IPP - SkillsSignoff 2

Question 1

[CAT - Tourniquet]

State the Indications of applying a Tourniquet

Answer 1

Indications:
➢ Severe bleeding for a limb that is uncontrolled despite firm, direct and sustained pressure.
➢ Bleeding from a limb that is immediately life threatening.
➢ Severe bleeding from a limb when the bleeding site cannot be reached.
➢ Crush injury of a limb (or more) that is trapped under a weight for more than 60 minutes prior to release.

Indications of applying a Tourniquet

Question 2

[CAT - Tourniquet]

State the Contraindications & Cautions of applying a Tourniquet

Answer 2

Contraindications:
➢ None
Cautions:
➢ None

Contraindications & Cautions of applying a Tourniquet

Question 3

[CAT - Tourniquet Application]

State the potential Complications of applying a Tourniquet

Answer 3

Complications:
➢ Severe pain
➢ Tissue damage
➢ If the tourniquet is applied to a limb with two bones it may limit the pressure that can be applied.
➢ Bleeding may be difficult to control if a tourniquet is placed over a thigh, particularly if large.

Potential Complications of applying a Tourniquet

Question 4

[CAT - Tourniquet]

Explain the Preparation for applying a Tourniquet

Answer 4

Preparation:
1. Explain procedure and again informed consent
1. Elevate (where suitable) and expose the limb
1. Demonstrate applying direct pressure
1. Prepare the CAT for application
➢ ARM: Slide the band over the arm
➢ LEG: Pass the strap around the leg and pass the band through the friction buckle

Preparation for applying a Tourniquet

Question 5

[CAT - Tourniquet]

State the correct Application of a Tourniquet

Answer 5

Application:
1. Position the CAT 5cm proximal to the wound. Do not apply over a joint
1. Pull the self-adhering band tightly and secure it back on itself.
1. Rotate the windlass rod until the bleeding has stopped and there is no distal pulse.
1. Lock the windlass rod in place in the windlass clip.
1. Secure the rod with the white securing strap.
1. Secure any remaining self-adhering strap around the windlass and fasten it back on itself.
1. Leave the wound exposed.
1. Record the time of application.
1. Check distal limb baselines.
1. Pulse, skin colour, temp, CRT.

Application of a Tourniquet

Question 6

[CAT - Tourniquet]

Discuss ongoing Considerations/Assessment after applying a Tourniquet

Answer 6

Discuss ongoing considerations:
➢ Re-check the tourniquet following treatment. It may need further tightening if blood pressure improves.
➢ If bleeding continues ensure tourniquet is tight enough and consider placing another one proximal to the first.

Ongoing Considerations/Assessment after applying a Tourniquet

Question 7

[Cardboard Splint]

State the Indications of applying a Cardboard Splint

Answer 7

Indications:
➢ Fractures or dislocations of the:
- Ankle
- Tibia and/or fibula
- Patella
- Hand, wrist, radius, ulna
- Elbow

Indications of applying a Cardboard Splint

Question 8

[Cardboard Splint]

State the Contraindications & Cautions of applying a Cardboard Splint

Answer 8

Contraindications:
➢ None.
Cautions:
➢ Time critical conditions: if the patient has time critical conditions, box splinting will cause unnecessary delay.

Contraindications & Cautions of applying a Cardboard Splint

Question 9

[Cardboard Splint]

State the Potential Complications of applying a Cardboard Splint

Answer 9

Potential complications:
➢ Pain during splinting
➢ Splints that are too small or too tight can cause ischaemia distal to the splint. This can increase pain and cause tissue damage.
➢ Splints that are too large or loose will not provide effective splinting.

Potential Complications of applying a Cardboard Splint

Question 10

[Cardboard Splint]

Explain the correct Preparation of applying a Cardboard Splint

Answer 10

Preparation:
1. Expose and examine the injured limb
1. Provide analgesia as required
1. Assemble the required equipment:
➢ Appropriate sized cardboard splint
➢ Towel
➢ 3x triangular bandages
➢ Tape
➢ Clothing shears
1. Cut and shape the cardboard splint as required to
1. Immobilise above and below the fracture
1. Pad the splint with towels to fill natural hollows and
1. Prevent movement

Preparation of applying a Cardboard Splint

Question 11

[Cardboard Splint]

Explain the correct Application for a Cardboard Splint

Answer 11

Application:
1. Perform neurological and cardiovascular limb baselines.
1. With the aid of a partner lift the limb slightly and position the splint under the limb.
1. Fold the cardboard splint around the limb and secure it with triangular bandages above and below the fracture site.
1. Reassess limb baselines.
1. Document application of the box splint.

Application for a Cardboard Splint

Question 12

[Cardboard Splint]

Provide Additional Therapy & Information after applying a Cardboard Splint

Answer 12

Additional Therapy & Information:
* To maintain the natural curve of the wrist when in a splint, instruct the patient to hold onto a roller bandage.
* Ensure adequate analgesia.

Additional Therapy & Information after applying a Cardboard Splint

Question 13

[C-Collar]

State the Indications of applying a C-Collar

Answer 13

Indications:
* The patients c-spine can not be clinically
cleared AND
➢ Significant posterior midline tenderness
AND/OR
➢ Signs or symptoms of spinal cord injury

Indications of applying a C-Collar

Question 14

[C-Collar]

State the ContraIndications & Cautions of applying a C-Collar

Answer 14

Contraindications:
➢ Patients who are unconscious.
➢ Identifies that significant abnormalities in the primary survey always take priority over the cervical spine.

Cautions:
➢ Patients with pre-existing c-spine abnormalities.
➢ Patients who are uncooperative.

ContraIndications & Cautions of applying a C-Collar

Question 15

[C-Collar]

State the Potential Complications of applying a C-Collar

Answer 15

Potential Complications:
* May worsen neck pain.
* May promote the development of pressure areas.
* Makes airway management more difficult.
* May raise intracranial pressure.

Potential Complications of applying a C-Collar

Question 16

[C-Collar]

Explain the Sizing and Preparation of applying a C-Collar

Answer 16

Sizing and Preparation:
1. Demonstrate correct sizing- measuring from the trapezius to the angle of the jaw.
2. Ensure the patient is in neutral alignment.
3. Pre-form the collar by squeezing it into a round shape.

Sizing and Preparation of applying a C-Collar

Question 17

[C-Collar]

Explain the correct Application of a C-Collar

Answer 17

Application:
1. Gain informed consent.
1. Advise patient not to move their head and provide manual stabilisation
1. Remove anything that may impede placement e.g. jewellery or a helmet.
1. Fit the collar:
➢ Slide the flat end of the collar behind the patient’s neck.
➢ Position the chin cup under the patient’s chin. Bring the end of the collar around & join Velcro edges together.
➢ Ensure the collar is well positioned, firm but not tight.
1. Record application of the cervical collar on the ePRF.

Application of a C-Collar

Question 18

[C-Collar]

Provide Additional Therapy & Information after applying a C-Collar

Answer 18

Further therapy and Information:
* Ensure the spine is still in neutral alignment, collars applied when sitting (e.g. in a car) may require adjustment once extricated.
* Consider placing head blocks or towels to limit lateral movement.
* Consider sitting the patient to 15° for comfort or to assist breathing.

Additional Therapy & Information after applying a C-Collar

Question 19

[Suctioning]

State the Indications of performing suctioning

Answer 19

Indications:
* Significant amounts of vomit or blood, that threatens airway patency and/or limits adequate ventilation.

Indications of performing suction.

Question 20

[Suctioning]

State the ContraIndications of performing suctioning

Answer 20

Contraindications:
➢ Suction of saliva or pulmonary oedema fluid.

ContraIndications of performing suction.

Question 21

[Suctioning]

State the Potential Complications of performing suctioning

Answer 21

Potential Complications:
* Damage to oropharynx.
* Hypoxia.
* Stimulation of the gag and cough reflex.
* Bradycardia and/or hypotension due to stimulation of the vagus nerve.

Complications of performing suction.

Question 22

[Suctioning]

State the correct Preparation for suctioning

Answer 22

Preparation:
* Apply PPE including safety glasses.
* Place patient in the recovery position unless in cardiac arrest to allow for fluids to clear the mouth via gravity.
* Manually clear the airway with OPA or finger of solid material if the patient is unconscious.

Preparation of performing suction.

Question 23

[Suctioning]

Demonstrate/Explain correct suctioning

Answer 23

Safe Suctioning:
* Turn suction on to maximum.
* Place catheter into mouth, only as far as can be seen.
* Cover the suction hole to initiate suction.
* Suction while withdrawing from mouth and in a circular motion.
* Take no longer than 10 seconds.

Safe Suctioning

Question 24

[Suctioning]

Provide Additional Therapy & Information for suctioning

Answer 24

Additional Therapy & Information:
* Demonstrate attaching a soft catheter and discuss when it is appropriate to use.

Additional Therapy & Information for suctioning.

Question 25

# [Sager Splint] State the **Indications** for applying a *Sager Splint*

Answer 25

**Indications:** * Suspected isolated fracture involving the shaft of the femur. | **Indications** for applying a *Sager Splint*.

Question 26

# [Sager Splint] State the **ContraIndications & Cautions** for applying a *Sager Splint*

Answer 26

**ContraIndications:** * None **Cautions:** * Time critical injuries. * Suspected fracture of the pelvis. * Suspected fracture of the foot or ankle. | **ContraIndications & Cautions** for applying a *Sager Splint*.

Question 27

# [Sager Splint] State the **Application** of a *Sager Splint*

Answer 27

**Application:** 1. Gain verbal consent. 1. Expose and examine the injured limb. 1. Assess limb baselines. 1. Provide analgesia as required. 1. Provide manual traction to the injured limb and ensure the limb is aligned. 1. Position the shaft between the legs. 1. Apply the strap around the upper thigh of the injured limb and ensure it is firm. 1. Extend the shaft until the crossbar is adjacent to the heel. 1. Fit the ankle harness and fasten to the crossbar. 1. Extend the shaft until the appropriate amount of traction is applied. 1. Apply the straps over the middle of the thigh, below the knee and above the ankle. 1. Consider strapping the legs together. 1. Reassess limb baselines. | **Application** of a *Sager Splint*.

Question 28

# [Airway Positioning] Correctly **Explain/Demonstrate** a *Sniffing Position*

Answer 28

**Sniffing Position:** * *Infants* ➢ Features: Large head, smaller body/torso. ➢ Manoeuvre: Towells under back/shoulders. * *Small Children* ➢ Features: Sternal Notch & Earlobes anatomically in line. ➢ Manoeuvre: Headtilt Chinlift * *Older Child / Adult* ➢ Features: Larger Torso, Smaller Head. ➢ Manoeuvre: Towel under head/shoulders. * *Obese patients* ➢ Features: Abnormally large body mass. ➢ Manoeuvre: Ramping. **Purpose:** To achieve earlobe parallel to sternal notch provides optimal position to secure the airway. | **Explain/Demonstrate** a *Sniffing Position*

Question 29

# [Airway Positioning] Correctly **Explain/Demonstrate** a *Jaw Thrust*

Answer 29

**Manoeuvre:** Adequate anterior push of posteior mandible. **Purpose:** Preferred manoeuvre for patients with suspected c- spine injuries to move tongue out the way. | **Explain/Demonstrate** a *Jaw Thrust*

Question 30

# [Airway Positioning] Correctly **Explain/Demonstrate** a *Head-Tilt Chin-Lift*

Answer 30

**Manoeuvre:** Whilst performing a CE grip and BVM ventilation. **Purpose:** Preferred manoeuvre for patients with suspected c- spine injuries to move tongue out the way. | **Explain/Demonstrate** a *Head-Tilt Chin-Lift*

Question 31

# [Airway Management - OPA] Accurately state **Indications** for an *OPA*

Answer 31

Should be routinely placed in all patients requiring airway support unless there is good reason not to. | Accurately state **Indications** for an *OPA*

Question 32

# [Airway Management - OPA] Accurately state **ContraIndications** for an *OPA*

Answer 32

Patient’s who are conscious or semiconscious with an intact gag reflex. | Accurately state **ContraIndications** for an *OPA*

Question 33

# [Airway Management - OPA] Accurately state **Potential Complications** for an *OPA*

Answer 33

**Potential Complications:** * Gagging, vomiting, aspiration. * Trauma to mouth structures. * Dental injury from biting. * Inadequate airway protection without adequate positioning. | Accurately state **Potential Complications** for an *OPA*

Question 34

# [Airway Management - OPA] Correctly demonstrate **Preparation & Insertion** of an *OPA*

Answer 34

**Preparation & Insertion:** * Correctly measures from corner of mouth to earlobe * Ensures patient is supine * Inserts concave upwards until the tip reaches the back of the tongue then rotated 180 degrees. * Flange positioned on top of teeth and under lips * Able to troubleshoot, inserting concave down in adult. * Able to state difference in small children and infants, inserting concave down. | Accurately state **Preparation & Insertion** for an *OPA*

Question 35

# [Airway Management - NPA] Accurately state **Indications** for a *NPA*

Answer 35

**Indications:** Patient requires airway support but has trismus, damage to oral cavity or gag reflex and OPA can’t be placed. | Accurately state **Indications** for a *NPA*

Question 36

# [Airway Management - NPA] Accurately state **ContraIndications** for a *NPA*

Answer 36

**ContraIndications:** Nasal trauma or extensive maxillofacial trauma​. | Accurately state **ContraIndications** for a *NPA*

Question 37

# [Airway Management - NPA] Accurately state **Potential Complications** for a *NPA*

Answer 37

**Potential Complications:** Epistaxis, ulceration, sinusitis, gag reflex. | Accurately state **Potential Complications** for a *NPA*

Question 38

# [Airway Management - NPA] Demonstrate/Explain **Preparation & Insertion** for a *NPA*

Answer 38

**Preparation & Insertion:** * Correctly measures from corner of nose to earlobe. * Ensures patient is supine and locates largest nostril. * Lubricates NPA. * Inserts aiming straight back. * Able to troubleshoot by rotating or changing nostril. | Accurately state **Preparation & Insertion** for a *NPA*

Question 39

# [Airway Management - BVM] Accurately states **Indications** for *BVM*

Answer 39

**Indications:** * Administration of high flow oxygen. * Providing PEEP. * Assisting ventilations or controlled ventilation. | **Indications** for *BVM*

Question 40

# [Airway Management - BVM] Accurately states **ContraIndications and Cautions** for a *BVM*

Answer 40

**Contraindications:** * Nil **Cautions:** * Active vomiting or insufficient breathing to open duckbill valve | **ContraIndications and Cautions** for a *BVM*

Question 41

# [Airway Management - BVM] Accurately states **Potential Complications** for a *BVM*

Answer 41

**Potential Complications:** * Hyper/hypoventilation. * Over ventilation leading to gastric inflation and increased intrathoracic pressure. * Brotrauma. * Asphyxiation due to the duckbill valve not opening adequately. | **Potential Complications** for a *BVM*

Question 42

# [Airway Management - BVM] Accurately states **Prepration & Insertion** for a *BVM*

Answer 42

**Preparation & Insertion:** * Have an appropriate adjunct inserted (OPA/NPA). * Correctly assembles BVM with all parts present; Correct mask, filter, PEEP, BVM chamber, reservoir bag, O2 tubing, O2 source (10L/min) * Correctly demonstrates single-handed CE grip with head tilt chin lift. * Correctly demonstrates double-handed VE grip with head tilt chin lift. * Demonstrates delivering ventilations utilising the rule of 3’s – 1/3 the bag, 3 fingers, no more than 3 seconds. | **Preparation & Insertion** for a *BVM*