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Foundations Of Para Res School > Res School > Flashcards

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

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2
Q

What are the contraindicators of a GCS

A

Use APGAR instead of GCS for newborns

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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
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4
Q

What are the Nexus Criteria?

A

Midline tenderness
Evidence of intoxication
Any loss of consciousness
Focal neurological Deficit
Distracting injury

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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

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6
Q

What are the contraindications for manual inline stabilisation?

A

Nil

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7
Q

What are the precautions for manual inline stabilisation?

A

Difficult Laryngoscopy

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8
Q

What are the different positions you can achieve manual inline stabilisation?

A

Side
Behind
Sitting up right

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9
Q

What are the indications for a cervical collar?

A

Suspicion of a cervical spine injury SCI

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10
Q

What are the contraindications for a cervical collar?

A

Surgical airway
Penetrating neck trauma

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11
Q

What are the precautions for a cervical collar?

A

Discomfort
Anxiety

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12
Q

What is the procedure for putting on a cervical collar?

A
  1. Align the patients head to a natural position or a position of greatest comfort
  2. Measure the distance from the base of the chin and suprasternal notch (notch in the middle of collar bones)
  3. Select the right size collar by comparing the patients neck to the width of the soft collar chin supports
  4. Slide the collar under the patients neck right to Kraft until the adhesive Velcro strap is clearly visible
  5. Secure the collar with the Velcro strap
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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

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14
Q

What is the Normal resp rate?

A

12-18 BPM

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15
Q

How long to count for a resp rate ?

A

No less than 30 seconds

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16
Q

What is Eupnoea.

A

Normal breathing rate and pattern

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17
Q

What is Tachypnoea?

A

Increased respiratory rate

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18
Q

What is bradypnoea?

A

Decreased respiratory rate

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19
Q

What is apnoea?

A

Absence of breathing

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20
Q

What is Hyperpnoea?

A

Increase depth and rate of breathing

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21
Q

What is Cheyenne-stokes

A

Gradual increases and decreases in respirations with periods of apnoea

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22
Q

What is biots?

A

Abnormal breathing pattern with groups/clusters of rapid respiration of equal depth and regular apnoea periods

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23
Q

What is kussmaul’s

A

Tachypnoea and hyperpnoea

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24
Q

What is Apneustic?

A

Prolonged inspiratory phase with a prolonged expiratory phase

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25
Q

What are the sights of increased effort when breathing?

A

Intercostal retraction/accessory muscle use
Nadal flaring
Forward/tripod posturing
Paradoxical respiration Anxiety or agitation

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26
Q

What is hypoxemia?

A

Decreased levels of oxygen in the arterial blood

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27
Q

What is cyanoais?

A

Bluish discolouration of skin and mucus membrane due to a lack if oxygen

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28
Q

What are the indications for suction?

A

The removal of airway blockages that cannot be spontaneously cleared

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29
Q

What are the contraindications due suction?

A

Nil

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30
Q

What are the precautions for suction?

A

Hypoxia
Airway trauma
Study,ate coughing or gagging
Vagaries stimulation

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31
Q

What is the procedure for oropharyngeal suction (yankauer)?

A
  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
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32
Q

What is the procedure for nasopharyngeal suction (Y-Suction )?

A
  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
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33
Q

What are the indicators of IPPV?

A

Acutely respiratory distress, hypoventilation or arrest requiring positive pressure ventilation

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34
Q

What are the contraindications of IPPV?

A

Spontaneously breathing patients with adequate tidal volume and an appropriate respiratory rate?

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35
Q

What are the precautions of IPPV?

A

Gastric inflammation
Pulmonary barotrauma
Undesirable cardiovascular effects such as hypotension secondary to caval compression

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36
Q

What is the procedure for IPPV?

A
  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
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37
Q

What are the indicators of an OPA?

A

Maintain airway patency
Bite block in advanced airways

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38
Q

What are the contraindications of an OPA?

A

Conscious patients
Patients with an intact gag reflex

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39
Q

What are the precautions of an OPA?

A

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

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40
Q

What is the procedure for inserting an OPA into an adult?

A
  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
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41
Q

What is the procedure for inserting an OPA for a child?

A
  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?
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42
Q

What are the indications for a nasopharyngeal airway?

A

Potential or actual airway obstruction

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43
Q

What are the contraindications for a nasopharyngeal airway?

A

Nil

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44
Q

What are the precautions for a Nasopharyngeal airway?

A

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

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45
Q

What is the procedure for inserting a nasopharyngeal airway?

A
  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
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46
Q

What is a normal pulse rate?

A

40-100 BPM

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47
Q

What is bradycardia?

A

A pulse rate of less than 60 BPM

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48
Q

What is tachycardia?

A

A pulse rate of more than 100 BPM

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49
Q

What are the different options of an irregular pulse rate?

A

Irregularly irregular
Regularly irregular

50
Q

What is a normal blood pressure?

A

Systolic - 100-149 mmHg
Diastolic - 70-90 mmHg

51
Q

What is hypotension

A

Low blood pressure

52
Q

What is hypertension

A

High blood pressure

53
Q

What are the indications for a blood pressure

A

Determine a patients blood pressure

54
Q

What are the contraindications of taking a blood pressure?

A

Do not apply to a lump with an AV fistula, significant injury or burn or lymph node removal pose mastectomy

55
Q

What are the precautions for taking a blood pressure

A

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
Q

What is the procedure for taking a blood pressure

A
  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
Q

What is a normal BGL?

58
Q

What is hypoglycaemia?

A

Low BGL levels

59
Q

What is hyperglycaemia

A

High BGL levels

60
Q

What are the indications of a blood analysis for glucose

A

Point of care glucometry analysis

61
Q

What are the contraindications of a BGL

A

Routine use in newborns unless clinically indicated

62
Q

What are the precautions of a BGL?

63
Q

What is hypoxemia

A

Low oxygen in the blood

64
Q

What is hypoxia

A

Low oxygen levels reaching the tissues

65
Q

What are the indicators of a SP02

A

To determine a patients oxygen saturation

66
Q

What are the contraindications of an SPO2

67
Q

What are the precautions of an SPO2

A

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
Q

What is a normal temperature

A

36-37 degrees

69
Q

What is normothermia?

A

Normal body temperature

70
Q

What is hyperthermia?

A

High body temperature

71
Q

What is hypothermia?

A

Low body temperature

72
Q

What is febrile?

A

Having or showing symptoms of a fever

73
Q

What is afebrile

A

Not marked by or having a fever?

74
Q

What are the indications for a tympanic temperature?

A

The monitoring of temperature when clinically indicated

75
Q

Hat are the contraindications of a tympanic temperature?

A

Blood or drainage in the ear canal
Acura or chronic inflammatory conditions pf the external ear canal
Perforated tympanic membrane

76
Q

What are the precautions of a tympanic temperature

77
Q

What is the basic ECG Electrode placement

A

White on the rights and make over fire

Ankles and wrists

78
Q

How much time does one small block represent on an ECG?

79
Q

What is the P wave

A

The first positive bump on the ECG

80
Q

What is the P-R interval

A

The interval from the start of the P wave to the start of the QRS wave

81
Q

What is the P-R segment?

A

The segment from the end of the P wave to the start of the QRS interval

82
Q

What is the Q point

A

The first negative point on the ECG right before the R point

83
Q

What is the R point on an ECG

A

The positive point after the P wave

84
Q

What is the S point on an ECG

A

The first negative point after the at point

85
Q

What is the QRS interval

A

The interval from the start of the Q point to the end of the S point

86
Q

What is the S-T segment on an ECG

A

The segment from the end of the S point to the start of the T wave

87
Q

What is the T wave

A

The positive wave after the QRS segment

88
Q

What is the S-T interval

A

The interval from the end of the S point to the end of the T wave

89
Q

What is the U wave?

A

The wave after the T wave

90
Q

How long should the PR interval be?

A

0.12-0.2 seconds (3-5 small boxes)

91
Q

What are the two methods of ECG rate interpretation

A
  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
Q

What is the normal height of a P wave?

93
Q

What is the normal interval for a P wave?

A

Less than 0.12 seconds

94
Q

How long should a PR internal last?

A

Between 0.12 and 0.2 seconds

95
Q

How long should a QRS complex last?

A

0.04-0.12 seconds

96
Q

What is Sinus Rhythm?

A

Regular rate, rhythm, P wave, PR interval and QRS complex

97
Q

What is Sinus arrhythmia?

A

Regular rate
IRREGULAR EHYTHM
Regular P wave, PR interval and QRS complex

98
Q

What is Sinus Tachycardia?

A

RATE OF MORE THAN 100BPM
Regular rhythm, P wave, PR interval and QRS complex

99
Q

What is Sinus Bradycardia?

A

RATE LESS THAN 60BPM
Regular rhythm, regular Peace, regular PR interval and regular QRS complex

100
Q

What is atrial fibrillation?

A

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
Q

Atrial flutter

A

‘Sawtooth’ appearance of P waves

102
Q

What is a ventricular tachycardia?

A

Rate more than 199
Regular rhythm
Not visible P wave
QRS complex is wide

PR interval N/A

103
Q

What is a ventricular fibrillation?

A

Rate fast
Rhythm irregular
P wave not present
PRS interval N/A
QRS complex wide and bizarre

104
Q

What is the 5 step method for interpreting an ECG?

A
  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?
  5. QRS Complex - less than 0.12 seconds
105
Q

When to start CPR?

A

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
Q

How many hands do you use in CPR for adults, children ages 1-8 and infants

A

Adults - 2
Children - 1
Infants - two fingers

107
Q

What are the indications for defibrillation?

A

Ventricular fibrillation or pulseless ventricular tachycardia

108
Q

What are the contraindications of defibrillation?

A

Non shockable rhythms, asystole, pulse less electrical activity or perfusing rhythms

109
Q

What are the complications of defibrillation?

A

Patient injury including burns
Explosion
Transmitted shock to the operator or bystanders

110
Q

What are the defibrillator energy levels

A

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
Q

What are the 4 Hs and 4 Ts in relation to pulseless electrical activity

A

Hypo Olaf is
Hypoxia
Hyper and hypokalaemia and metabolic disorders
Hyper and hypothermia
Toxicity
Tension pneumothorax
Tamponade - cardiac
Thromboembolism - MI or PE

112
Q

When to stop CPR after resuscitation has commenced

A

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
Q

When to stop CPR if resuscitation was not commenced

A

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
Q

What are the signs of life extinct?

A

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
Q

What are the aims after ROSC?

A

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
Q

What are the indications of a triple airway manoeuvre?

A

Patients unable to maintain patency

117
Q

What are the contraindications of a TAM

118
Q

What are the precautions of a TAM

A

Potential Cspine injury

119
Q

What is the procedure of a TAM

A

Head tile, Jaw thrust and open mouth

120
Q

What is an indicator of a DAM

A

A patient cannot maintain patency of airway but there is a potential of a cosine injury

121
Q

What is the procedure of a DAM

A

Jaw thrust and open mouth WITHOUT head tilt

Foundations Of Para Res School (3 decks)

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