ALS Skills Flashcards
(131 cards)
1
Q
OG tube indications and contraindications
A
indications: gastric decompress in ped & adult pts getting assisted ventilations
Contraindications: alert, gag reflex, esophagus issues (varices, disease, structures), no advanced airway, Caustic ingestions
2
Q
What size OG tube to use for infants, pediatrics, and adults?
A
infants (3-15kg) = 6FR
Peds (16-25kg) = 12 FR
Adults (>25kg) = 18 FR
3-15-25… 6-12-18
3
Q
Your pt is about 10kg. What size OG tube to use and why?
A
All pts 3 to 15kg get a 6FR.
4
Q
Your pt is about 20kg. What size OG tube to use and why?
A
All pts 16-25kg get a 12 FR
5
Q
Your pt is about 30kg. What size OG tube to use and why?
A
all pts >25kg get an 18 FR
6
Q
how to measure an OG tube?
A
Corner of mouth > behind earlobe > midpoint between sternum tip and navel
7
Q
how would you insert an OG tube differently between a king airway and an ETT
A
King airway = insert into the OG slot/hole
ETT = insert NEXT TO the ET tube
8
Q
what position do you want the pt’s head when inserting an OG tube?
A
neutral
9
Q
how do you confirm placement of an OG tube?
A
inject 5-20 ml bolus of air (depending on pt size) into OG tube via 60cc catheter tip syringe, while listening w/ stethoscope. Listen for gurgling sounds
10
Q
what sounds should you hear with a stethoscope when confirming OG tube placement? where should you hear it?
A
gurgling in the stomach
11
Q
what suction setting to use on an OG tube? when to stop suctioning an OG tube?
A
low non-continuous suction. Stop the suction when there is no more stomach gunk coming out
12
Q
how to secure an OG tube?
A
tape lightly to exterior cheek
13
Q
What are the basic overview steps of inserting an OG tube?
A
- I-MACC
- Choose appropriate tube size & measure length
- Place the tube (w/ lube)
- Confirm placement
- Suction
- Secure tube
14
Q
Indications and contraindications of a King Airway
A
Indications: cardiac arrest, resp insufficiency/failure/arrest
contra = known esophageal disease, caustic substance, height < 4ft
15
Q
what sizes do the king airways come in?
A
3 tube = 4-5ft
#4 tube = 5-6ft
#5 tube = 6-7ft
16
Q
What technique to insert (just the insertion part) a king tube in the mouth?
A
- grab jaw & tongue > lift anteriorly
- tube in corner of mouth, rotated 45-90 deg to the side
- advance down posterior tongue and rotate back to midline
- stop when hub at lip/gum line
- inflate balloon up to 60cc air for seal
17
Q
how much air to inflate a king airway
A
Up to 60cc, but varies based on packaging
18
Q
how far down to push a king airway
A
until the hub is at lip/gum line
19
Q
once you initially insert a king airway, what should happen as you start bagging?
A
gently retract the tube as you bag until it “seats”. the ventilations will be easy after
20
Q
what to do if you fully inflate a king tube and air is still leaking?
A
add additional 20cc air
21
Q
5 confirmation methods of a king tube placement
A
- good bag compliance
- good Etco2 waveform
- chest rise
- lung sounds
- no epigastric sounds
*bag to butt
22
Q
What ventilation rate and ETCO2 to maintain with a king tube?
A
12-16 breaths/min
EtCO2 35-45 mmH20
23
Q
What are the general steps to inserting a king tube?
A
- I-MACC
- choose appropriate device size
- lube & insert tube
- inflate
- attach EtCO2 & ventilate/seat the tube
- confirm placement
- secure
- maintain ventilations/spo2/etco2
24
Q
Adult Endotracheal Intubation indications and contraindications
A
Indication: Resp insufficiency/failure/arrest
Contraindications: none
25
How long to pre-oxygenate the pt and what does pre-oxygenating actually mean?
Oxygenating the pt for 30 seconds prior to intubation. NOT hyperventilating.
26
How many seconds per adult intubation attempt? What is the total number of attempts per pt?
Max 15s per attempt, max 2 attempts per pt
27
What are the 5 confirmation methods for adult intubation?
1. Good bag compliance.
2. Good waveform capno
3. Chest rise
4. Lung sounds
5. No epigastric sounds
28
What would you do if you suspected your intubation tube when into the R bronchus only>
Retract 1-2cm & reassess
29
What are the general steps for adult endotracheal intubation?
1. I-MACC
2. Assemble equipment
3. Pre-oxygenation
4. Insert tube
5. Confirm (EtCO2)
6. Secure
30
Medication Facilitation Intubation indications and contraindications
Indications = resp insufficiency/failure/arrest, need airway mgmt but is still conscious, gag reflex, or jaw clenching
Contra = medication allergy
31
Can you facilitate intubate kids?
Only in extreme cases w/ OLMC consult
32
What’s the “SAFETY ALERT” for medication facilitation intubation?
Be extremely cautious with difficult airways
33
What medications and dosages for facilitated intubation?
Fentanyl 2 mcg/kg IVP
Etomidate 0.3 mg/kg SIVP (over 20s)
After success = Versed 2.5mg repeat x1 PRN
34
How much fentanyl to give for a facilitated intubation
2 mcg/kg IVP
35
How much Etomidate to give during an adult facilitated intubation? How fast to push it?
0.3mg/kg SIVP (over 20s)
36
How much Midazolam to give to an adult during a facilitated intubation?
2.5mg, repeat x1 PRN
37
What to do if you are unsuccessful at a facilitated intubation?
Call OLMC asap
38
General steps for medication facilitation intubation
1. I-MACC
2. Prep equipment
3. IV or IO access
4. Administer meds (fentanyl then etomidate)
5. Intubate, confirm, and secure
6. Versed (2.5mg, repeat x1 PRN)
39
IO Access indications and contraindications
Indication: cardiac arrest, or can’t get a critical IV on a red pt
Contraindication (FLIIP) - fracture, no landmarks/excessive tissue, infection, prosthetics
40
What landmarks for an IO
Proximal tibial plateau
Proximal humeral head
Distal tibia (proximal to medial malleolus)
41
Which pts get a hand bore IO instead of the power drill?
Pt < 1 years old
42
When performing an IO, what drug and dose to give for the pain?
Lidocaine 2%
Adult = 20 mg SIVP
Peds = 0.5mg/kg (max 20mg) SIVP
43
How do you know if an IO site has infiltrated?
Swelling at site
Fluids not running
44
General steps for IO access
1. I-MACC
2. Prep & drill w/ proper needle length
3. Confirm (aspiration) & flush
4. Lidocaine 2$ (if pt conscious)
5. Note time & operator name on limb
6. Secure
45
How do you confirm proper placement of an IO?
Aspirate the line before flushing.
Assess for swelling or fluids running
46
Needle Thoracostomy indications and contraindications
Indications = suspected pneumothorax w/ severe resp distress, hypotension or cardiovascular collapse (shock), traumatic cardiac arrest w/ chest/abdominal injury
Contraindications = simple pneumothorax
47
Primary vs secondary site to needle decompress an adult vs ped?
Adult:
Primary = Lateral 5th intercostal, anterior axillary
2nd = anterior 2nd intercostal, mid-clavicular (10g 3.25in)
Ped:
1st = lateral 4th intercostal, anterior axillary
2nd = anterior 2nd intercostal, mid clavicular (16g, 1.16in)
48
What needle decompression size for adults vs peds
Adult = 10g - 3.25in
ped = 16g, 1.16in
49
How do you know your needle decompress is in the correct spot?
Rush of air from catheter
Ventilation improvements
Equal chest rise returns
50
Needle thoracostomy general steps
1. I-MACC
2. Prep equip
3. Expose/prep site & identify landmarks
4. Insert needle
5. Confirm placement
6. Secure and reassess (lungs/vitals) per 5min
51
Defibrillation indications and contraindications
Indications: V-fib, pVtach, polymorphic Vtach
Contraindications: hazardous environment, DNR
52
2 ways to dump a charge
1. Switch down to “on” position then back
2. Press the soft key
53
how to manually change the MRX pacer from fixed back to demand mode
Check mark (menu) > pacer mode > demand
54
MRX fixed vs demand pacing?
Demand = MRX analyzes and paces as needed
Fixed = MRX paces regardless of underlying rhythm
55
When pacing someone, which setting (fixed or demand) does the MRX automatically start on? When does it transition?
It starts on demand, but will transition to fixed if the limb leads are pulled off
56
What two pieces of equipment do you need attached, in order to pace a pt?
Limb leads
Defib pads
57
Fast way to calculate fentanyl single dose (in mL for pain management)
Pt weight (in pounds) move decimal 2 to the left:
80kg = 160lb = 1.6mL (single dose)
58
What’s the dose of fentanyl for adult facilitated intubation? Max dose? Repetitions?
2mcg/kg
Only ONE single dose (no repetitions) with max 400mcg
59
Fast way to calculate fentanyl dose (in mL) for adult facilitated intubation? (Ex. Pt weights 80kg)
Pt weight (in kg) x 4 / 100
80kg x 4 = 320 / 100 = 3.2mL
60
Can you facilitate intubation for peds?
Only in extreme circumstances after OLMC consult
61
How does our fentanyl come packaged (dose per volume)
100mcg/2mL
62
How does our etomidate come packaged? (Dose/volume)
40mg/20ml vial
63
What is the dose of etomidate for facilitated intubation? how should you push it?
0.3mg/kg SIVP (over 20seconds)
64
What is the fast way to calculate dosage of etomidate for facilitated intubation (ex 100kg pt)
Pt weight (in kg) times 3 / 10 / 2
100 x 3 = 300 /10 = 30 / 2 = 15mL
65
What meds to give to a pt gnawing on their tube in a facilitated intubation vs all other cases where pt is intubated
All non-facilitated cases = 50mcg fentanyl + 2.5mg versed (repeat doses x1 in 5 min)
Facilitated = ONLY 2.5mg versed (repeat x1)
66
During facilitated intubation, how long after pushing fentanyl do you give the etomidate?
1-2min after
67
Why SHOULDNT you push air into an amio vial prior to drawing it up?
You will cause foaming
68
What packaging do we carry Amio?
150mg/3mL vial
69
Amio drip rate, time, and volume?
150mg mixed 100mL bag over 10min (Just remember 50 drops per 15s)
70
Why site would you confirm a mechanical pulse when pacing a pt?
Radial or femoral
71
Transcutaneous Pacing indications and contraindications
Indications = unstable bradycardia
Contraindications = hazardous environment
72
When pacing, whats the initial rate and amps to start? Which would you adjust upwards until you get mechanical capture? By how much each increment?
60 BPM & 60 milliamps
Increase MILLIAMPS by 10 until pulses felt
73
What to do if you begin pacing a pt and they end up hypotensive? Normotensive?
Hypotensive = increase rate by 10 > 70bpm up to 90bpm. Epi drip if still hypo
Normotensive = monitor pt condition
74
What are the general steps to transcutaneous pacing
1. I-MACC
2. Limb leads (press “lead select” > pick best R wave
3. Attach & connect pads
/
4. Switch knob > pacer & verify R wave markers
5. “Pacer rate” = 60bpm, “Pacer output” = 60milliamps > “start pacing”
6. Confirm mechanical capture (radial or femoral) & adjust output PRN
7. Reassess & maintain BP
75
Synchronized Cardioversion indications and contraindications
Indications = unstable tachydysrhythmia
Contraindications = hazardous environment
76
When doing a synchronized cardiovert, how do you know the monitor is synced?
A sync marker will appear with each R-wave
77
What joules to start & progress for regular (narrow or wide) unstable tachycardia?
100J - 120 - 150 - 170
78
What joules to start and progress for an irregular - narrow tachycardia?
120J - 150J - 170J
79
What to say every time you want to clear the pt before a cardiovert or defib
“I’m clear”, “you’re clear”, “Oxygen clear”
80
What general steps for synchronized cardioversion
1. I-MACC
2. Knob to “Monitor”
3. Sync button
4. Confirm sync marker
5. Charge & clear
6. HOLD shock button
81
When defibrillating, what position to place the pads on an Adult vs Ped?
Adult = anterior / anterior
Ped = Anterior / Posterior
82
Vector change indications
Adult refractory V-fib w/ x3 shocks & antiarrhythmics onboard
83
what general steps to perform defibrillation?
1. I-MACC
2. Expose & prep skin (watch for devices)
3. Pads (place & connect)
4. Turn dial knob > "Manual Defib"
5. Charge & CLEAR
6. Shock
84
Surgical Cricothyrotomy indications and contraindications
indications = >10years w/ resp insufficiency/failure/arrest and inability to ventilation/oxygenate by ETT, BVM, or extraglottic
Contra = <10 years, can't locate landmarks
85
what equipment do you need to do a surgical cric?
alcohol prep or betadine
scalpel
6.0 ETT
Curved Kelly Clamp
ETCO2, 10ml syringe, BVM
86
What are the general steps to performing a surgical cric?
1. I-MACC
2. Gather equipment & prep pt
3. non-dominant hand stabilize thyroid cartilage
4. 3cm vertical cut on cricothyroid membrane
5. transverse cut & insert scalpel
6. Insert Kelly clamps & pry open
7. guide down ETT, Confirm placement, secure
8. Ventilate & monitor ETCO2 / SPO2
87
how to confirm tube placement on a surgical cric?
*Bag to Butt:
Bag compliance
Etco2
Bilat chest rise
Equal lung sounds
no epigastric sounds
88
Pediatric Endotracheal Intubation indications & contraindications
indications = resp. insufficiency/failure/arrest
Contraindications = BVM is effective enough
89
what equipment do you want to have ready when intubating a kid?
ETT
blades & laryngoscope
ETCO2
Tube securing device
suction
rescue airway
90
max time and number of attempts to intubate a kid?
<15 seconds
total of 2 times
91
should you inflate the ETT cuff on a kid?
Yes but NOT if < 30 days
92
how long to pre-oxygenate a kid? what does pre-oxygenate mean?
30s of Oxygen prior to ETT. NOT hyperventilating
93
General steps to intubating a pediatric?
1. I-MACC
2. Assemble gear (tell partner to continue bagging during)
3. pre-oxygenate
4. Insert
5. Confirm placement
6. secure & ventilate
7. OG TUBE
94
when should you confirm placement of an ETT on a pt?
VERY often during pt contact and on arrival at ED
95
is ventilation rate and ETCO2 goal different on a pediatric vs an adult? what about for trauma's?
NO. they are identical
96
Needle Cricothryotomy indications and contraindications
indications: peds <10years, can't ventilate by other means due to facial trauma or obstructed airway
Contra = can't find landmarks. Neck tumor obstructs landmarks
97
what equipment do you need to needle cric a kid?
alcohol prep or betadine
14g IV
10cc syringe
3.0mm ETT
Pedi BVM
98
how to position a kid prior to needle cric
Supine w/ neck slightly hyperextended (rule out C-spine first)
99
where should the clinician stand during a needle cric?
Right handed = L side of pt
Left handed = R side of pt
100
What are the general steps to needle cric
1. I-MACC
2. assemble gear
3. position pt and self
4. grab the larynx & cricothyroid membrane
5. insert @ 45 degree w/ syringe (drawback as you go)
6. advance catheter & remove needle
7. attach 15mm adapter and ventilate
8. secure best you can
101
How to mix an Epi drip? What dose and frequency to titration? Max dose?
1mg (either 10,000 or 1000) mix in 1000cc bag - 60gtt set
Start at 60gtt per min > increase by 60 each mcg (1mcg = 60 drops) until 5mcg/min max
102
How to mix norepi (dose, drip set)
What starting and max dose?
4mg in 1000cc bag in 60gtt set
Start at 1 mcg/min (15drops) to max 10 mcg
Each mcg is 15drop increments
103
How to mix push dose Epi
What dose to give
Squirt out 1cc from a 10cc flush
Add 1cc 1:10,000
Give 1ml (10mcg) until max of 5
104
What Epi drip range for bradycardia? Allergic?
Brady = 2-5mcg/min
Allergic = 1-4 mcg/min
105
Minimum IV size for norepi
18g
106
Cyanokit dose? Mix? Time of administration
5g in 200ml over 15min
107
Pt bucks the tube. What drugs to give this pt if you facilitated intubated vs normal arrest intubated him?
Facilitated intubation = just 2.5mg versed, repeat x1
Normal arrest intubation = 2.5versed, 50mcg fentanyl, repeat x1
108
Indications and dosage of cardizem?
Stable narrow irregular tachycardia (or regular w/ hx a-fib)
.25mg/kg SIVP (max single dose 20mg)
109
Indications and dose/mix of an amio infusion?
Stable wide tachyarrhythmia (regular or irregular)
150mg in a 100bag over 10min
110
Versed dose for a psych?
2.5mg IV/IM or 5mg IN, repeat x1
Severe = double dose, repeat normal dose x1
111
Versed dose for a seizure
2.5mg IV/IM or 5mg IN
Repeat per 5min until max of 10mg total
112
Dose mag sulfate for ecclampsia? severe asthma? Torsades?
Ecclampsia = 4g over 10min
Asthma = 2g over 10min
Torsades = 2g over 10min
113
Atropine dose?
0.5mg repeat until max 3mg
114
Adenosine adult dose?
6mg then 12mg then OLMC
115
How to do modified valsalva
Semifowlers > vagal 15s > supine w/ legs raised 45 degrees > semifowlers again
116
What is SVT for a ped vs infant?
>220 infant
>180 ped
117
Ped stable tachy Rx
Fluid
Vagal
Adenosine x2
Amio drip x20min
118
Ped brady Rx
Rule out reversible (hypoxia, OD, seizure, BGL)’
Epi 1:10,000 per 3-5min
Atropine if block/vagal/organo
3rd degree = pace
Bolus x2
119
Ped ROSC Rx
Fluid bolus x1
Epi drip > titrate to SBP 90
OLMC for norepi
120
ped w/ RONF bucks the tube. What Rx
Versed and fentanyl
121
Ped arrest has suspected hyper K . What Rx?
Sodium bicarb (4.2% - diluted 1:1 w/ NS) & calcium chloride
122
Sodium bicarb dose
100mEq
123
Calcium chloride dose
1g
124
Narcan dose on an arrest? (max dose?)
2mg IV/IO (max 6mg)
125
D10 dose on an arrest?
25g (250ml) repeat x1
126
Nitro dose for a CHF pt
90 - 120 - 160
0.4 - 0.8 - 1.2
127
What sex drugs are contraindicated for nitro? What times
Gotta be SLiC for the Chicks*
Stendra (<12hr)
Levitra viagra (<24)
Cialis (<48)
128
What needle decompress size for an adult? A kid?
Adult = 10g - 3.25in
Kid = 16g - 1.16in
129
What size ETT requires the yellow inline capno
4.5 and below
130
What size ETT needed for a surgical cric?
6.0mm
131
What size ETT needed for a needle CRIC? What needle size?
3.0 ETT
14g
