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ALS Protocols > Skills > Flashcards

Skills Flashcards

1
Q

OG tube indication/contraindication

A

Indication - pts getting bagged and you need to empty/decompress

Contraindication - gag reflex/awake, caustic ingestion, esophagela disease/structure/varices, no adult adv airway in place

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2
Q

Pediatric Gastric tube sizes

A

Kg = 3, 16, 25

Size = 6, 12, 18

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3
Q

How to measure a Gastric tube?

A

1/2 way between naval and xiphoid process, up around ear, to corner of mouth

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4
Q

How to confirm placement of a gastric tube

A

Draw use 60 cc syringe & inject 5-20ml air into stomach & listen for gurgling in stomach

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5
Q

Once you have a gastric tube inserted, how do you set your suction? When to discontinue it?

A

Low non-continuous suctioning. Stop when no more coming out of stomach.

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6
Q

How to secure gastric tube after insertion

A

Lightly tap to pt’s cheek

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7
Q

Indications/contraindications of King airway

A

Indications = Cardiac arrest. Respiratory insufficiency/failure/arrest

Contraindications = sophageal disease, caustic substance ingestions, <4ft height

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8
Q

How to place your King airway? How much to inflate?

A

Lift jaw, insert sideways 45-90 degrees, rotate down w/ insertion until hub at lip line

Inflate 60cc’s (or specs on side of tube)

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9
Q

5 ways to confirm airway placement

A

Bag to butt (good compliance, ETc02, chest rise, lung sounds, negative epigastric)

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10
Q

What rate to ventilate an advanced airway?

A

12-16 breaths per min. Maintain ETCO2 35-45

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11
Q

Indications / contraindications of Endotracheal intubation

A 
Indication = resp insufficency, failure, arrest	
Contraindications = None
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12
Q

How long to pre-oxygenate pt

A

30s

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13
Q

When intubating, how many seconds per attempt? How many attempts total per pt?

A

15s, 2 attempts max

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14
Q

What do you do if you intubate and hear diminished lung sounds unilaterally?

A

Deflate cuff, retract 1-2cm and re-assess

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15
Q

Indications/ contraindications for facilitated intubation

A

Indication = respiratory insufficiency/failre/arrest that needs airway mgmt in pts w/ consciousness, gag reflex, jaw clenching

Contraindications = allergy to any of the meds

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16
Q

What meds & doses for facilitated intubation

A

Fentanyl 2mcg/kg IVP

Etomidate 0.3mg/kg SIVP

Midazolam 2.5mg (2 max)

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17
Q

Indications/contraindications of surgical cric? What age?

A

Indictions = age >10yrs, all other airway attempts fail

Contraindications - Age < 10 years, cant find landmarks

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18
Q

What length incision over what membrane when you’re doing a cric

A

3cm vertical incision over cricothyroid membrane w/ scalpel

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19
Q

What size ETT for a cric?

A

6.0 ETT

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20
Q

Indications/contraindications of defibrillation

A

Indication = vfib, pvtach, polymorphinc Vtach

Contraindications = hazardous environment, valid DNR

21
Q

How does pad placement differ on adult vs ped w/ defib pads?

A

Adult = anterior-anterior

Peds = anterior - posterior

22
Q

What do you say before you shock a pt

A

Im clear, your clear, oxygen clear

23
Q

What’s a vector change and when can you do it?

A

Vector change = after 3 shocks of adult refractory V-fib, and after antiarrhythmic therapy, you use new pads + new placement AND get OLMC

24
Q

How do you perform a vector change?

A

Get OLMC

Apply new pads to sternum & posterior

Switch MRX to new set of pads

25
Q

Indications/contraindications of Transcutaneous pacing

A

Indications = unstable bradycardia

contraindications = hazardous environment

26
Q

Steps to pace on a phillips

A
  1. Apply limb leads & select Lead w/ R wave
  2. Apply pads
  3. Turn pacer knob & verify R wave markers on waveform
  4. Start pacer rate @ 60bpm, output at 60mAp (titrate up amps until capture)
  5. Mechanical capture
  6. Increase rate by 10bpm to 90 max PRN
  7. Consider epi drip
27
Q

Indications and contraindications of synchronized cardioversion

A

Indications = unstable tachycardia

Contraindications = hazardous environment

28
Q

How to synchronized Cardiovert

A
  1. Turn knob to monitor & press sync
  2. Set joules
  3. Charge, clear, HOLD shock button
29
Q

What Joules to cardiovert for regular vs irregular rhythms?

A

Regular = 100,120,150,170

Irregular narrow = 120,150,170

Irregular wide = DEFIB 150J

30
Q

IO indications vs contraindications

A

Indications - cardiac arrest, cant get IV access in red pt’s

Contraindications - bone fractured, no landmarks, area infection, IO at site <48hr prior, hx ortho procedure at site

31
Q

What are the approved IO sites

A

Proximal tibial plateau, proximal hural head, distal tibia, proximal to medial malleolus

32
Q

What age do you hand bore, not drill an IO?

A

Peds < 1yr

33
Q

How do you confirm placement of an IO? How do you know it’s infiltrated

A

Aspiration of bone marrow = good

Site swelling/ fluids not running = bad

34
Q

If your IO pt is conscious, how much lidocaine and how fast to inject it?

A

2% lidocainE

Adults = 30mg SIVP

Peds = 0.5mg/kg - max 30 SIVP

35
Q

What do you do once you insert and aspirate an IO?

A

Label placement time/operator name and tape it to limb

Secure IO w/ device

36
Q

Indications & contraindications of Needle Thoracostomy

A

Indications = suspected pneumothorax w/ bad shock, traumatic arrest w/ chest or ab injury

Contra = simple pneumothorax

37
Q

What is the primary vs secondary site of a needle thoracostomy in an adult? What size needle?

A

Adult = main = lateral 5th intercostal… secondary = 2nd intercostal mid clavicular

10g, 3.25in

38
Q

What is the primary vs secondary perferred site of a needle thoracostomy in peds? What needle size?

A 
Main = lateral 4th intercostal anterior axillary
Second = 2nd intercostal mid clavicular

16g, 1.16in

39
Q

How do you know if your needle decompress works? How often to reassess

A

Rush of air from catheter
Improved ventilations
Equal chest rise again

Reassess lungs & vitals every 5min

40
Q

Indications contraindications of pediatric intubation

A

Indication - resp insufficiency/failure/arrest

Contraindication - effective bagging

41
Q

While assembling all your equipment for intubation, what other piece should you have nearby

A

Suction

42
Q

What age CANT you inflate an ETT

A

<13

43
Q

What rate to bag kids with ICP

A

20

44
Q

After inserting an ETT on a Ped, what must you verbalize

A

Need to insert OG tube

45
Q

When do you reconfirm tube placement on a pediatric ETT

A

Throughout contact and on arrival at ED

46
Q

Needle cric indications contraindications

A

Indications- ped up to 10yrs, all other methods failed

Contra - can’t find landmarks. Neck tumor obstructs landmarks

47
Q

What size iv catheter and ETT do you need for a needle cric

A

3.0 ETT

14g

48
Q

How do you position the head on a needle cric

A

Slightly hyperextended

49
Q

What side of pt do you stand on if you’re r handed in a needle cric

A

Patients left side

ALS Protocols (4 decks)

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