Ventilation and BSL Flashcards
Resus and life support
You see a pt in their bed. You call their name and get no answer.
How do you confirm they are unresponsive and not breathing normally?
- Call name
- Try to rouse patient calling name and moving them/
- Trapezius squeeze
- Call for help
- Look, listen, feel for breathing - HTCL, feeling carotid pulse, look for rise and fall of chest, listen for breath.
You have found a patient unresponsive and not breathing normally.
Describe steps of advaced adult life support
- Start CPR
- Help arrives –> 2222, adult cardiac arrest, location, bring resus trolley
- CPR 30:2, attach defib pads
- assess rhythm
- decide whether it is shockable or non-shockable and shock or continue CPR as required.
- Aim is ROSC.
While carrying out advanced life support, what should you ensure is done alongside chest compressions?
there are lots !
- give oxygen
- minimise interruptions to compressions
- Get IV or IO access
- Give adrenaline every 3-5 mins
- Give amiodarone after 3 shocks
- ID and treat reversible causes
- In advanced life support, how often should you give adrenaline?
- After how many shocks is amiodarone given?
- every 3-5 mins
- 3 shocks
reversible causes cardiac arrest
What are 4Hs and 4Ts to consider during cardiac arrest?
- Hypoxia
- Hypovolaemia
- Hypo-/hyperkalaemia/ metabolic
Consider - Hypo/hyperthermia
- Thrombosis – coronary or pulmonary
- Tension pneumothorax
- Tamponade – cardiac
- Toxins
After ROSC, what needs to be done for patient?
ABCDE
A = A-E assessment is needed to review pt
B = Bloods need to be taken to id causes, find any underlying infection / electrolyte abnormalities
C = CXR required - to assess trauma from CPR and also check for causes e.g tension pneumothorax
D = drugs - what medications are they on, what drugs do you need to add, what drugs do you need to stop, what drugs were a cause of cardiac arrest
E = ECG is required to assess heart rhythym.
What are shockable rhythms?
VF and pulseless VT
what are non-shockable rhythms?
PEA and asystole
You find a shockable rhythm when assessing rhythm for resus. What do you do next?
Shock once at 200J (then 300J, 360)
Immediately resume CPR for 2 mins.
You find a non-shockable rhythm when assessing rhythm for resus. What do you do next?
Immediately resume CPR for 2 mins
Give 1:10000 1mg (10ml prefilled syringe in resus meds box) adrenaline
What are causes of airway obstruction?
- contents - vomit, blood, gastric contents, foreign body
- constriction - bronchospasm
- odema - from burns, inflam or anaphylaxis
- compression - tumour.
In airway obstruction, air entry can be noisy.
What noises can be made and what do they suggest?
- Inspiratory stridor - caused by obstruction at the laryngeal level or above.
- Expiratory wheeze - suggests obstruction of the lower airways, which tend to collapse and obstruct during expiration.
- Gurgling - suggests the presence of liquid or semisolid foreign material in the upper airways.
- Snoring - arises when the pharynx is partially occluded by the tongue or palate.
- Crowing or stridor - is the sound of laryngeal spasm or obstruction.
What are basic manoeuvres to open airway?
HTCL
Jaw thrust - in C spine fractures.
What are oropharyngeal and nasopharyngeal airways designed to do?
to overcome the soft palate obstruction and backward tongue displacement
Describe insertion technique of oropharyngeal airway
- measure up airway size - corresponding to the vertical distance between the patient’s incisors and the angle of the jaw
- open mouth, ensure foreign material moved out with suction
- insert airway in ‘upside down position’ as far as the junction between the hard and soft palate
- at this point, rotate it 180 and advance airway.
Why is a laryngeal mask airway used in resus?
- efficient
- easire than bag-mask apparatus
- gastric inflation is minimised
- used when tracheal intubation has been tried but failed.
Describe the technique for laryngeal mask airway insertion
- maintain chest compressions throught insertion attempt
- select appropriate size for patient - usually men are size 5, women are size 4.
- lubricate airway cuff
- HTCL
- holding LMA like a pen, insert it into the mouth.
- Advance tip behind upper incisiors with upper surface applied to the palate until posterior pharyngeal wall is reached.
- press mask around corner of pharynx until feel resistance (jaw thrust can help this)
- inflate the cuff with air. As it inflates, the tube wil lift a few cms as cuff finds correct poisiton and larynx is pushed forwards.
- insert bite block along tube and tape LMA into place
