Skills Flashcards
OG tube indication/contraindication
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
Pediatric Gastric tube sizes
Kg = 3, 16, 25
Size = 6, 12, 18
How to measure a Gastric tube?
1/2 way between naval and xiphoid process, up around ear, to corner of mouth
How to confirm placement of a gastric tube
Draw use 60 cc syringe & inject 5-20ml air into stomach & listen for gurgling in stomach
Once you have a gastric tube inserted, how do you set your suction? When to discontinue it?
Low non-continuous suctioning. Stop when no more coming out of stomach.
How to secure gastric tube after insertion
Lightly tap to pt’s cheek
Indications/contraindications of King airway
Indications = Cardiac arrest. Respiratory insufficiency/failure/arrest
Contraindications = sophageal disease, caustic substance ingestions, <4ft height
How to place your King airway? How much to inflate?
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)
5 ways to confirm airway placement
Bag to butt (good compliance, ETc02, chest rise, lung sounds, negative epigastric)
What rate to ventilate an advanced airway?
12-16 breaths per min. Maintain ETCO2 35-45
Indications / contraindications of Endotracheal intubation
Indication = resp insufficency, failure, arrest Contraindications = None
How long to pre-oxygenate pt
30s
When intubating, how many seconds per attempt? How many attempts total per pt?
15s, 2 attempts max
What do you do if you intubate and hear diminished lung sounds unilaterally?
Deflate cuff, retract 1-2cm and re-assess
Indications/ contraindications for facilitated intubation
Indication = respiratory insufficiency/failre/arrest that needs airway mgmt in pts w/ consciousness, gag reflex, jaw clenching
Contraindications = allergy to any of the meds
What meds & doses for facilitated intubation
Fentanyl 2mcg/kg IVP
Etomidate 0.3mg/kg SIVP
Midazolam 2.5mg (2 max)
Indications/contraindications of surgical cric? What age?
Indictions = age >10yrs, all other airway attempts fail
Contraindications - Age < 10 years, cant find landmarks
What length incision over what membrane when you’re doing a cric
3cm vertical incision over cricothyroid membrane w/ scalpel
What size ETT for a cric?
6.0 ETT
Indications/contraindications of defibrillation
Indication = vfib, pvtach, polymorphinc Vtach
Contraindications = hazardous environment, valid DNR
How does pad placement differ on adult vs ped w/ defib pads?
Adult = anterior-anterior
Peds = anterior - posterior
What do you say before you shock a pt
Im clear, your clear, oxygen clear
What’s a vector change and when can you do it?
Vector change = after 3 shocks of adult refractory V-fib, and after antiarrhythmic therapy, you use new pads + new placement AND get OLMC
How do you perform a vector change?
Get OLMC
Apply new pads to sternum & posterior
Switch MRX to new set of pads
Indications/contraindications of Transcutaneous pacing
Indications = unstable bradycardia
contraindications = hazardous environment
Steps to pace on a phillips
- Apply limb leads & select Lead w/ R wave
- Apply pads
- Turn pacer knob & verify R wave markers on waveform
- Start pacer rate @ 60bpm, output at 60mAp (titrate up amps until capture)
- Mechanical capture
- Increase rate by 10bpm to 90 max PRN
- Consider epi drip
Indications and contraindications of synchronized cardioversion
Indications = unstable tachycardia
Contraindications = hazardous environment
How to synchronized Cardiovert
- Turn knob to monitor & press sync
- Set joules
- Charge, clear, HOLD shock button
What Joules to cardiovert for regular vs irregular rhythms?
Regular = 100,120,150,170
Irregular narrow = 120,150,170
Irregular wide = DEFIB 150J
IO indications vs contraindications
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
What are the approved IO sites
Proximal tibial plateau, proximal hural head, distal tibia, proximal to medial malleolus
What age do you hand bore, not drill an IO?
Peds < 1yr
How do you confirm placement of an IO? How do you know it’s infiltrated
Aspiration of bone marrow = good
Site swelling/ fluids not running = bad
If your IO pt is conscious, how much lidocaine and how fast to inject it?
2% lidocainE
Adults = 30mg SIVP
Peds = 0.5mg/kg - max 30 SIVP
What do you do once you insert and aspirate an IO?
Label placement time/operator name and tape it to limb
Secure IO w/ device
Indications & contraindications of Needle Thoracostomy
Indications = suspected pneumothorax w/ bad shock, traumatic arrest w/ chest or ab injury
Contra = simple pneumothorax
What is the primary vs secondary site of a needle thoracostomy in an adult? What size needle?
Adult = main = lateral 5th intercostal… secondary = 2nd intercostal mid clavicular
10g, 3.25in
What is the primary vs secondary perferred site of a needle thoracostomy in peds? What needle size?
Main = lateral 4th intercostal anterior axillary Second = 2nd intercostal mid clavicular
16g, 1.16in
How do you know if your needle decompress works? How often to reassess
Rush of air from catheter
Improved ventilations
Equal chest rise again
Reassess lungs & vitals every 5min
Indications contraindications of pediatric intubation
Indication - resp insufficiency/failure/arrest
Contraindication - effective bagging
While assembling all your equipment for intubation, what other piece should you have nearby
Suction
What age CANT you inflate an ETT
<13
What rate to bag kids with ICP
20
After inserting an ETT on a Ped, what must you verbalize
Need to insert OG tube
When do you reconfirm tube placement on a pediatric ETT
Throughout contact and on arrival at ED
Needle cric indications contraindications
Indications- ped up to 10yrs, all other methods failed
Contra - can’t find landmarks. Neck tumor obstructs landmarks
What size iv catheter and ETT do you need for a needle cric
3.0 ETT
14g
How do you position the head on a needle cric
Slightly hyperextended
What side of pt do you stand on if you’re r handed in a needle cric
Patients left side
