Squid Skills!

Question 1

Write on the board: indication(s), contraindications (2), and complications (2) and perform this skill:

IO- include identifying landmarks and the process.

Answer 1

Unable to obtain an IV after (2) attempts or (2) minutes.

Humerus: The humerus should be internally rotated and the hand placed on the abdomen with the elbow flexed to 90 degrees, ensuring that the bicep tendon is medially located and not penetrated. The surgical neck is palpated, and the needle is placed 2 cm above the surgical neck into the greater tubercle at about 45 degrees to the anterior plane. A longer IO needle is necessary, such as the 45 mm needle, to access the intramedullary space.

Distal femur: With the leg straightened and centered in the anterior plane, 1 cm proximal to the patella, and 1 to 2 cm medially.

Proximal tibia: 1 cm to 2 cm inferior and medial to the tibial tuberosity in the flat portion of the tibia

Distal tibia: 2 cm proximal to the medial malleolus in the flat portion of the tibia.

INDICATIONS:
-Fracture of the boney site
-Burn site
-Cellulitis or infection at the site
-Osteogenesis imperfect
-Osteoporosis (relative)
-Previous IO attempted site or IO less than 48 hours
-Recent orthopedic surgery

COMPLICATION:
-Infiltration, compartment syndrome, fracture, cellulitis, osteomyelitis, fat embolism

Question 2

Write on the board: Discuss indication(s), contraindications (2), and complications (2) and perform this skill:

Cricothyroidotomy include identifying landmarks and the process.

Answer 2

Cannot Intubate, Cannot Oxygenate
Cannot protect airway

COMPLICATIONS:
hypoxia, death
bleeding, lacerations of tracheal cartilage, including the thyroid, cricoid, or tracheal rings, perforation of the trachea, creation of a false tract

Question 3

Write on the board: Discuss indication(s), contraindications (2), and complications (2) and perform this skill:

Chest decompression include identifying landmarks and the process.

What is the preferred site per PHTLS?

Answer 3

INDICATIONS: Tension pneumothorax-

PHTLS: Anterior axillary line in the fourth or fifth intercostal space tracking above the rib so as not to injure the intercostal bundle (artery, vein, nerve).

Mid-clavicular second or third ICS

COMPLICATIONS:
- incorrect placement, bleeding, infection

Question 4

Write on the board: Discuss indication(s) and perform this skill:

Primary Assessment

Answer 4

All patients who allow you to perform an assessment.

BSI, assess and manage the scene
Assess LOC
Assess and manage airway
Assess and manage breathing
Assess and manage circulation

Question 5

Write on the board: Discuss indication(s), contraindications (2), and complications (2), the class of drug, primary action the concentration of the drip you mixed, and perform this skill:

Prepare a Levophed drip and administer at 4 mcg/ min.

Answer 5

Cardiogenic shock SBP < 90, crackles. Consider in septic shock if unresponsive to fluid resuscitation, and/or if patient is experiencing fluid overload.

Mix 4 mg/ 500 ml [8mcg/ml] (or equivalent- adjust infusion for concentration).

• using a 60 gtt set administer at 1 drop every other second (30 gtt/min).
  -using a 10 gtt set administer at 1 drop every 12 seconds (5 gtt/min).

Question 6

Write on the board: Discuss indication(s), contraindications (2), and complications (2), the class of drug, primary action the concentration of the drip you mixed, and perform this skill:

Prepare a MgSO4 drip and administer appropriately. Please indicate what type of patient you are managing above.

Answer 6

Pre/Eclampsia:

-4 mg/ over 10 minutes
-100 gtt/ min with 10 gtt set

Severe bronchoconstriction:

-2 mg/ 100 ml over 10 minutes
-100 gtt/ min with 10 gtt set

Question 7

Write on the board: Discuss indication(s), contraindications (2), and complications (2), the class of drug, primary action the concentration of the drip you mixed, and perform this skill:

Prepare an epinephrine drip and administer appropriately.

Answer 7

Severe bronchoconstriction

• 1 mg/ 1 L [1 mcg/ml]
• 1 ml/minute
• 60 drip - 60 gtt/ min
• 10 drip- 10 gtt/ min

Question 8

An infant is choking.

Demonstrate your next steps:

Answer 8

1. hold infant face down with head lower than feet
2. support head and jaw
3. give 5 back slaps
4. then put baby face up 5
5. give 5 chest thrusts
   repeat until obstruction clears

Question 9

Apply a tourniquet. The fastest team wins!
-snug and 3 twists

Answer 9

Not over the joint
May be high and tight or 2-3 inches above the injury