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Clinical Skills Flashcards

(60 cards)

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1
Q

What must you be before every kit dump?

A

Establish a sterile field
Check equipment is in date and packaging is intact
Check if fluids are clear and not contaminated
Check you have a sharps box

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2
Q

What is an adverse reaction from an IM injection?

A

Swelling/oedema

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3
Q

What can occur with poor cannulation/infusion techniques?

A

Air embolism

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4
Q

What is an adverse reaction from infusion?

A

Allergic reaction

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5
Q

What is an adverse reaction from advanced airway interventions?

A

Gastric distension (excessive air pressure within abdomen)

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6
Q

What is an adverse reaction from cannulation?

A

Tissuing (accidental introduction of fluid into bodily tissue)

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7
Q

If a problem arises when using clinical skills, who do you report to?

A

Patient
Crewmate
Other clinicians at hospital
Management

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8
Q

When is Endotracheal intubation used?

A

Unconscious patients with no gag reflux
When airway has been managed with basic adjuncts
ROSC patients who remain unconscious and require transportation

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9
Q

What does Endotracheal intubation protect against?

A

Protects against aspiration of solid or liquid - inflation of cuff within trachea creates a seal

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10
Q

What is a mistake that happens within endotracheal intubation?

A

Inflating within oesophagus instead of the trachea - likely to result in death

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11
Q

When doing a kit dump what must we do to keep items sterile?

A

Keep items in packaging until use
Do NOT place items on the floor

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12
Q

What is part of a endotracheal intubation kit dump?

A

Oxygen + BVM
OPA might be already inserted
Suction
Laryngoscope
Forceps
Bougie
ET tube
Etco2 monitor
Catheter mount
Stethoscope
10ml syringe
Thomas tube holder

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13
Q

Explain the steps of endotracheal intubation

A

Bougie is inserted first - bent end goes into the mouth first
ET tube is threaded over bougie - bevelled end entering mouth first
Hold top of bougie while paramedic inserts tube into trachea
Bougie is removed and paramedic still holding ET tube in place
Etco2 monitor is then attached to tube
Catheter mount then BVM attached
Stethoscope is used to auscultation to confirm correct tube placement
10ml syringe is used to inject 6-8ml of air into inflation valve to inflate cuff while pt is being ventilated
Thomas tube holder is used to secure ET tube

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14
Q

How can a para confirm correct ET tube placement in endotracheal intubation?

A

Check Etco2
Observe bilateral chest movement
Auscultate
Check if air is entering stomach

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15
Q

What is BURP and when is it used?

A

BURP is used to improve visibility of the epiglottis
Place thumb and index/middle finger on either side of the patient’s thyroid cartilage and follow BURP
Backwards
Upwards
Rightwards
Pressure

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16
Q

What are complications that can happen during endotracheal intubation?

A

Displacement - etco2 can be an early warning sign showing patient is not being ventilated adequately
Obstruction - thick pulmonary secretions
Pneumothorax - unilateral chest movement (reach for Steph) - decompression of chest
Equipment failure
Stomach - overuse of BVM can lead to abdominal distension - especially in children can splint diaphragm and impede ventilation - insert nasogastric tube and apply gentle pressure over abdomen to expel air

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17
Q

What must every clinician do before performing any intervention?

A

Obtain consent

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18
Q

When do we use IV?

A

When administering drugs or fluid
To expedite ongoing care in hospitals
Prophylactically in unstable patients (preventing infection)

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19
Q

What the downsides of IV?

A

Painful
Delays ONS times
Provides direct entry for infectious pathogens
Accidental damage to nerves, tendons, arteries
Extravasion - leakage of fluid if cannula not sited properly

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19
Q

When do we NOT use IV?

A

Presence of injury, inflammation, or infection on site
Arterio-venous fistulas
Dorsum of hand in pt’s who are going for PPCI (primary percutaneous coronary intervention)

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20
Q

What is included in an IV dump?

A

Tourniquet
Chloraprep
Cannula
Gauze
Syringe
Saline flush
Sharps box

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21
Q

What is included in an IV infusion dump?

A

IV dump + giving set + fluids

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22
Q

How do you prepare an infusion?

A

Confirm correct drug and concentration
Check drug is not expired, clear and free of contaminants and packaging is intact

Hang fluids (avoid placing on floor or contaminated surfaces)

Close roller clamp
Puncture bag with piercing spike
Fill drip chamber half way
Open roller clamp/remove protective cover from leur lock and run fluid slowly to remove air bubbles
Close roller clamp and if chamber has become too full invert the bag and squeeze the chamber to return some of the fluids back into the bag
DO NOT let tubing drop onto floor

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23
Q

When do we use intraosseous?

A

Vascular access is required urgently and IV cannulation has failed or is not possible to obtain

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24
When do we NOT use intraosseous?
Conscious patients When the targeted bone has sustained a fracture Previous orthopaedic procedures at insertion site e.g. prosthetic If an IO has been attempted on bone within past 48 hours Infection at area of insertion Excessive tissue/absence of adequate anatomical landmarks
25
What are the downsides of intraosseous?
Painful Extravasation of fluid Compartment syndrome - if extravasation goes undetected limb can require surgical intervention or amputation Osteomyletis - serious infection following IO insertion
26
What is included in an intraosseous kit dump?
Power driver Needle set, ez connect extension set Stabiliser dressing Cleansing agent Luer lock syringe with sterile saline flush Sharps container 5mm (black mark closest to hub) must be visible when needle inserted
27
What are the typical insertion sites for intraosseous?
Humerus Proximal tibia
28
What is high-pitched inhalations/sometimes expirations indications of?
Upper airway narrowing - stridor
29
What are lower-pitched inhalations usually heard on expirations indications of?
Wheeze
30
If snoring is heard what must be done?
Manual airway manoeuvres or adjuncts
31
If gurgling is heard what must be done?
Suctioning
32
What is see-saw movements (paradoxical) of abdomen with chest an indication of?
Complete airway obstruction Chest expands and abdomen sinks and vice versa
33
When is a head tilt chin lift indicated and not indicated?
Indicated - unresponsive patients who have an airway obstruction NOT indicated - patients who have a potential spinal injury
34
When is a jaw thrust indicated and not indicated?
Indicated - unresponsive patient who has obstruction caused by loss of pharyngeal muscle NOT indicated - patients who have fractured jaws
35
What does a jaw thrust do?
Maintain neutral alignment of the head
36
What are the downsides of a jaw thrust?
Difficult to maintain for prolonged periods Requires second person to ventilate
37
How do you do a jaw thrust?
Place fingers behind mandible and lift upwards, use thumbs to open pt's mouth
38
What should ideally be done before suctioning?
Preoxygenation
39
What PPE should you use when suctioning?
Eyewear and gloves
40
What are the differences between the two suction catheters?
Rigid and wide-bore - suitable for blood and vomit Smaller flexible one can fit the oropharyngeal/nasopharyngeal airway - unsuitable for blood and vomit
41
How do we suction appropriately?
Visualise end of catheter at all times Suction for no more than 15 seconds Re-oxygenate patient Reassess constantly
42
When can postural drainage be used?
Immobilised patients on an orthopaedic stretcher
43
When is an OP indicated?
Unconscious patients with absent gag reflux Clear airway
44
How do you sized an OP?
Measure incisors to the angle of the jaw
45
When is an NP indicated?
Unresponsive patient with reduced LOC and intact gag reflux
46
When is an NP not indicated?
If not tolerated Basal skull fracture Nasal polyps
47
How do you use NP?
Lubricate beforehand (not over open ends) Insert bevel end facing nasal septum Rotate 180 degrees once enters nasopharynx
48
How do we know if an NP is not being tolerated?
Blanching of nostrils Remove it and insert smaller size
49
What do we do after inserting adjuncts?
Check chest rise and listen for breath sounds
50
When is a supraglottic airway indicated?
BVM ventilation not effective Prolonged ventilation required Intubation fails
51
When is a supraglottic airway NOT indicated?
Patient has a gag reflex Patient is not deeply unconscious Patient has truisms or limited mouth opening
52
What is included in a supraglottic kit dump?
Suction BVM + oxygen Forceps Laryngoscope Igel Lube OPA Stethoscope Etco2 - connect igel to capnography, catheter mount and BVM Catheter mount Securing device - thomas tube
53
What are the steps of an i-gel?
Place small amount of lube onto inner and outer rim of the device Push I-gel in until resistance is felt - bite block should end at incisors Connect gel to capnography, catheter mouth and BVM Check end-tidal co2 and bilateral chest air entry/movement of chest Secure igel
54
How do we handle oxygen safely?
Keep free from naked flames, fuel pumps, and extreme temps, defib shocks Check cylinders before use for damage/oil/grease i.e. check clean Do NOT handle if just used alcohol rub Do NOT use if leaky valve/avoid poorly ventilated rooms - oxygen in room at 24% increases danger dramatically
55
How do we know entonox is fit for use?
Store above 10 degrees 24 hours prior to use If not, warm to 10 degrees then invert x3 times prior to usage - gas mixture separates
56
When do we administer oxygen?
Hypoxia Critically ill pt's requiring oxygen supplementation COPD - monitor and do not go above 92 as can increase co2 levels in blood and lead to respiratory depression
57
When do we not administer oxygen?
If in explosive environments Defib pads being used Around fire hazard Paraquat poisoning - can worsen with oxygen supplementation so target 88-92 saturations Not indicated
58
When is entonox indicated?
Moderate to severe pain Labour pains ACS bundle
59
When is entonox not used?
Severe head injuries with impaired consciousness Decompression sickness Violently disturbed psychiatric patients Risk of pneumothorax Abdominal obstruction

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