Skills Flashcards
According to the Bandaging skill what should you check before bandaging?
Circulation
Motor function
Sensation
According to the Bandaging skill where should you check for circulation, motor function, and sensation before bandaging?
Distal to injury
According to the Bandaging skill what technique should you use when covering with dressing?
Aseptic technique
According to the Bandaging skill how should you secure dressing?
With appropriate pressure and no excessive movement
According to the Bandaging skill how often should you check circulation, motor function, and sensation distal to the injury?
Before and after bandaging
According to the Bandaging skill what should you document?
All assessment findings and pts response to procedure
According to the Tourniquet skill what is the rationale behind the use of a tourniquet?
Use of a tourniquet is appropriate when upper or lower extremity hemorrhage cannot be controlled by applying direct pressure or a pressure dressing to the site of bleeding.
According to the Tourniquet skill what should you wear appropriate for the potential of blood exposure?
PPE
According to the Tourniquet skill prior to tourniquet placement what should you do?
Visually inspect injured extremity
According to the Tourniquet skill where should you avoid placement of a tourniquet?
Over a joint Angulated or open fracture Stab or gunshot wound sites Lower arm Lower leg
According to the Tourniquet skill why should tourniquet placement be avoided in the lower arm and/or lower leg?
Occlusion of the arterial supply may not be possible there
According to the Tourniquet skill what should you assess and document before and after placement?
Circulation
Motor
Sensation
According to the Tourniquet skill where should you assess circulation, motor, and sensation?
Distal to injury site
According to the Tourniquet skill when applying a tourniquet to the upper arm or upper leg what distance from the wound should the tourniquet be placed?
4 finger breadths proximal to wound
According to the Tourniquet skill how should you tighten the tourniquet?
Tighten incrementally to the least amount of pressure required to stop bleeding
According to the Tourniquet skill with what should you cover the wound?
Appropriate sterile dressing and/or bandage
According to the Tourniquet skill should the tourniquet be covered?
DO NOT cover tourniquet (keep tourniquet visible)
According to the Tourniquet skill what should you be sure that the receiving facility is aware of?
Tourniquet placement
Time tourniquet placed
According to the Tourniquet skill what are 4 things you should document?
- Estimated blood loss
- Vital signs
- Assessment of circulation, motor, and sensation distal to injury site before and after tourniquet application
- Time tourniquet applied
According to the Splinting skill what should you check before and after splinting?
Circulation
Motor function
Sensation
According to the Splinting skill where should you check for circulation, motor function, and sensation?
Distal to injury
According to the Splinting skill with what should you immobilize the injury?
Appropriate device
According to the Splinting skill how should the splinted extremity be positioned?
Elevated
According to the Traction Splinting skill in what situation should a traction splint never be applied?
Open Fracture
According to the Traction Splinting skill what should you check before and after application?
Circulation
Motor function
Sensation
According to the Traction Splinting skill where should you check for circulation, motor function, and sensation before and after application?
Distal to injury
According to the Traction Splinting skill how should a traction splint be applied?
Maintaining traction, elevation, and gentleness
According to the Traction Splinting skill who’s guidelines and instructions should you follow when applying a traction splint?
Manufacturer
According to the Spinal Immobilization-Supine skill what should happen with the face mask of a helmet?
Removed prior to transport
According to the Spinal Immobilization-Supine skill when should helmets and shoulder pads be left in place?
If the motion of the pts spine can be adequately and effectively restricted
According to the Spinal Immobilization-Supine skill if the helmet and shoulder pads must be removed how should they be removed?
As a unit
According to the Spinal Immobilization-Supine skill what 5 situations call for the helmet and shoulder pads to be removed as a unit?
- Helmet and chin strap do not hold the head securely
- Immobilization of helmet does not immobilize head
- Airway cannot be controlled or pt cannot be ventilated effectively
- Face mask cannot be removed after reasonable period of time
- Helmet prevents immobilization for transport in an appropriate position
According to the Spinal Immobilization-Seated skill what should you initially do?
Direct partner to establish and maintain neutral spine alignment
According to the Spinal Immobilization-Seated skill what should you check before and after spinal immobilization?
Circulation
Motor function
Sensation
According to the Spinal Immobilization-Seated skill where should you check for circulation, motor function, and sensation before and after spinal immobilization?
In all 4 extremities
According to the Spinal Immobilization-Seated skill which should you apply to the pt first? Cervical collar or Short device?
Cervical collar
According to the Spinal Immobilization-Seated skill whose recommendations are you to follow in applying the short spinal device?
Manufacturer’s
According to the Spinal Immobilization-Seated skill which part of the body is secured to the short spinal device first?
Torso
According to the Spinal Immobilization-Seated skill after applying the short spinal board to the Torso what part of the body should then be secured?
Head
According to the Spinal Immobilization-Seated skill what should you consider about pt respirations when applying the short spinal board?
Do not compromise or impede respirations
According to the Spinal Immobilization-Seated skill should the pt be transported while secured to the short spinal board?
NO. Remove pt from shot spinal device prior to transport
According to the Bronchodilator Administration skill what should you inform the pt of?
The order for medication
According to the Bronchodilator Administration skill what should you inquire of the pt?
Allergies
Recent Doses of other bronchodilators
According to the Bronchodilator Administration skill what should you verbalize you have checked?
For contamination
Expiration date
According to the Bronchodilator Administration skill who’s standard should you follow in assembling the nebulizer?
Manufacturers standard
Local protocol
According to the Bronchodilator Administration skill what oxygen flow should you provide?
Manufacturers recommendations
According to the Bronchodilator Administration skill when should you position nebulizer device on pt?
After adjusting oxygen flow and allowing mist to fill breathing tube or mask
According to the Peripheral Venipuncture skill what should you avoid?
Contamination of equipment
According to the Peripheral Venipuncture skill what should you confirm when confirming the order?
Solution
Rate
According to the Peripheral Venipuncture skill what should you inform the pt of?
The order for IV access and/or fluid therapy
According to the Peripheral Venipuncture skill what should you verbalize as you are checking?
Correct IV solution
For contamination
Expiration date
According to the Peripheral Venipuncture skill after connecting tubing to fluid bag what should you next do?
Clear pulse
According to the Peripheral Venipuncture skill what should you check after applying a constricting band?
Distal pulse
According to the Peripheral Venipuncture skill where should your site be located in reference to the constricting band?
Below the constricting band
According to the Peripheral Venipuncture skill what technique should you use when cleansing the skin with an alcohol prep?
Circular motion working outward
According to the Peripheral Venipuncture skill what should you inspect the catheter and needle for?
Defects
According to the Peripheral Venipuncture skill when inspected the catheter and needle for defects what should you avoid?
Advancing the catheter over the needle
According to the Peripheral Venipuncture skill how many attempts do you get to perform venipuncture?
3
According to the Peripheral Venipuncture skill what should you consider if the venipuncture is unsuccessful?
IO
According to the Peripheral Venipuncture skill after performing venipuncture where should you attach the tubing?
The hub
According to the Peripheral Venipuncture skill prior to attempting to verify flow what should you first do?
Remove constricting band
According to the Peripheral Venipuncture skill once flow has been verified what is the next step?
Secure catheter and dress sit
According to the Peripheral Venipuncture skill what rate should the flow be set at?
As ordered
According to the Peripheral Venipuncture skill what do you do with contaminated equipment?
Dispose
According to the Intramuscular Drug Injection skill what 3 things are you checking for when confirming an order?
Medication
Dosage
Route
According to the Intramuscular Drug Injection skill what should you ask of the pt?
Allergies
According to the Intramuscular Drug Injection skill what should you check the medication for?
Contamination
Expiration date
According to the Intramuscular Drug Injection skill after drawing up correct amount of the medication what is the next step in preparation?
Expel air from syringe
According to the Intramuscular Drug Injection skill what 3 sites should you choose from for injection?
Thigh
Gluteal
Deltoid
According to the Intramuscular Drug Injection skill in the order of most preferred to least preferred rate the 3 sites from which you should choose for an injection?
- Thigh
- Gluteal
- Deltoid
According to the Intramuscular Drug Injection skill how many time should you check the medication prior to injecting?
3 times
According to the Intramuscular Drug Injection skill prior to needle insertion what should you do?
Cleanse the site with alcohol
According to the Intramuscular Drug Injection skill after performing needle insertion and prior to administering the medication what should you do?
Aspirate for the absence of blood return
According to the Intramuscular Drug Injection skill what are you looking for when aspirating a needle that has just been inserted?
Absence of blood return
According to the Intramuscular Drug Injection skill after injecting the medication and withdrawing the needle what should you do with the site?
Apply pressure
According to the Intravenous Drug Administration skill what 3 things should you confirm about the order?
Dosage
Medication
Route
According to the Intravenous Drug Administration skill what should you ask the pt?
Allergies
According to the Intravenous Drug Administration skill what 2 things should you check the medication for?
Contamination
Expiration date
According to the Intravenous Drug Administration skill before connecting the syringe to the IV tubing port what should you do?
Expel air from syringe
According to the Intravenous Drug Administration skill which medication port on an IV tube should you choose to inject medication?
The one closest to the IV site
According to the Intravenous Drug Administration skill before attaching the syringe to the port what should you do?
Cleanse the port with alcohol
According to the Intravenous Drug Administration skill how many times should you check the medication before administering?
3
According to the Intravenous Drug Administration skill what are the 2 places on an IV tube where you can connect a syringe for drug administration?
Medication port
Stopcock
According to the Intravenous Drug Administration skill how do you ensure a patent IV line?
Aspirate for blood
Check for infiltration
Check for IV flow
According to the Intravenous Drug Administration skill where should you occlude flow prior to giving medication?
Above the medication port
According to the Intravenous Drug Administration skill after administering thed medication and removing the needle/syringe what should you do?
Flush tubing
According to the Intravenous Drug Administration skill how should most drugs be pushed?
SLOW
According to the Intravenous Drug Administration skill what is meant by SLOW IV push?
Over 3-5 minutes
According to the Intravenous Drug Administration skill what medication is the exception to the SLOW IV push?
Adenosine
According to the Intravenous Drug Administration skill what situation is the exception to the SLOW IV push?
Cardiac arrest
According to the Intranasal Drug Administration skill what should you attach to the syringe after drawing up the medication?
Atomizer
According to the Intranasal Drug Administration skill how much extra medication should be drawn up?
0.1ml
According to the Intranasal Drug Administration skill why should an extra 0.1ml of medication be drawn up?
To account for the dead space within the atomizer at the of the procedure
According to the Intranasal Drug Administration skill what is the ideal volume per nostril?
0.2-0.3ml
According to the Intranasal Drug Administration skill what is the max volume per nostril?
1ml
According to the Intranasal Drug Administration skill what should you do with your free hand while administering the medication?
Hold the crown of the head stable
According to the Intranasal Drug Administration skill how should the atomizer be placed against the nostril?
Snugly
According to the Intranasal Drug Administration skill how should the atomizer be aimed in the nostril?
Slightly up and outward (towards the top of the ear on the same side as the nostril)
According to the Intranasal Drug Administration skill how should the syringe be plunged?
Briskly
According to the Intranasal Drug Administration skill how much of the medication should be plunged into each nostril?
Half
According to the External Jugular Vein Access skill how should the pt be position?
Supine
Head down position
Head slightly turned to the side opposite the intended venipuncture site
According to the External Jugular Vein Access skill how should the catheter be aligned?
In the direction of the vein with the point aimed toward the shoulder on the side of the venipuncture
According to the External Jugular Vein Access skill where should the puncture of the external jugular vein take place?
Midway between the angle of the jaw and the mid-clavicular line
According to the External Jugular Vein Access skill what should you use caution not to allow to enter the catheter?
Air
According to the External Jugular Vein Access skill how should the catheter be secured?
Carefully without taping around the pts neck
According to the Endotracheal Drug Administration skill what 7 medications are approved for endotracheal drug administration?
- Epinephrine
- Vasopressin
- Narcan
- Atropine
- Albuterol
- Atrovent
- Duoneb
According to the Endotracheal Drug Administration skill what should you confirm about the order?
Medication
Dosage
Route
According to the Endotracheal Drug Administration skill what should you inquire of the pt about?
Medication allergies
According to the Endotracheal Drug Administration skill what should you check the medication for?
Contamination
Expiration date
According to the Endotracheal Drug Administration skill what is the dose for endotracheal drug administration for a medication compared to the dose given by IV?
Double the IV dose per protocol
According to the Endotracheal Drug Administration skill what should you instruct your partner to do prior to giving the medication?
Hyperventilate the pt
According to the Endotracheal Drug Administration skill what should you instruct your partner to do after giving the medication?
Hyperventilate the pt
According to the Piggyback Drug Administration skill what should you confirm about the order?
Medication
Dosage
Route
According to the Piggyback Drug Administration skill what should you inquire the pt about?
Allergies
According to the Piggyback Drug Administration skill what should you check the medication for?
Contamination
Expiration date
According to the Piggyback Drug Administration skill where should the medication be injected for piggyback drug administration?
Into secondary IV bag and mix solution
According to the Piggyback Drug Administration skill what should be done with the IV bag which has been injected with medication?
Labeled with name of drug and amount added
According to the Piggyback Drug Administration skill how do you expel air from piggyback solution and tubing?
Connect tubing and needle to solution to expel air
According to the Piggyback Drug Administration skill how do you insure the patency of the original IV line?
Lower original bag to observe for blood return
Check for infiltratoin and flow
According to the Piggyback Drug Administration skill where should the tubing connected to the solution bag be connected for administration into pt?
Medication port of the tubing of the original IV bag
According to the Piggyback Drug Administration skill what should you do before you begin infusion and adjust flow rate?
Recheck medication label
According to the PICC Line/ Central Line Access skill how do you prep the port?
With sterile technique (chloraprep swab and sterile gloves)
According to the PICC Line/ Central Line Access skill before infusing a medication what should occur with the system?
Aspirate the system
Flush the system with 10cc NS to confirm fluid flows through the system
According to the PICC Line/ Central Line Access skill if you are unable to aspirate blood what should you do?
STOP the procedure
According to the PICC Line/ Central Line Access skill when a PICC Line is finished being used what should be done?
PICC lines should always be flushed with Heparin at the ER when they are finished being used
According to the Dialysis Catheter Access skill when should the dialysis catheter be accessed?
Only in EMERGENT SITUATION when and IV/IO is unable to be accessed
According to the Dialysis Catheter Access skill after identifying the site of the dialysis catheter line what tools are used to prep the port with a sterile technique?
Chloraprep swab
Sterile gloves
According to the Dialysis Catheter Access skill what should first be done with the system to be used?
Aspirate for blood
According to the Dialysis Catheter Access skill after aspirating for blood what is the next thing to be done with the system to be used?
Flush the system with 10cc NS solution
According to the Dialysis Catheter Access skill why do you flushed the system with 10cc NS solution?
To confirm that fluid flows through the system
According to the Dialysis Catheter Access skill what should you do if you are unable to aspirate blood?
STOP the procedure
According to the Medi-port access skill what should occur after identifying the sit of the medi-port?
Prep area with sterile technique (Chloraprep swab and sterile gloves)
According to the Medi-port access skill what should a 10cc syringe filled with NS be connected to?
An extension set
According to the Medi-port access skill what should happen after an extension set has been connected to a 10cc syringe filled with NS?
Expel all air and clamp shut
According to the Medi-port access skill what kind of needle is used to access the medi-port?
Non-coring needle
According to the Medi-port access skill how is the non-coring needle inserted into the medi-port?
Through the skin and portal septum at a 90 degree angle
According to the Medi-port access skill how should the non-coring needle be secured?
With tape or a transparent dressing
According to the Medi-port access skill after securing the medi-port and taping all connections what should occur before infusing any solution?
Release clamp, aspirate for blood, flush system with NS to confirm that fluid flows through the system
According to the Medi-port access skill if you are unable to aspirate blood what is the next step?
STOP the procedure and remove the needle
According to the Medi-port access skill if the aspiration and flush are successful what is the next step?
Clamp extension set and remove the syringe
According to the Medi-port access skill one the IV solution is attached to the extension set what is the next step?
Release clamp and infuse IV fluid
According to the Medi-port access skill what should be done with a Medi-port when they are finished being used?
Flushed with Heparin at the ER
According to the Umbilical Vein Cannulation skill what is the indication for umbilical vein cannulation?
Newborn infant requiring resuscitation with intravenous fluid and/or intravenous medication
According to the Umbilical Vein Cannulation skill what are the contraindications for umbilical vein cannulation?
NONE
According to the Umbilical Vein Cannulation skill what is the first step in the umbilical vein cannulation?
Trim the infant’s umbilical cord with a scalpel just proximal to the clamp to provide a fresh end
According to the Umbilical Vein Cannulation skill where should you trim the umbilical cord?
Just proximal to the clamp
According to the Umbilical Vein Cannulation skill with what should you clean the umbilical cord end?
Chloraprep swab
According to the Umbilical Vein Cannulation skill how many vessels are in the umbilical cord?
3
According to the Umbilical Vein Cannulation skill how many of the 3 vessels located in the umbilical cord are arteries?
2
According to the Umbilical Vein Cannulation skill how many of the 3 vessels located in the umbilical cord are veins?
1
According to the Umbilical Vein Cannulation skill what does an umbilical artery look like?
Small with a thick wall
According to the Umbilical Vein Cannulation skill what does an umbilical vein look like?
The largest vessel in the umbilical cord with a thin wall
According to the Umbilical Vein Cannulation skill what gauge angiocath should be placed in the umbilical vein?
16 or 18 gauge without the needle
According to the Umbilical Vein Cannulation skill when placing the angiocath in the umbilical vein how is the cord stabilized?
With constant manual stabilization
According to the Umbilical Vein Cannulation skill after placing the angiocath in the umbilical vein what should you do?
Aspirate for blood return
According to the Umbilical Vein Cannulation skill if you get no blood return on aspiration what is your next step?
Reposition the catheter
According to the Umbilical Vein Cannulation skill once the angiocath has found its proper place and blood return has been aspirated what is the next step?
Attach a 3 way stopcock/extensin set and flush with 10cc NS
According to the Umbilical Vein Cannulation skill how is the cannulation secured in place?
Umbilical tape
Use enough pressure to secure but also to allow fluid to flow
According to the Intraosseous Insertion skill what is the indication for intraosseous insertion?
Anytime in which vascular access is difficult to obtain in emergent, urgent, or medically necessary cases.
According to the Intraosseous Insertion skill what are the 3 sizes of IO needles?
- 15mm
- 25mm
- 45mm
According to the Intraosseous Insertion skill what color is the 15mm needle?
Pink
According to the Intraosseous Insertion skill what size person is the pink 15mm needle appropriate for?
3-39kg
According to the Intraosseous Insertion skill what color is the 25mm needle?
Red
According to the Intraosseous Insertion skill what size person is the red 25mm needle appropriate for?
40kg and over
According to the Intraosseous Insertion skill what color is the 45mm needle?
Yellow
According to the Intraosseous Insertion skill what size person is the yellow 45mm needle appropriate for?
40kg and over with excessive tissue
According to the Intraosseous Insertion skill what are the possible sites for IO placement?
Proximal tibia
Proximal humerus
According to the Intraosseous Insertion skill what are the 4 contraindications for IO insertion?
- Fracture of the bone selected for IO infusion
- Excessive tissue at insertion site with the absence of anatomical landmarks
- Previous significant orthopedic procedures (IO within 24 hour, prosthesis)
- Infection/burn at the site selected for insertion
According to the Intraosseous Insertion skill if any of the 4 contraindications for IO insertion are met what should be done?
Consider alternate sites
According to the Intraosseous Insertion skill within how many hours of a previous IO insertion at the site is IO insertion contraindicated?
Within 24 hours
According to the Intraosseous Insertion skill of the 4 considerations for IO insertion #1 has you ensure what prior to infusion?
A rapid and vigorous 10ml flush with NS
According to the Intraosseous Insertion skill of the 4 considerations for IO insertion #1 what should you do if there is NO FLUSH?
NO FLOW
According to the Intraosseous Insertion skill of the 4 considerations for IO insertion #2 recommends what to facilitate the infusion of fluids through the IO?
Pressure bag
According to the Intraosseous Insertion skill of the 4 considerations for IO insertion #3 would have you consider what prior to the 10ml NS flush?
Cardiac lidocaine flush for anesthetic
According to the Intraosseous Insertion skill of the 4 considerations for IO insertion #4 would have you do what if a humeral IO is placed?
Tie arms across the chest
According to the Intraosseous Insertion skill what should you do if the pt is conscious?
Explain the procedure
According to the Intraosseous Insertion skill what kind of gloves should you wear?
Non-sterile latex free
According to the Intraosseous Insertion skill with what should you cleanse the site?
Alcohol swab
According to the Intraosseous Insertion skill after cleansing the site what should you allow to happen before insertion?
Allow the site to air dry thoroughly
According to the Intraosseous Insertion skill to stabilize the site for a humeral IO what should you do?
Position arm across chest
According to the Intraosseous Insertion skill when inserting the IO needle how should you position the driver and needle?
At the insertion site with the needle set at a 90 degree angle to the bone surface
According to the Intraosseous Insertion skill before using the drill what should you do with the needle?
Gently pierce the skin with the needle until it touches bone
According to the Intraosseous Insertion skill how do you use the drill to penetrate the bone cortex?
By squeezing the driver’s trigger and applying gentle, consistent, steady, downward pressure
According to the Intraosseous Insertion skill what should you be cautious not to do when driving the needle into the bone?
Use excessive force
According to the Intraosseous Insertion skill how long can it take in some patients to have successful insertion?
Greater than 10 seconds
According to the Intraosseous Insertion skill when should you release the driver’s trigger?
When a sudden “give or pop” is felt upon entry
According to the Intraosseous Insertion skill while driving how can you tell when you have drilled into the correct spot/
A sudden “give or pop” is felt
According to the Intraosseous Insertion skill after removing the driver from the set while stabilizing the catheter hub what is the next step?
Remove stylet from catheter
According to the Intraosseous Insertion skill how do you remove the stylet from the catheter?
Turning counter-clockwise
According to the Intraosseous Insertion skill with what should you flush the catheter with?
10ml of NS
According to the Intraosseous Insertion skill if the patient is responsive to pain what should you consider prior to the flush?
2% Lidocaine (cardiac lidocaine)
According to the Intraosseous Insertion skill what is the dose of 2% Lidocaine given if a pt is responsive to pain?
2ml
According to the Intraosseous Insertion skill when is a dose of 2% Lidocaine given if a pt is responsive to pain?
Prior to the 10ml NS flush
According to the Intraosseous Insertion skill what should you assess for during the flush?
Potential IO complications
According to the Intraosseous Insertion skill what tool do you utilize for infusion?
Pressure bag delivery system
According to the Transcutaneous Pacing skill what 3 things should you confirm first?
Presence of dysrhythmia
Patients hemodynamic status
12 lead EKG
According to the Transcutaneous Pacing skill should you have an IV established?
Yes
According to the Transcutaneous Pacing skill what are your treatment options you should consider for sedation if needed?
Etomidate
Ketamine
According to the Transcutaneous Pacing skill by what route is Etomidate given?
IV/IO
According to the Transcutaneous Pacing skill what is the IV/IO adult dose of Etomidate?
0.1 mg/kg
According to the Transcutaneous Pacing skill by what route is Ketamine given?
IV/IO
According to the Transcutaneous Pacing skill what is the IV/IO adult dose of Ketamine?
1mg/kg
According to the Transcutaneous Pacing skill when should you choose Ketamine over Etomidate?
SBP < 90
According to the Transcutaneous Pacing skill for what reason do you adjust the EKG size?
So machine can sense intrinsic QRS activity
According to the Transcutaneous Pacing skill what are the 2 methods of applying the pacemaker electrodes?
- Anterior-posterior
2. Posterior-posterior
According to the Transcutaneous Pacing skill after turing the monitor/defibrillator on what should you do next?
Select the proper lead
According to the Transcutaneous Pacing skill what is the usual desired pacing rate?
60-70
According to the Transcutaneous Pacing skill after selecting the desired pacing rate what are you observing for on the monitor?
“Sense” marker on each QRS complex
According to the Transcutaneous Pacing skill if no “sense” markers are present on each QRS complex what is your next course of action?
Increase QRS size
According to the Transcutaneous Pacing skill when do you depress the “start” button?
Once sensing
According to the Transcutaneous Pacing skill what should you observe for after depressing the “start” button?
Pacer spikes
According to the Transcutaneous Pacing skill after you have depressed the “start” buttong what is your next course of action?
Increasing the current (mA) slowly while observing for electrical capture
According to the Transcutaneous Pacing skill after electrical capture has occurred what should you do?
Turn current down to lowest possible
According to the Cardioversion skill what lead should you place the monitor in?
Lead 2
According to the Cardioversion skill before applying the defibrillation pads what 2 things should you do?
Confirm rhythm
Check pulse
Before charging the cardioverter what should you be sure to do?
Activate the synchronizer
According to the Cardioversion skill what should you do again prior to synchronized cardioversion?
Reconfirm the rhythm
According to the Cardioversion skill after synchronized cardioversion what 2 things should you do?
Confirm rhythm
Check pulse
According to the Defibrillation skill what should you set the monitor to?
Paddles
According to the Defibrillation skill before setting defibrillator to the proper energy setting what 2 things should you do?
Confirm rhythm
Check pulse
According to the Defibrillation skill prior to defibrillating what should you do one last time?
Reconfirm rhythm
According to the Defibrillation skill after defibrillating what 2 things should you do?
Confirm rhythm
Check pulse
According to the AED skill what is the first thing you must do?
Direct rescuers to stop CPR
According to the AED skill after CPR has been stopped what is your next step?
Check pulse
According to the AED skill after checking for a pulse and prior to turning on AED what should happen?
Direct rescuers to continue CPR if necessary
According to the AED skill after turning on the AED and properly placing the pads what should you do?
Direct rescuers to stop CPR and “Clear”
According to the AED skill once AED is on with pads on the pt and all rescuers are clear what should you do?
Initiate analysis of rhythm
According to the AED skill if necessary to shock what should you confirm prior to delivering a shock?
All personnel are clear
According to the AED skill how many shocks should you deliver prior to checking for a pulse?
3
According to the AED skill prior to each shock what 2 things must occur each time?
Analysis of rhythm
Confirm personnel are clear
According to the AED skill if pt remains pulseless after 3 shocks what should you do?
Direct rescuers to continue CPR
According to the Needle Decompression skill what are the 3 indications for needle decompression?
- Pt with signs of tension pneumothorax
- Traumatic CPR with high suspicion of underlying chest injury (especially pt in PEA)
- Intubated pt that is becoming increasingly difficult to ventilate with signs of tension pneumothorax
According to the Needle Decompression skill what are the 5 signs of a tension pneumothorax?
- Jugular vein distention
- Tracheal deviation
- Hypotension
- Decreased breath sounds
- Dyspnea
According to the Needle Decompression skill how will tracheal deviation present?
Away from the affected side
According to the Needle Decompression skill how will hypotension present?
With narrowing pulse pressure
According to the Needle Decompression skill how will decreased breath sounds present?
On the affected side
According to the Needle Decompression skill which approach does our protocols allow?
Anterior only
According to the Needle Decompression skill where should you located for needle decompression?
2nd or 3rd intercostal space midclavicular
According to the Needle Decompression skill what should you use to prep the area?
Chloraprep swab
According to the Needle Decompression skill where should you insert the needle?
Over the rib of the intercostal space you chose
According to the Needle Decompression skill what should indicate that the needle has entered the pleural space?
Popping sensation
According to the Needle Decompression skill once in the pleural space what is your next step?
Withdraw the needle from the catheter and secure the device with tape
According to the Needle Decompression skill what 3 things should you continuously monitor after a successful needle decompression?
Breath sounds
Respiratory rate
Effort
According to the Needle Decompression skill what is the appropriate size catheter for a pt who is <1 year old and/or <10kg?
20g
According to the Needle Decompression skill what is the appropriate size catheter for a pt who is 1-5 years old and/or 0-20kg?
18g
According to the Needle Decompression skill what is the appropriate size catheter for a pt who is 5-12 years old and/or 0-40kg?
16g
According to the Needle Decompression skill what is the appropriate size catheter for a pt who is >12 years old and/or >40kg?
14g
According to the Aids to Airway/Breathing Oxygen skill after assembling the regulator to the tank what should you check?
Tank pressure
According to the Aids to Airway/Breathing Oxygen skill before placing a mask on the pt what should you do?
Pre-fill reservoir bag
According to the Aids to Airway/Breathing Oxygen skill prior to discontinuing the flow of oxygen what should you do?
Remove the cannula or mask
According to the Aids to Airway/Breathing Nasopharyngeal Airway skill what kind of pt may a nasopharyngeal airway be used for?
Responsive pts with gag reflex
According to the Aids to Airway/Breathing Nasopharyngeal Airway skill what should you monitor on a pt for whom you have used a nasopharyngeal airway?
Vitals
Oxygen saturation
According to the Aids to Airway/Breathing Oropharyngeal Airway skill what should you check prior to insertion?
Unresponsiveness
According to the Aids to Airway/Breathing Oropharyngeal Airway skill what should you monitor for while inserting?
Gag reflex
According to the Aids to Airway/Breathing Oropharyngeal Airway skill what should you monitor on a pt for whom you have used an oropharyngeal airway?
Vitals
Oxygen saturations
According to the Aids to Airway/Breathing Bag Valve Mask skill what should you maintain around the mouth and nose?
Adequate seal
According to the Aids to Airway/Breathing Bag Valve Mask skill what is the time frame to begin effective ventilation?
Within 30 seconds
According to the Aids to Airway/Breathing Bag Valve Mask skill prior to connecting to an oxygen source who long should you perform effective ventilations?
1 minute
According to the Aids to Airway/Breathing Bag Valve Mask skill at what rate should you provide ventilations?
10-20 ventilations per minute
According to the Aids to Airway/Breathing Bag Valve Mask skill after connecting to an oxygen source what is the time frame to resume ventilations?
Within 15 seconds
According to the Aids to Airway/Breathing Bag Valve Mask skill how long should you continue ventilations when you have resumed?
30 seconds
According to the Aids to Airway/Breathing Suctioning skill how should the pt be positioned?
To prevent aspiration
According to the Aids to Airway/Breathing Suctioning skill what 2 methods are used to position pt to prevent aspiration?
- Turning pt head to the side
2. Turning pt to the side as a unit
According to the Aids to Airway/Breathing Suctioning skill how long should suctioning be applied?
5-10 seconds
According to the Aids to Airway/Breathing Mouth to Mask skill what type of valve should be connected to the mask?
One way valve
According to the Aids to Airway/Breathing Mouth to Mask skill within what time frame should effective ventilations begin?
Within 30 seconds
According to the Aids to Airway/Breathing Mouth to Mask skill how long should effective ventilations occur prior to connecting mask to oxygen source?
1 minute
According to the Aids to Airway/Breathing Mouth to Mask skill at what rate should ventilations occur?
10-20 ventilations per minute
According to the Aids to Airway/Breathing Mouth to Mask skill after connecting mask to an oxygen source within what time frame should ventilations resume?
15 seconds
According to the Aids to Airway/Breathing Chronic Tracheostomy skill what 3 conditions are required for this skill?
- Pt has a chronic tracheostomy
- Tracheostomy is not functional/clogged
- Pt not maintaining oxygen saturations
According to the Aids to Airway/Breathing Chronic Trachestomy skill what are the 4 steps for this skill?
- Remove tracheostomy
- Place similar size ET tube in opening
- Gently inflate balloon
- Use Ambu bag for ventilation to maintain normal oxygen saturation
According to the Aids to Airway/Breathing RSI skill what are the 7 scenarios in which you should consider RSI?
- Respiratory burns with impending respiratory failure
- Combative head trauma where behavior threatens life
- Possible C spine injury where immobilization not possible due to delirium
- Impending respiratory arrest which warrants immediate intubation
- GCS =<8 who warrants immediate intubation
- Penetrating neck trauma
- Loss of gag reflex
According to the Aids to Airway/Breathing RSI skill with what will all intubations be performed?
Bougie
According to the Aids to Airway/Breathing RSI skill when does bougie become optional?
Video Larygoscopy
According to the Aids to Airway/Breathing RSI skill what is the treatment option for a pt suspicious for a head injury or increased ICP?
Lidocaine
According to the Aids to Airway/Breathing RSI skill what route is Lidocaine used for a pt with suspected head injury or increased ICP?
IV/IO
According to the Aids to Airway/Breathing RSI skill what is the IV/IO adult dose for Lidocaine used for a pt with suspected head injury or increased ICP?
1 mg/kg
According to the Aids to Airway/Breathing RSI skill when should Lidocaine NOT be used for a pt with suspected head injury or increased ICP?
Heart block present
According to the Aids to Airway/Breathing RSI skill what is the treatment option for a pt 5 years old or less?
Atropine
According to the Aids to Airway/Breathing RSI skill by what what is Atropine given for the pt 5 years old or less?
IV/IO
According to the Aids to Airway/Breathing RSI skill wht is the IV/IO pediatric dose for Atropine given to the pt 5 years old or less?
0.02 mg/kg
According to the Aids to Airway/Breathing RSI skill if the pt is unresponsive and mouth able to be opened with no gag reflex what is your next step?
Endotracheal Intubation
According to the Aids to Airway/Breathing RSI skill what are you treatment options for induction?
Etomidate
Ketamine
According to the Aids to Airway/Breathing RSI skill by what route is Etomidate given for induction?
IV/IO
According to the Aids to Airway/Breathing RSI skill what is the IV/IO dose of Etomidate given for induction?
0.3 mg/kg
According to the Aids to Airway/Breathing RSI skill what is the typical adult dose of Etomidate?
20mg
According to the Aids to Airway/Breathing RSI skill by what route is Ketamine given for induction?
IV/IO
According to the Aids to Airway/Breathing RSI skill what is the IV/IO dose of Ketamine given for induction?
1 mg/kg
According to the Aids to Airway/Breathing RSI skill in what 3 situations is Ketamine the preferred agent?
Acute asthma exaceration
Hypotensive pt (SBP<90)
Septic pt
According to the Aids to Airway/Breathing RSI skill if after induction pt is able to be intubated without paralytics what is the next step?
Endotracheal Intubation
According to the Aids to Airway/Breathing RSI skill if after induction your pt requires paralytics what is your treatment option?
Succinylcholine
According to the Aids to Airway/Breathing RSI skill if after induction your pt requires paralytics by what route is Succinylcholine administered?
IV/IO
According to the Aids to Airway/Breathing RSI skill if after induction your pt requires paralytics what is the IV/IO dose of Succinylcholine?
1-1.5 mg/kg
According to the Aids to Airway/Breathing RSI skill if after induction your pt requires paralytics but there is a contraindication for Succinylcholine what are your treatment options?
Rocuronium
Vecuronium
According to the Aids to Airway/Breathing RSI skill if after induction your pt requires paralytics but there is a contraindication for Succinylcholine by what route is Rocuronium given?
IV/IO
According to the Aids to Airway/Breathing RSI skill if after induction your pt requires paralytics but there is a contraindication for Succinylcholine what is the IV/IO dose of Rocuronium?
1 mg/kg
According to the Aids to Airway/Breathing RSI skill if after induction your pt requires paralytics but there is a contraindication for Succinylcholine by what routes is Vecuronium given?
IV/IO
According to the Aids to Airway/Breathing RSI skill if after induction your pt requires paralytics but there is a contraindication for Succinylcholine what is the IV/IO dose of Vecuronium?
0.1 mg/kg
According to the Aids to Airway/Breathing RSI skill what should you be sure you can effectively do before using Rocuronium or Vecuronium as a paralytic?
Effectively ventilate the patient
According to the Aids to Airway/Breathing RSI skill why should you be sure you can effectively ventilate the pt before using Rocuronium or Vecuronium as a paralytic?
Both are long acting paralytics
According to the Aids to Airway/Breathing RSI skill if after chosen paralytic relaxation is adequate what should you do?
Endotracheal Intubation
According to the Aids to Airway/Breathing RSI skill if relaxation is inadequate after 60-120 seconds what is your next step?
Repeat dose of previously used paralytic and reattempt intubation
According to the Aids to Airway/Breathing RSI skill for sedation during intubation what are your treatment options?
Versed
Ketamine
According to the Aids to Airway/Breathing RSI skill by what route is Versed given for sedation during intubation?
IV/IO
According to the Aids to Airway/Breathing RSI skill what is the IV/IO dose of Versed for sedation during intubation?
0.1mg
Repeat every 5-10 minutes if SBP>100
According to the Aids to Airway/Breathing RSI skill by what route is Ketamine given for sedation during intubation?
IV/IO
According to the Aids to Airway/Breathing RSI skill what is the IV/IO dose of Ketamine given for sedation during intubation?
0.5 mg/kg
Every 5-10 minutes
According to the Aids to Airway/Breathing RSI skill what are your treatment options for pain management during intubation?
Fentanyl
Ketamine
According to the Aids to Airway/Breathing RSI skill by what route is Fentanyl given for pain management during intubation?
IV/IO
According to the Aids to Airway/Breathing RSI skill what is the IV/IO dose of Fentanyl given for pain management during intubation?
1 mcg/kg
Every 3-5 minutes if SBP>90
According to the Aids to Airway/Breathing RSI skill by what route is Ketamine given for pain management during intubation?
IV/IO
According to the Aids to Airway/Breathing RSI skill what is the IV/IO dose of Ketamine given for pain management during intubation?
0.5 mg/kg
Max dose 10 mg
Every 5-10 minutes
According to the Aids to Airway/Breathing RSI skill when pt is adequately sedated what are your treatment options for further paralytics?
Rocuronium
Vecuronium
According to the Aids to Airway/Breathing RSI skill by what route is Rocuronium given for further paralytic when pt has been adequately sedated?
IV/IO
According to the Aids to Airway/Breathing RSI skill what is the IV/IO dose of Rocuronium given for further paralytic when pt has been adequately sedated?
1 mg/kg
According to the Aids to Airway/Breathing RSI skill by what route is Vecuronium given for further paralytic when pt has been adequately sedated?
IV/IO
According to the Aids to Airway/Breathing RSI skill what is the IV/IO dose of Vecuronium given for further paralytic when pt has been adequately sedated?
0.1 mg/kg
According to the Aids to Airway/Breathing RSI chart what is the max dose of Atropine?
1 mg
According to the Aids to Airway/Breathing RSI chart at what weight does a pt reach the max dose for Atropine?
110lbs or 50kg
According to the Aids to Airway/Breathing Endotracheal Intubation skill what are the 3 indications for Endotracheal Intubation?
- Inadequate oxygen exchange or depressed ventilatory state
- Need to provide airway protection in obtunded pt with a depressed gag reflex
- Prophylactically in the pt suspected having suffered inhalation injuries
According to the Aids to Airway/Breathing Endotracheal Intubation skill what is the first step?
Instruct partner to ventilate/oxygenate pt
According to the Aids to Airway/Breathing Endotracheal Intubation skill what is the goal O2 saturation when partner is ventilating/oxygenating pt prior to intubation?
100%
According to the Aids to Airway/Breathing Endotracheal Intubation skill what is the name of the score which determines the difficulty of the intubation?
Mallampati score
According to the Aids to Airway/Breathing Endotracheal Intubation skill in what 2 ways does the Mallampati score rate the difficulty of the intubation?
Class
Grade
According to the Aids to Airway/Breathing Endotracheal Intubation skill what does the Class of the Mallampati score look at?
Oropharynx
According to the Aids to Airway/Breathing Endotracheal Intubation skill what are the classes of the Mallampati score?
I
II
III
IV
According to the Aids to Airway/Breathing Endotracheal Intubation skill from easiest to most difficult how do the classes of the Mallampati score line up?
I (easiest) to IV (most difficult)
According to the Aids to Airway/Breathing Endotracheal Intubation skill what does the grade of the Mallampati score look at?
Vocal cords
According to the Aids to Airway/Breathing Endotracheal Intubation skill what are the grades of the Mallampati score?
I
II
III
IV
According to the Aids to Airway/Breathing Endotracheal Intubation skill from easiest to most difficult how do the grade of the Mallampati score line up?
I (easiest) to IV (most difficult)
According to the Aids to Airway/Breathing Endotracheal Intubation skill when choosing an appropriate sized ET tube what is the average range for adults?
7.0-8.0
According to the Aids to Airway/Breathing Endotracheal Intubation skill when choosing an appropriate sized ET tube what is the formula for pediatrics?
(Age/4)+4
According to the Aids to Airway/Breathing Endotracheal Intubation skill what are the 2 head positions to consider?
Sniffing
In-line
According to the Aids to Airway/Breathing Endotracheal Intubation skill when c-spine inury is possible what head position should you use?
In-line
According to the Aids to Airway/Breathing Endotracheal Intubation skill when inserting larygoscope what should you be sure NOT to do when lifting?
Use teeth as fulcrum
According to the Aids to Airway/Breathing Endotracheal Intubation skill when trachea is visible what is your next step?
Place bougie into trachea
According to the Aids to Airway/Breathing Endotracheal Intubation skill when trachea is visible in what situation can you choose not to use a bougie?
Video laryngoscopy
According to the Aids to Airway/Breathing Endotracheal Intubation skill with bougie in the trachea what is your next step?
Place ET tube over bougie and into trachea
then remove bougie
According to the Aids to Airway/Breathing Endotracheal Intubation skill how long do you get to successfully place the bougie/tube?
30-60 seconds
According to the Aids to Airway/Breathing Endotracheal Intubation skill if after 30-60 seconds you cannot successfully place the bougie/tube what should you do?
Ventilate/oxygenate the pt
According to the Aids to Airway/Breathing Endotracheal Intubation skill when can you reattempt placing the bougie/tube?
When pt effectively ventilated/oxygenated
According to the Aids to Airway/Breathing Endotracheal Intubation skill how many attempts do you get to successfully place the bougie/tube?
2
According to the Aids to Airway/Breathing Endotracheal Intubation skill if after 2 attempts you have not been successful placing the bougie/tube what is your next course of action?
Place King Airway
According to the Aids to Airway/Breathing Endotracheal Intubation skill if you are unable to ventilate the pt by BVM/ ET tube/ or King Airway what is your next course of action?
Surgical Airway
According to the Aids to Airway/Breathing Endotracheal Intubation skill upon successful intubation what should you inflate the cuff to?
10cc
According to the Aids to Airway/Breathing Endotracheal Intubation skill what 7 methods are there to confirm tube placement?
- Visualization of the cords
- Condensation in the tube
- Auscultation of the bilateral lung fields
- Auscultation of the epigastric area
- Positive ETCO2 detection
- Improved pulse ox
- Capnography
According to the Aids to Airway/Breathing Endotracheal Intubation skill when securing the tube what should you take note of?
Depth of the ET tube
According to the Aids to Airway/Breathing Endotracheal Intubation skill what are the 2 acceptable measurements of tube depth?
Teeth
Lip Line
According to the Aids to Airway/Breathing Endotracheal Intubation skill what should you use to reduce the change of tube displacement?
C collar
According to the Aids to Airway/Breathing Endotracheal Intubation skill what should you do often during your care for the pt who has been successfully intubated?
Reconfirm tube placement
According to the Aids to Airway/Breathing Endotracheal Intubation skill what should you monitor throughout transport and on movement to ER bed?
Pulse ox
Capnography
Vitals signs
According to the Aids to Airway/Breathing Nasotracheal Intubation skill what are the 3 indications for nasotracheal intubation?
- Respiratory failure (oxygenation or ventilation)
- Failure to protect airway due to altered mental status
- Oral anatomy, injury, or jaw clenching preventing indicated orotracheal intubation
According to the Aids to Airway/Breathing Nasotracheal Intubation skill what are the 5 contraindications for nasotracheal intubation?
- Apnea
- Basilar skull fracture
- Midfacial fractures/ instability
- Pts on anticoagulants (relative contraindication)
- Patient combativeness
According to the Aids to Airway/Breathing Nasotracheal Intubation skill with what should you lubricate the tube?
Water soluble lubricant
According to the Aids to Airway/Breathing Nasotracheal Intubation skill how should you shape the tube?
Form “circle”
According to the Aids to Airway/Breathing Nasotracheal Intubation skill where should you insert the tube?
Into the nares and into the nasopharynx
According to the Aids to Airway/Breathing Nasotracheal Intubation skill what 2 signs indicates you are in the correct area?
Vapor in tube
Breath sounds heard
According to the Aids to Airway/Breathing Nasotracheal Intubation skill when listening to breath sounds when is the correct moment to insert tube into trachea?
During pt inspiration
According to the Aids to Airway/Breathing Nasotracheal Intubation skill how far do you advance the tube into the trachea?
Till adapter meets nares
According to the Aids to Airway/Breathing Nasotracheal Intubation skill what 5 indications confirm tube placement?
- Ausculation of the bilateral lung fields
- Auscultation of the epigastric area
- Positive ETCO2 detection
- Stable pulse ox
- Normal capnography
According to the Aids to Airway/Breathing Nasotracheal Intubation skill to what should you inflate the cuff of the tube?
10cc
According to the Aids to Airway/Breathing Nasotracheal Intubation skill how should you adjust ventilation rate?
To capnography readings (normal pCO2 35-45)
According to the Aids to Airway/Breathing King Airway skill what is the indication for the king airway?
Emergency of difficult intubation in the apneic or unresponsive pt without a gag reflex in pts greater than 4 feet tall to secure a patent airway and deliver ventilations
According to the Aids to Airway/Breathing King Airway skill what are the 4 contraindications for use of a King Airway?
- Responsive pts with an intact gag reflex
- Pts with known esophageal disease
- Pt ingested caustic substances
- Pt < 4 feet tall
According to the Aids to Airway/Breathing King Airway skill warnings what does the king airway NOT do?
Protect the airway from the effects of regurgitation and aspiration
According to the Aids to Airway/Breathing King Airway skill warnings what may high pressure do?
Divert gas either to the stomach or to the atmosphere
According to the Aids to Airway/Breathing King Airway skill warnings what cannot be ruled out as a potential complication of the insertion of the king airway?
Intubation of the trachea
According to the Aids to Airway/Breathing King Airway skill warnings what should be done after placement?
Perform standard checks for breath sounds and utilize as appropriate
According to the Aids to Airway/Breathing King Airway skill warnings what may be required by protocol?
Use of a carbon dioxide monitor
According to the Aids to Airway/Breathing King Airway skill warnings where should you lubricate the king airway?
Only the posterior surface of the king airway
According to the Aids to Airway/Breathing King Airway skill warnings why should you only lubricate the posterior surface of the king airway?
To avoid blockage of the ventilation apertures or aspiration of the lubricant
According to the Aids to Airway/Breathing King Airway skill warnings can the king airway be re-used?
NO
According to the Aids to Airway/Breathing King Airway skill what PPE should be worn?
Gloves
Mask
Eye protection
According to the Aids to Airway/Breathing King Airway skill what should occur while assembling equipment?
Continuing ventilations
According to the Aids to Airway/Breathing King Airway skill how are tube sizes chosen?
Based on pt height
According to the Aids to Airway/Breathing King Airway skill what is the maximum recommended volume of air for a size 3 cuff?
30ml
According to the Aids to Airway/Breathing King Airway skill what is the maximum recommended volume of air for a size 4 cuff?
80ml
According to the Aids to Airway/Breathing King Airway skill what is the maximum recommended volume of air for a size 5 cuff?
90ml
According to the Aids to Airway/Breathing King Airway skill what type of lubricant should be applied to the beveled distal tip and posterior aspect of the tube?
Water based lubricant
According to the Aids to Airway/Breathing King Airway skill where on the tube should a water based lubricant be applied?
Beveled distal tip
Posterior aspect
According to the Aids to Airway/Breathing King Airway skill what should you take care not to do with the water based lubricant?
Introduce it in or near the ventilatory openings
According to the Aids to Airway/Breathing King Airway skill what should you have prepared and turned on prior to positioning the head?
Suction
According to the Aids to Airway/Breathing King Airway skill what is the ideal head position for insertion of a king airway?
“Sniffing” position
According to the Aids to Airway/Breathing King Airway skill although the ideal position for insertion is the “sniffing” position what about the tube allows it to also be inserted with the head in a neutral position?
The angle and shortness of the tube
According to the Aids to Airway/Breathing King Airway skill with what hand should you hold the king airway?
Dominant hand
According to the Aids to Airway/Breathing King Airway skill with the dominant hand where on the king airway should you hold?
At the connector
According to the Aids to Airway/Breathing King Airway skill what should you do with the non-dominant hand?
Hold the mouth open and apply chin lift
According to the Aids to Airway/Breathing King Airway skill how should you orient the king airway for introduction into the mouth?
Rotated laterally 45-90 degrees such that the blue orientation line is touching the corner of the mouth
According to the Aids to Airway/Breathing King Airway skill when introducing the tip of the king airway into the mouth where should you advance it?
Behind the base of the tongue
According to the Aids to Airway/Breathing King Airway skill should you meet resistance while advancing should you for it into position?
NO
According to the Aids to Airway/Breathing King Airway skill as the tube passes under the tongue how should you adjust the tube/
Rotate tube back to midline (blue orientation line faces chin)
According to the Aids to Airway/Breathing King Airway skill on the LTS-D model how far should you advance the king airway?
Until proximal opening of gastric lumen is aligned with the teeth or gums
According to the Aids to Airway/Breathing King Airway skill on the LT-D model how far should you advance the king airway?
Until the base of connector is aligned with the teeth or gums
According to the Aids to Airway/Breathing King Airway skill what is the typical inflation volume of the size 3 king airway?
45-50ml
According to the Aids to Airway/Breathing King Airway skill what is the typical inflation volume of the size 4 king airway?
60-80ml
According to the Aids to Airway/Breathing King Airway skill what is the typical inflation volume of the size 5 king airway?
70-90ml
According to the Aids to Airway/Breathing King Airway skill what is the size of the connector of the king airway where the BVM is attached for ventilation?
15mm
According to the Aids to Airway/Breathing King Airway chart what is the model number shown for the size 3 king airway?
KLTSD413
According to the Aids to Airway/Breathing King Airway chart what is the model number shown for the size 4 king airway?
KLTSD414
According to the Aids to Airway/Breathing King Airway chart what is the model number shown for the size 5 king airway?
KLTSD415
According to the Aids to Airway/Breathing King Airway chart for what height is the size 3 king airway recommended?
4-5 feet (122-155cm)
According to the Aids to Airway/Breathing King Airway chart what is the connector color of the size 3 king airway?
Yellow
According to the Aids to Airway/Breathing King Airway chart what is the inflation volume of the size 3 king airway?
45-60ml
According to the Aids to Airway/Breathing King Airway chart for what height is the size 4 king airway recommended?
5-6 feet (155-180cm)
According to the Aids to Airway/Breathing King Airway chart what is the connector color of the size 4 king airway?
Red
According to the Aids to Airway/Breathing King Airway chart what is the inflation volume of the size 4 king airway?
60-80ml
According to the Aids to Airway/Breathing King Airway chart for what height is the size 5 king airway recommended?
> 6 feet (> 180cm)
According to the Aids to Airway/Breathing King Airway chart what is the connector color of the size 5 king airway?
Purple
According to the Aids to Airway/Breathing King Airway chart what is the inflation volume of the size 5 king airway?
70-90ml
According to the Aids to Airway/Breathing King Airway chart what is the OD of the size 3,4, and 5 king airways?
18mm
According to the Aids to Airway/Breathing King Airway chart what is the ID of the size 3,4,and 5 king airways?
10mm
According to the Aids to Airway/Breathing King Airway chart what is the gastric tube size of the size 3,4, and 5 king airways?
<=18 Fr
According to the Aids to Airway/Breathing King Airway skill page 2 how far should you withdraw the airway?
Until ventilation is easy and free flowing
According to the Aids to Airway/Breathing King Airway skill page 2 where are the depth markings on the king airway?
The proximal end
According to the Aids to Airway/Breathing King Airway skill page 2 what do the depth markings refer to?
The distance (in cm) from the vocal cords to the upper teeth
According to the Aids to Airway/Breathing King Airway skill page 2 where is the proper placement of the distal tip and cuff of the king airway?
In the upper esophagus with the ventilatory openings aligned with the opening to the larynx
According to the Aids to Airway/Breathing King Airway skill page 2 when confirming proper tube placement with several breaths where should you auscultate breath sounds?
Bilaterally at the apices and the bases
According to the Aids to Airway/Breathing King Airway skill page 2 when confirming proper tube placement with several breaths what are you auscultating for?
Presence of equal bilateral lung sounds
According to the Aids to Airway/Breathing King Airway skill page 2 when confirming proper tube placement with several breaths what should you observe of the pt chest?
Symmetrical rise and fall with each breath
According to the Aids to Airway/Breathing King Airway skill page 2 when confirming proper tube placement with several breaths where is the first place you auscultate?
Epigastrum
According to the Aids to Airway/Breathing King Airway skill page 2 when confirming proper tube placement with several breaths what are you looking for in the tube with each breath?
Moisture condensation
According to the Aids to Airway/Breathing King Airway skill page 2 when confirming proper tube placement with several breaths what are you observing the pt for?
Clinical improvement (ie pulse oximetry, skin condition)
According to the Aids to Airway/Breathing King Airway skill page 2 when confirming proper tube placement with several breaths what tool can you use to confirm proper tube placement?
CO2 detection device
According to the Aids to Airway/Breathing King Airway skill page 2 what should the BVM be supplied with?
100% O2
According to the Aids to Airway/Breathing King Airway skill page 2 how many breaths per minute should be supplied during CPR?
8-10 breath per minute
According to the Aids to Airway/Breathing King Airway skill page 2 how should each breath be delivered during CPR?
Over about 1 second while chest compressions are delivered at a rate of 100 per minute
According to the Aids to Airway/Breathing King Airway skill page 2 what should you NOT do during CPR?
Attempt to synchronize the compressions with ventilations
According to the Aids to Airway/Breathing King Airway skill page 2 how many breaths per minute should you deliver to a pt with a perfusing rhythm?
10-12 breath per minute (1 breath every 5-6 seconds)
According to the Aids to Airway/Breathing King Airway skill page 2 how should each breath be delivered to a pt with a perfusing rhythm?
Over 1 second
According to the Aids to Airway/Breathing King Airway skill page 2 how should the king airway be secured?
with a commercial device while continuing ventilatory support
According to the Aids to Airway/Breathing King Airway skill page 2 when should the airway be reconfirmed?
After device is secured and after every pt movement and at regular intervals
According to the Aids to Airway/Breathing King Airway skill page 2 what will help to prevent movement of the airway?
C collar
According to the Aids to Airway/Breathing King Airway skill page 2 what 3 things should be monitored throughout pt transport and on movement to ER bed?
Pulse ox
Capnography
Vital signs
According to the Aids to Airway/Breathing King Airway skill page 2 special notes what should you NOT do?
Cover the proximal opening of the gastric access lumen
According to the Aids to Airway/Breathing King Airway skill page 2 special notes what does the gastric lumen access allow?
Insertion of up to an 18 French diameter gastric tube into the esophagus and stomach
According to the Aids to Airway/Breathing King Airway skill page 2 once the king airway is in the correct position when is it no longer well tolerated?
Return of protective reflexes
According to the Aids to Airway/Breathing King Airway skill page 2 what should you ensure is ready prior to removal of a king airway?
Suctioning equipment
According to the Aids to Airway/Breathing King Airway skill page 2 prior to removing the king airway what 2 things must be done?
- Deflate both cuffs completely
2. Turn pt onto side
According to the Aids to Airway/Breathing King Airway skill page 2 while removing the king airway what may you do?
Suction as needed
According to the Aids to Airway/Breathing King Airway skill page 2 once the king airway has been removed what 2 devices may be chosen for use if needed?
Oropharyngeal airway
Nasopharyngeal airway
According to the Aids to Airway/Breathing King Airway skill page 2 after removing the king airway how should you continue ventilations?
With a BVM and O2 at 10-15lpm as needed
According to the Aids to Airway/Breathing CPAP skill how many of the inclusion criteria are to be met?
2 or more
According to the Aids to Airway/Breathing CPAP skill what are the 4 inclusion criteria?
- Retractions or accessory muscle use
- Respiratory rate > 24/min
- Pulse ox < 94%
- Age 7 or above
According to the Aids to Airway/Breathing CPAP skill what are the 5 exclusion criteria?
- Pneumothorax
- Unable to follow commands
- Apnea
- Vomiting or active GI bleed
- Major trauma
According to the Aids to Airway/Breathing CPAP skill what are the 4 conditions CPAP is indicated for?
- Congestive heart failure
- COPD
- Asthma
- Pneumonia
According to the Aids to Airway/Breathing CPAP skill what type of oxygen outlet should the CPAP be connected to?
50psi oxygen outlet
According to the Aids to Airway/Breathing CPAP skill what kind of oxygen supply is necessary for device?
Adequate oxygen supply to ventilate device
According to the Aids to Airway/Breathing CPAP skill how should the face mask seal on the pt?
Seals the bridge of the nose and fully covers the nose and mouth
According to the Aids to Airway/Breathing CPAP skill what is the name of the adapter used to connect the device to the supply of O2?
Locking bayonet outlet adapter
According to the Aids to Airway/Breathing CPAP skill how is the locking bayonet outlet adapter secured?
Turning clockwise
According to the Aids to Airway/Breathing CPAP skill what should you obtain and record prior to delivering pressure to the pt?
ETCO2 measurement
According to the Aids to Airway/Breathing CPAP skill what should you always observe about the airway pressure gauge needle prior to setting the pressure?
That the airway pressure gauge needle indicator is at the 0 value with the CPAP adjustment knob in the fully counterclockwise position and the breathing circuit is connected
According to the Aids to Airway/Breathing CPAP skill how do you set the continuous positive airway pressure?
Turn the CPAP adjustment clockwise to the “6-O’ Clock” positoin and observe the needle indicator on the airway pressure gauge
According to the Aids to Airway/Breathing CPAP skill to adjust the continuous positive airway pressure how do you make adjustments?
Turn the CPAP adjustment clockwise in 1/4 turn (9, 12, 3, 6 O’Clock) increments
According to the Aids to Airway/Breathing CPAP skill what continuous positive airway pressure do you want for treatment?
5-15cm H2O
According to the Aids to Airway/Breathing CPAP skill when the pressure has been set what should you check for?
Air leaks
According to the Aids to Airway/Breathing CPAP skill when the pressure has been set what should you monitor and document?
Pt respiratory response to the treatment
According to the Aids to Airway/Breathing CPAP skill how often should you evaluate vital signs and ETCO2?
Every 5 minutes
According to the Aids to Airway/Breathing CPAP skill if respiratory status deteriorates what should you do?
Remove device
Consider BVM or intubation
According to the Aids to Airway/Breathing CPAP skill what is the removal procedure?
CPAP needs to be continuous and should NOT be removed unless the pt cannot tolerate the mask or experiences continued or worsening respiratory failure.
According to the Aids to Airway/Breathing CPAP skill what is the pediatric consideration?
CPAP should not be used in children under 7 years of age
According to the Aids to Airway/Breathing CPAP skill special notes why should you advise the receiving hospital as soon as possible?
So they can be prepared for the pt
According to the Aids to Airway/Breathing CPAP skill special notes when can you remove the CPAP once at the hospital?
When hospital therapy is ready to be placed on pt
According to the Aids to Airway/Breathing CPAP skill what should you watch for when using the CPAP?
Gastric distention
According to the Aids to Airway/Breathing CPAP skill how often should reassessment of the pts status be performed?
Every 5-10 minutes
According to the Aids to Airway/Breathing CPAP skill may inline nebulized treatments be given?
YES
May use “T” piece attachment from standard nebulizer set up
According to the Aids to Airway/Breathing Open Cricothyrotomy skill what are the 4 indications?
- Age >=10 or weight >=40kg
- Unable to ventilate pt with standard techniques
- Upper airway obstruction and unable to ventilate pt or remove the obstruction
- Head/facial trauma making it impossible to ventilate with standard techniques
According to the Aids to Airway/Breathing Open Cricothyrotomy skill what are the 4 contraindications?
- Anytime a less invasive maneuver would allow ventilation of the pt
- Age <10 or weight <40kg
- Tracheal transection
- Fractured larynx or significant damage to the cricoid cartilage or larynx
According to the Aids to Airway/Breathing Open Cricothyrotomy skill how should the pt be positioned?
Supine with neck in neutral position
According to the Aids to Airway/Breathing Open Cricothyrotomy skill how should the pt neck be cleaned?
In a sterile fashion using chloraprep swab
According to the Aids to Airway/Breathing Open Cricothyrotomy skill what should you locate for the procedure?
Cricothyroid membrane
According to the Aids to Airway/Breathing Open Cricothyrotomy skill where is the cricothyroid membrane located?
Anteriorly between the thyroid and cricoid cartilage
According to the Aids to Airway/Breathing Open Cricothyrotomy skill what should you do with your left hand until the trachea is intubated?
Stabilize the trachea
According to the Aids to Airway/Breathing Open Cricothyrotomy skill what kind of incision should be made through the skin?
A 2-3cm midline vertical incision from the caudal end of the thyroid cartilage to the cephalic end of the cricoid cartilage
According to the Aids to Airway/Breathing Open Cricothyrotomy skill after making the vertical incision through the skin what kind of incision should be made through the cricothyroid membrane?
A 1-2cm transverse incision
According to the Aids to Airway/Breathing Open Cricothyrotomy skill after making both the vertical incision through the skin and the transverse incision through the cricothyroid membrane what is the next step?
Insert the scalpel handle into the trachea
According to the Aids to Airway/Breathing Open Cricothyrotomy skill after placing the handle of the scalpel into the trachea what should you do next?
Insert a bougie into the opening over your scalpel
According to the Aids to Airway/Breathing Open Cricothyrotomy skill after inserting a bougie into the trachea what is your next step?
Place a size 6.0 ET tube over the bougie into the trachea. Once the tube is in place remove the bougie.
According to the Aids to Airway/Breathing Open Cricothyrotomy skill once the tube has been inserted into the trachea and the bougie removed what should you inflate cuff of the tube to?
10cc
According to the Aids to Airway/Breathing Open Cricothyrotomy skill what 5 methods are there to confirm tube placement?
- Auscultation of the bilateral lung fields
- Auscultation of the epigastric area
- Positive ETCO2 detection
- Stable pulse ox
- Normal capnography
According to the Aids to Airway/Breathing Open Cricothyrotomy skill what should you use to reduce the chances of tube displacement?
C collar
According to the Aids to Airway/Breathing Open Cricothyrotomy skill if cervical immobilization is needed and unable to place collar what technique can you use?
Manual stabilization
According to the Aids to Airway/Breathing Open Cricothyrotomy skill how should you adjust your ventilation rate?
To capnography readings (normal pCO2 35-45)
According to the Aids to Airway/Breathing Needle Cricothyrotomy skill what are the 4 indications for needle cricothyrotomy?
- Pediatric pt (<10 year old or weight <40kg)
- Unable to ventilate pt with standard techniques
- Upper airway obstruction and unable to ventilate pt or remove obstruction
- Head/facial trauma making it impossible to ventilate pt with standard techniques
According to the Aids to Airway/Breathing Needle Cricothyrotomy skill what are the 2 contraindications to needle cricothyrotomy?
- Anytime a less invasive maneuver would allow ventilation of the pt
- Tracheal transection
According to the Aids to Airway/Breathing Needle Cricothyrotomy skill how should the pt be positioned?
Supine with neck in a neutral position
According to the Aids to Airway/Breathing Needle Cricothyrotomy skill how should the pt neck be cleaned?
In a sterile fashion using a chloraprep swab
According to the Aids to Airway/Breathing Needle Cricothyrotomy skill what kind of needle will you need for the procedure?
16-18 gauge over the needle catheter
According to the Aids to Airway/Breathing Needle Cricothyrotomy skill with what should you assemble a 16-18 gauge over the needle catheter?
10ml syringe
According to the Aids to Airway/Breathing Needle Cricothyrotomy skill what should you locate for the procedure?
The cricothyroid membrane
According to the Aids to Airway/Breathing Needle Cricothyrotomy skill where is the cricothyroid located?
Anteriorly between the thyroid and cricoid cartilage
According to the Aids to Airway/Breathing Needle Cricothyrotomy skill how should you stabilize the trachea?
With the thumb and forefinger of one hand
According to the Aids to Airway/Breathing Needle Cricothyrotomy skill where should you puncture the skin with the needle?
Midline with the needle over the cricothyroid membrane
According to the Aids to Airway/Breathing Needle Cricothyrotomy skill what may you do first to facilitate passage of the needle?
Make a small incision with the scalpel
According to the Aids to Airway/Breathing Needle Cricothyrotomy skill how should the needle be directed through the cricothyroid membrane?
At a 45 degree angle caudally
According to the Aids to Airway/Breathing Needle Cricothyrotomy skill what should you do with the attached syringe while directing the needle at a 45 degree angle caudally through the cricothyroid membrane?
Apply negative pressure to the syringe
According to the Aids to Airway/Breathing Needle Cricothyrotomy skill what should you maintain as the needle is inserted through the lower half of the cricothyroid membrane?
Maintain needle aspiration
According to the Aids to Airway/Breathing Needle Cricothyrotomy skill what signifies entry into the tracheal lumen?
Aspiration of air
According to the Aids to Airway/Breathing Needle Cricothyrotomy skill after aspiration of air what should you do next?
Remove syringe and needle while advancing the catheter to the hub
According to the Aids to Airway/Breathing Needle Cricothyrotomy skill when the catheter has been attached to the hub what should you attach the the catheter?
Reattach the syringe and attach ET tube adapter to syringe
According to the Aids to Airway/Breathing Needle Cricothyrotomy skill after attaching BVM what should you check for?
Chest rise
Breath sounds
According to the Vagal Maneuvers skill what must be in place before vagal maneuvers are performed?
Continuous cardiac monitoring
According to the Vagal Maneuvers skill what 2 techniques are there for vagal maneuvers?
- “Bearing down”
2. “Straining against a close glottis”
According to the Vagal Maneuvers skill what are the steps to “Bearing Down”?
- Have pt bear down like they are having a bowel movement
2. May be repeated as needed
According to the Vagal Maneuvers skill what is the step for “Straining against a closed glottis.”?
Have the pt cough and keep their airway
According to the Epinephrine Push Dose Pressor skill what is the 1 step to mixing?
Take a 10ml syring with 9ml of Normal Saline
According to the Epinephrine Push Dose Pressor skill during the 2nd step what do you draw into 10ml syringe that already has 9ml of NS?
1 ml of Epinephrine 1:10,000
According to the Epinephrine Push Dose Pressor skill once you have combined 9ml of NS with 1ml of Epinephrine 1:10,000 what do you have?
10ml of Epinephrine (10mcg/ml)
According to the Epinephrine Push Dose Pressor skill what is the dose of the mixed Epinephrine Push Dose Pressor?
0.5-2ml IV/IO every 2-5 minutes for SBP<90
According to the EKG skill what are the 9 precordial leads?
V1 V2 V3 V4 V5 V6 V4R V8 V9
According to the EKG skill where is V1 placed?
4th intercostal space just to the right of the sternum
According to the EKG skill where is V2 placed?
4th intercostal space just to the left of the sternum
According to the EKG skill where is V3 placed?
In between V2 and V4
According to the EKG skill where is V4 placed?
5th intercostal space mid clavicular line
According to the EKG skill where is V5 placed?
Anterior axillary line lever with V4
According to the EKG skill where is V6 placed?
Mid axillary line level with V4 and V5
According to the EKG skill where is V4R placed?
5th intercostal space in right mid clavicular (label on EKG)
According to the EKG skill where is V8 placed?
5th intercostal space mid scapular line (label on EKG)
According to the EKG skill where is V9 placed?
5th intercostal space between V8 and spine (label on EKG)
According to the EKG skill what three leads require labeling on the EKG?
V4R
V8
V9
According to the EKG skill what do leads I, AVL, V5, and V6 see?
Lateral wall, left ventricle
According to the EKG skill what do leads II,III, and AVF see?
Inferior wall, left ventricle
According to the EKG skill what do leads V1, and V2 see?
Septal wall, left ventricle
According to the EKG skill what do leads V3 and V4 see?
Anterior wall, left ventricle
According to the EKG skill what does lead V4R see?
Right ventricle
According to the EKG skill what do leads V8 and V9 see?
Posterior wall
