0.12 and 0.2 seconds
95
How long should a QRS complex last?
0.04-0.12 seconds
96
What is Sinus Rhythm?
Regular rate, rhythm, P wave, PR interval and QRS complex
97
What is Sinus arrhythmia?
Regular rate
IRREGULAR EHYTHM
Regular P wave, PR interval and QRS complex
98
What is Sinus Tachycardia?
RATE OF MORE THAN 100BPM
Regular rhythm, P wave, PR interval and QRS complex
99
What is Sinus Bradycardia?
RATE LESS THAN 60BPM
Regular rhythm, regular Peace, regular PR interval and regular QRS complex
100
What is atrial fibrillation?
Heart rate of less than 100 controlled or more than 100 uncontrolled
Irregular rhythm
Not visible P wave
Normal QRS complex
PR interval N/A
101
Atrial flutter
‘Sawtooth’ appearance of P waves
102
What is a ventricular tachycardia?
Rate more than 199
Regular rhythm
Not visible P wave
QRS complex is wide
PR interval N/A
103
What is a ventricular fibrillation?
Rate fast
Rhythm irregular
P wave not present
PRS interval N/A
QRS complex wide and bizarre
104
What is the 5 step method for interpreting an ECG?
1. Rate - 6 second method or 300 method
2. Rhythm - regular or irregular
3. P wave- upright and rounded proceeding each QRS?
4. PR interval - 0.12-0.2 seconds?
4. QRS Complex - less than 0.12 seconds
105
When to start CPR?
There are no signs of life, unresponsive, not breathing normally, carotid pulse cannot be confidently palpated within 10 seconds
OR
There are signs of inadequate perfusion unresponsive, pallor or central cyanosis, inadequate pulse evidence by less than 40bpm in an adult of child over 1 years of age or less than 60BPM in a child less than 1 years old
106
How many hands do you use in CPR for adults, children ages 1-8 and infants
Adults - 2
Children - 1
Infants - two fingers
107
What are the indications for defibrillation?
Ventricular fibrillation or pulseless ventricular tachycardia
108
What are the contraindications of defibrillation?
Non shockable rhythms, asystole, pulse less electrical activity or perfusing rhythms
109
What are the complications of defibrillation?
Patient injury including burns
Explosion
Transmitted shock to the operator or bystanders
110
What are the defibrillator energy levels
Corpus - 200J
Life Pack 15
Shock one - 200J
Shock two - 300 J
Shock Three - 360J
Subsequent - 360J
Children 6 years or under are shocked at 4J/KG- round up to closest setting
111
What are the 4 Hs and 4 Ts in relation to pulseless electrical activity
Hypo Olaf is
Hypoxia
Hyper and hypokalaemia and metabolic disorders
Hyper and hypothermia
Toxicity
Tension pneumothorax
Tamponade - cardiac
Thromboembolism - MI or PE
112
When to stop CPR after resuscitation has commenced
If there has been 20 minutes continuous resuscitation AND no ROSC AND arrest was not witnessed by a QAS personnel AND no shockable rhythm at any stage of the resuscitation
113
When to stop CPR if resuscitation was not commenced
Pt was observed to be unconscious, unresponsive to stimuli, not breathing and pulseless for at least 10 minutes riot to arrival of a paramedic AND no CPR was given in this time AND the patient is exhibiting signs of life extinct AND the patients cardiac rhythm is asystole or a broad PEA of less than 40bpm
114
What are the signs of life extinct?
No palpable carotid pulse
No heart sounds heard for 30 continuous seconds
No breath sounds heard for 30 continuous seconds
Fixed dilated pupils and
No response to central stimuli
115
What are the aims after ROSC?
Support circulation, airway and breathing
Maintain cerebral perfusion
Aim for a BL of more than 100 in adults and 80 in paediatrics
Ventilate at a rate of 8-12 breaths for an adult and maintaining SPO2 of 94%+
Manage cardiac dysrhythmias
Maintain normothermia
Determine and manage the cause of the cardiac arrest - 4H’s and 4T’s
12 lead ECG is needed
116
What are the indications of a triple airway manoeuvre?
Patients unable to maintain patency
117
What are the contraindications of a TAM
Nil
118
What are the precautions of a TAM
Potential Cspine injury
119
What is the procedure of a TAM
Head tile, Jaw thrust and open mouth
120
What is an indicator of a DAM
A patient cannot maintain patency of airway but there is a potential of a cosine injury
121
What is the procedure of a DAM
Jaw thrust and open mouth WITHOUT head tilt
