2nd Year

Question 1

In order of preference, list insertion sites for adult ez-io

Answer 1

humeral head, proximal tibia, distal tibia

Question 2

In order of preference, list insertion sites for paediatric ez-io sites.

Answer 2

Under 6 - distal femur, proximal tibia, distal tibia

Over 6 - Proximal tibia, distal tibia

Question 3

Contraindications for IO access.

Answer 3

Fracture in the insertion site.
Absence of landmarks.
Knee replacement surgery.
Patient has had an IO in the last 48 hours.
Infection of the site.

Question 4

Identify the complications with IO access.

Answer 4

Dislodgement
Osteomyelitis
Growth plate damage
Compartment syndrome
Tissue necrosis

Question 5

What happens if you cannulate a healthy lung?

Answer 5

Pneumothorax

Question 6

Indications for a tension pneumothorax?

Answer 6

Hyper-tesonance
Surgical emphysema
Reduced spo2
High respiratory rate
Reduced air entry/No air entry on affected lung/side
Tracheal deviation
Unequal rise and fall of chest
The mechanism of injury

Question 7

What is the physiological process that can reduce output during tension pneumothorax?

Answer 7

A build-up of air in the pleural space raise intrathoracic pressure and pushes on the mediastinum.
This obstructs venous return to the heart and leads to circulatory instability and may result in traumatic arrest.

Question 8

What should you do if the primary site in Needle decompression is not accessible?

Answer 8

5th intercostal space mid-axilla

Question 9

What should you do if unsuccessful in needle decompression?

Answer 9

Remove the needle, place dressing over it, and record it.

Question 10

Complications of a needle cricothyroidotomy?

Answer 10

Barotrauma or a pneumothorax.

Misplacement.

Question 11

Limitations of a needle cricothyroidotomy?

Answer 11

20-30 minutes working time.
A size 14 cannula requires high pressure to ventilate
Barotrauma

Question 12

What pressure is required to provide trans-tracheal jet insufflations?

Answer 12

50 PSI

Question 13

When would you do a needle cricothyroidotomy?

Answer 13

When you can’t intubate and can’t ventilate.

Question 14

Main anatomical features you might expect in difficult intubation?

Answer 14

Short neck
Receding jaw
Obesity
Facial trauma
Large incisors
Dentures

Question 15

Which Malampati classification is more difficult?

Answer 15

Class 4.

Question 16

What are the degrees of difficult in the cormack and lehane classifications?

Answer 16

Grade 1-2 is acceptable/good.

Grade 3-4 is bad.

Question 17

Possible complications of intubation?

Answer 17

Aspirating the stomach
Pneumothorax from excessive ventilation
Laryngospasm
Induced bradycardia

Question 18

What ETCO2 range would you aim for in a pulsed adult patient?

Answer 18

4.0 - 5.7

Question 19

What ETCO2 range would you aim for in a pulsed child patient?

Answer 19

4.5 - 5.0

Question 20

What clinical findings are there that would indicate a failed intubation?

Answer 20

An ETCO2 of less than 1.
Stomach rise.
Silent chest.
No chest rise and fall.

Question 21

How can you reduce the risk to the patient when considering human factors in intubation?

Answer 21

Using a bougie.
Regular CPD.
2 max attempts at intubation per person.
Back up plans.

Question 22

What colours/sizes are for fluids in cannulation?

Answer 22

Green - 18G
Grey - 16G
Orange - 14G

Question 23

What colours/sizes are for drugs in cannulation?

Answer 23

Blue - 22G

Pink - 20G

Question 24

Should you use a razor if the cannulation insertion site is hairy?

Answer 24

No, due to microabrasions.

Question 25

Who is responsible for sharps?

Answer 25

The person using the sharps.

Question 26

Can you remove and re-insert a cannula if unsuccessful?

Answer 26

No, it blunts the cannula and you can cause micro-emobli

Question 27

What are the risks with cannulation?

Answer 27

Haematoma.
Syncope.
Phlebitis.
Extravisation
Local infection
Sepsis

Question 28

What sites to avoid when cannulating?

Answer 28

Valves.
The mastectomy side.
Oedema
Celluliitis
AV fistula
Arteries