Skills

Question 1

Indications for EZ-IO access

Answer 1

Adult - cardiac arrest with difficulty obtaining IV access
Paediatric - all cardiac arrests

Adult & Paediatric - unconscious and unalert patients (requires consult)

Question 2

Contraindications for EZ-IO access

Answer 2

Fracture in target bone
Previous orthopaedic procedures near insertion site
Failed IO attempt within last 48 hours
Inability to locate landmarks or excessive tissue over insertion site (obesity)
Infection at site of insertion

Acutely burnt skin is not a contraindication for EZ0-IO access

Question 3

Complications for EZ-IO access

Answer 3

Dislodgement
Extravasion
Compartment syndrome
Fracture of target bone
Infection
Pain on use

Question 4

Positioning for EZ-IO access via humeral head

Answer 4

Position the target arm flexed over the abdomen or “thumb to bum”

Insert the yellow EZ-IO needle at a slight downward angle (45 degrees) above the target shoulder, visualising >1 black line prior to drilling

Question 5

Positioning for EZ-IO access via distal and proximal tibial insertions

Answer 5

Position self on the opposite side of the patient, locate landmarks, and inset the blue needle

Proximal tibia:
Insertion site is 2 cm below the patella, and 2 cm medial to the tibial tuberosity (tibial plateau)

Distal tibia:
Insertion site is located 3 cm proximal to the medial malleolus

Question 6

Placement of EZ-IO access in cardiac arrest

Answer 6

Opt for tibial placement to reduce risk of dislodgement during CPR

Question 7

Aftercare once successful EZ-IO access has been acheived:

Answer 7

Withdraw and dispose of sharps
Attach a primed right angle connector and 3 way tap and aspirate for confirmation of marrow
Flush with 10 mL NaCl (2 - 5 mL paeds)
Check for extravasion
Apply an EZ-IO wristband

Question 8

Indications for EJV

Answer 8

Adult - cardiac arrest with 2 unsuccessful IV attempts

Question 9

Procedure for obtaining EJV access

Answer 9

Don PPE
Turn head to L) side, expose the R) external jugular vein
Identify the clavicle and angle of the jaw (landmarks)
Engorge vein by placing the side of your hand inferiorly or raising the patients legs
Swab the area
Prepare giving set, tegaderm, and a 14g cannula
Stabilise EJV and insert cannula downward (towards the clavicle), observe for flashback
Occlude, attach fluid, and secure with a tegaderm

Question 10

EJV can be attempted ___

Answer 10

Once

Question 11

Important structures that are around the external jugular vein

Answer 11

Carotid artery
Phrenic nerve

Question 12

Chest decompression/needle thoracocentesis indications

Answer 12

Any patient with a suspected tension pneumothorax with signs of obstructive shock (tachycardia, tachypnoea, absent radial pulse, hypotension, cold and clammy skin)

Question 13

Chest decompression/needle thoracocentesis procedure

Answer 13

Don PEE
Swab area
Identify the second intercostal space at the mid clavicular line
Prepare 14 g cannula and syringe
Insert cannula at 90 degree angle
Remove syringe and cannula
Secure with a tegaderm

Question 14

Any subsequent chest decompression/needle thoracocentesis must be placed ____

Answer 14

Laterally

Question 15

Needle cricothyroidotomy indications

Answer 15

Patients with a near/complete airway obstruction with inability to oxygenate or ventilate

Question 16

Needle cricothyroidotomy complications

Answer 16

Damage to underlying structures

Question 17

Needle cricothyroidotomy procedure

Answer 17

Don PPE
Position patient supine, exposing neck structures
Identify thyroid cartilage and cricothyroid cartilage
Palpate the cricothyroid membrane
Prepare 14 g cannula, syringe and tegaderm
Remove white lock and lewr lock off cannula
Swab area
Insert cannula at 90 degrees into cricothyroid cartilage and aspirate for air
Advance at 45 degrees
Secure with tegaderm
Connect O2 tubing via 3 way tap (each direction must be open)
Commence transtracheal jet insufflation (adults 1:4, peads 0.5:2)