Ventilatory Management - Adult Flashcards
Steps 1 - 3
- Takes or verbalizes BSI precautions
- Opens the airway manually
- Elevates tongue, inserts simple adjunct (OPA or NPA)
…No gag reflex is present and pt accepts adjunct
Steps 4 & 5
- Ventilates the pt immediately with BVM device unattached to O2
- Ventilates the pt with room air
Examiner now informs candidate that ventilation is being performed without difficulty … (SPO2) is 85%
Steps 6 & 7
- Attaches O2 reservoir to BVM device and connects to high-flow O2 regulator (12-15 lpm)
- Ventilates pt at a rate of 10 -12/min with appropriate volume
After 30 seconds …The examiner must now take over ventilation
Steps 8 - 10
- Directs assistant to pre-oxygenate pt
- Identifies/selects proper equipment for intubation
- Checks equipment for: -Cuff leaks (1 point) -Laryngoscope operational with bulb tight (1 point)
Examiner to remove OPA …
Steps 11 - 13
- Positions head properly
- Inserts blade while displacing tongue
- Elevates mandible with laryngoscope
Steps 14 & 15
- Introduces ET tube and advances to proper depth
* Inflates cuff to proper pressure and disconnects syringe
Steps 16 & 17
- Directs ventilation of patient
* Confirms proper placement by auscultation bilaterally over each lung and over epigastrium
“If you had proper placement…”
Step 18
Secures ET tube (may be verbalized)
“…dditional method of verifying proper tube placement…”
Steps 19 & 20
- Identifies/selects proper equipment
* Verbalizes findings and interpretations (checks end-tidal CO2, colorimetric device, EDD recoil, etc.)
“You see secretions in the tube and hear gurgling sounds with the patient’s exhalation”
Steps 21 - 23
- Identifies/selects a flexible suction catheter
- Pre-oxygenates patient
- Marks maximum insertion length with thumb and forefinger
Steps 24 - 26
- Inserts catheter into the ET tube leaving catheter port open
- At proper insertion depth, covers catheter port and applies suction while withdrawing catheter
- Ventilates/directs ventilation of patient as catheter is flushed with sterile water
Critical 1 & 2
- Failure to initiate ventilations within 30 seconds after taking body substance isolation precautions or interrupts ventilations for greater than 30 seconds at any time
- Failure to take or verbalize BSI precautions
Critical 3 - 5
- Failure to voice and ultimately provide high oxygen concentration (at least 85%)
- Failure to ventilate the patient at a rate of 10 – 12/minute
- Failure to provide adequate volumes per breath (maximum 2 errors/minute permissible)
Critical 6 - 9
- Failure to pre-oxygenate patient prior to intubation and suctioning
- Failure to successfully intubate within 3 attempts
- Failure to disconnect syringe immediately after inflating cuff of ET tube
- Uses teeth as a fulcrum
Critical 10 - 14
- Failure to assure proper tube placement by auscultation bilaterally and over the epigastrium
- If used, stylette extends beyond end of ET tube
- Inserts any adjunct in a manner dangerous to the patient
- Suctions patient excessively
- Does not suction the patient
Critical 15 - 17
- Failure to manage the patient as a competent EMT
- Exhibits unacceptable affect with patient or other personnel
- Uses or orders a dangerous or inappropriate intervention
