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EMS Procedures > Procedures I > Flashcards

Procedures I Flashcards

1
Q

Name three (of four listed) ways to increase the prominence of the enterojugular vein before performing an EJ.

A
  1. Lower the head of the bed / raise the feet;
  2. Valsalva (have the patient “bear down”);
  3. Place a stethoscope around the neck to occlude the distal vein;
  4. Percuss the vein (smack it);

Note: Once the vein has been identified, feel free to mark it with a sharpie;

- https://www.youtube.com/watch?v=JIP5p8E0ejw

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2
Q

When preparing for synchronized cardioversion with the LIFEPAK 15, which lead should be selected for view?

A
  1. Lead II, or the lead with the greatest QRS amplitude;

Stryker LIFEPAK 15 monitor/defibrillator poster, 2019

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3
Q

When preparing for synchronized cardioversion with the LIFEPAK 15, what should be confirmed after pressing the SYNC button and before charging the monitor?

A
  1. Confirm that a triangle sense marker appears near the middle of each QRS complex.

Stryker LIFEPAK 15 monitor/defibrillator poster, 2019

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4
Q

When preparing for synchronized cardioversion with the LIFEPAK 15, what should be done if triangle sense markers do not appear after the SYNC button has been pressed (or if the markers appear in the wrong locations, e.g. on the T wave)?

A
  1. Adjust the ECG size or select another lead;

Stryker LIFEPAK 15 monitor/defibrillator poster, 2019

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5
Q

When preparing for synchronized cardioversion with the LIFEPAK 15, at what point does Stryker recommend that the electrical therapy pads be placed?

A
  1. After ECG monitoring and synchronization have been achieved with the ECG cables / electrodes;

Stryker LIFEPAK 15 monitor/defibrillator poster, 2019

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6
Q

When preparing for synchronized cardioversion of a narrow, regular rhythm, the AHA recommends an initial dose of ___ J for adults.

A
  1. 50-100 J (biphasic or monophasic);

AHA 2015 Handbook of Emergency Cardiovascular Care for Healthcare Providers, Adult Tachycardia with a Pulse Algorhythm

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7
Q

When preparing for synchronized cardioversion of a narrow, irregular rhythm, the AHA recommends an initial dose of ___ J for adults.

A
  1. 120-200 J biphasic (or 200 J monophasic);

AHA 2015 Handbook of Emergency Cardiovascular Care for Healthcare Providers, Adult Tachycardia with a Pulse Algorhythm

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8
Q

When preparing for synchronized cardioversion of a wide, regular rhythm, the AHA recommends an initial dose of ___ J for adults.

A
  1. 100 J;

AHA 2015 Handbook of Emergency Cardiovascular Care for Healthcare Providers, Adult Tachycardia with a Pulse Algorhythm

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9
Q

When preparing for synchronized cardioversion of a wide, irregular rhythm, the AHA recommends an initial dose of ___ J for adults.

A
  1. The AHA recommends defibrillation for this rhythm, not synchronized cardioversion;

AHA 2015 Handbook of Emergency Cardiovascular Care for Healthcare Providers, Adult Tachycardia with a Pulse Algorhythm

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10
Q

After failed rhythm conversion from an initial synchronized cardioversion shock, the AHA recommends increasing the energy in a ___ fashion, per ___.

A
  1. Stepwise;
  2. Manufacturer;
    * AHA 2015 Handbook of Emergency Cardiovascular Care for Healthcare Providers, Electrical Cardioversion Algorithm;*
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11
Q

When preparing for synchronized cardioversion, if delays in synchronization occur and the patient’s clinical condition is critical, what does the AHA recommend?

A
  1. Immediately resort to unsynchronized shocks;

AHA 2015 Handbook of Emergency Cardiovascular Care for Healthcare Providers, Electrical Cardioversion Algorithm

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12
Q

When performing synchronized cardioversion requiring a stepwise increase in energy, the sync mode should be reset (or verified to still be set) after each shock delivery, as most defibrillators default back to unsynchronized mode. Why does this default exist?

A
  1. This default allows for an immediate defibrillation if the cardioversion produces VF;

AHA 2015 Handbook of Emergency Cardiovascular Care for Healthcare Providers, Electrical Cardioversion Algorithm

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13
Q

When preparing to perform synchronized cardioversion on a pediatric patient (for all applicable rhythms), what initial energy does does the AHA recommend?

A
  1. 0.5-1 J/kg;

AHA 2015 Handbook of Emergency Cardiovascular Care for Healthcare Providers, Steps for Pediatric Defibrillation and Cardioversion

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14
Q

When performing synchronized cardioversion on a pediatric patient (for all applicable rhythms), what dose of energy does does the AHA recommend for follow-up shocks beyond the initial does?

A
  1. 2 J/kg;

AHA 2015 Handbook of Emergency Cardiovascular Care for Healthcare Providers, Steps for Pediatric Defibrillation and Cardioversion

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15
Q

When performing a synchronized cardioversion with the LIFEPAK 15, ___ and ___ the shock button on the difibrillator until the ___.

A
  1. Press;
  2. Hold;
  3. ENERGY DELIVERED message appears on the screen;
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16
Q

When preparing to perform noninvasive transcutaneous pacing with the LIFEPAK 15, after applying the ECG and the electrical therapy electrodes, press the ___ button and confirm that the ___ marker is near the ___.

A
  1. PACER;
  2. Triangle sense marker;
  3. Middle of each QRS;
    * Stryker LIFEPAK 15 monitor/defibrillator poster, 2019*
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17
Q

When preparing to perform noninvasive transcutaneous pacing with the LIFEPAK 15, after confirming placement of the trinagle sense marker near the middle of each QRS, press the ___ button to _(objective)_, then the ___ button until _(objective)_.

A
  1. RATE;
  2. Select the desired pacing rate;
  3. CURRENT;
  4. Electrical capture occurs;
    * Stryker LIFEPAK 15 monitor/defibrillator poster, 2019*
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18
Q

When performing noninvasive transcutaneous pacing with the LIFEPAK 15, Stryker recommends checking ___ and ___ to verify mechanical capture.

A
  1. Blood pressure;
  2. Pulse;
    * Stryker LIFEPAK 15 monitor/defibrillator poster, 2019*
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19
Q

How may temporary viewing of a patient’s underlying rhythm be achieved during noninvasive transcutanous pacing?

A
  1. PAUSE button;

Stryker LIFEPAK 15 monitor/defibrillator poster, 2019

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20
Q

The ___ button on the LIFEPAK 15 initiates analysis in AED mode.

A
  1. ANALYZE;

Stryker LIFEPAK 15 monitor/defibrillator poster, 2019

21
Q

The ___ button on the LIFEPAK 15 initiates (or silences) the metronome feature.

A
  1. CPR;

Stryker LIFEPAK 15 monitor/defibrillator poster, 2019

22
Q

When performing SPO2 monitoring with a LIFEPAK 15, on which finger does Stryker recommend placing the sensor? How is it recommended that the cable be oriented?

A
  1. The ring finger of the non-dominant hand;
  2. Orient the cable on the back of the patient’s hand;
    * Stryker LIFEPAK 15 monitor/defibrillator poster, 2019*
23
Q

On the LIFEPAK 15, only ___® sensors are capable of reading SpCO / SpMet.

A
  1. Rainbow;

Stryker LIFEPAK 15 monitor/defibrillator poster, 2019

24
Q

When SpCO or SpMet are selected for readout on the LIFEPAK 15, the selected value will only display for ___ seconds.

A
  1. 10;

Stryker LIFEPAK 15 monitor/defibrillator poster, 2019

25
Q

On the LIFEPAK 15, if SpCO or SpMet readings are above normal limits (SpCO greater than ___%, SpMet greater than ___%) an advisory message will occur.

A
  1. 10;
  2. 3;
    * Stryker LIFEPAK 15 monitor/defibrillator poster, 2019*
26
Q

What causes the ALARM APNEA message to appear on the LIFEPAK 15 during EtCO2 monitoring?

A
  1. No breath has been detected for 30 seconds since the last valid breath (> 8 mmHg);

Stryker LIFEPAK 15 monitor/defibrillator poster, 2019

27
Q

Name four (of six listed) methods for increasing the success rate of nasogastric tube placement in a sedated, intubated patient.

A
  1. Lift the thyroid cartilate upward and rightward (facilitates separation of larynx and esophagus);
  2. Deflate the endotracheal balloon cuff (facilitates separation of larynx and esophagus);
  3. Flex the patient’s neck (facilitates passages of NG tube along posterior pharynx);
  4. Stiffen the NG tube (e.g. by refrigeration or use of an inner catheter / guidewire);
  5. Insert the NG tube perpendicularly to a length equal to the distance from the patient’s nostril to their mandibular angle, then rotate 180 degrees before advancing further(facilitates passages of NG tube along posterior pharynx);
  6. Pull the NG tube out of the Patient’s mouth with Magill forcepts, place the straight end of a bougie introducer into the distal suction hole of the NG tube, pull the tube back into the pharynx and guide it into the esophagus using the bougie.
    * https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1365-2044.2005.04418.x*
    * https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5637449/*
28
Q

Nasogastric tubes should generally be inserted to the ___-___ cm mark in an adult patient.

Gastric placement of an NG tube may be confirmed in the field by ___.

A
  1. 50-55;
  2. Auscultation;
    * https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5637449/*
29
Q

___ cricothyrotomy is indicated as a life-saving, last-resort procedure in children younger than ___ years who present or progress to the “can’t intubate, can’t oxygenate” scenario and whose obstruction is ___ to tglottic opening.

A
  1. Needle;
  2. 10;
  3. Proximal (or cephalad);

Major Memory System: A record player’s needle drops on the eighties’ (10) best album, Thriller.

The Walls Manual of Emergency Airway Management, Fifth Edition, 2018, p. 306

30
Q

The classic indication for needle cricothyrotomy is _(condition)_ where ___ and ___ are judged to have failed.

A
  1. Epiglottitis;
  2. Bag mask ventilation (BMV);
  3. Intubation;

Note: Other indications include facial trauma, angioedema, and other conditions that preclude access to the glottic opening from above.

The Walls Manual of Emergency Airway Management, Fifth Edition, 2018, p. 306

31
Q

Needle cricothyrotomy would be of questionable value in a patient with croup because the obstruction is _(location)_.

A
  1. Subglottic;

The Walls Manual of Emergency Airway Management, Fifth Edition, 2018, p. 306

32
Q

When preparing for a percutaneous needle tracheostomy (PNT) or “needle cric,” in what position should the child be placed?

A
  1. Supine with the head extended over a towel under the shoulder;

The Walls Manual of Emergency Airway Management, Fifth Edition, 2018, p. 306

33
Q

In small children, it may be impossible to precisely locate the cricothyroid membrane, so the ___ is utilized for access (hence the name ___ versus “needle cric”).

A
  1. Proximal trachea;
  2. Percutaneous Needle Tracheostomy (PNT);
    * The Walls Manual of Emergency Airway Management, Fifth Edition, 2018, p. 306*
34
Q

When performing a percutaneous needle tracheostomy, consider the trachea as one would a large vein, and cannulate it with the catheter-over-needle device directed caudad at a ___ degree angle.

A
  1. 30;

Major Memory System: Michael Jackson hums (30) while his Thriller album rotates under the needle of a record player.

The Walls Manual of Emergency Airway Management, Fifth Edition, 2018, p. 306

35
Q

Once an airway circuit has been constructed, all needed supplies gathered, and the patient has been positioned correctly, what is the basic six-step procedure for completing a percutaneous needle tracheostomy (aka “needle cric”) (as adapted from The Walls Manual of Emergency Airway Management)?

A
  1. Disinfect anterior neck;
  2. Locate and mark cricothyroid membrane (or poxmal trachea when membrane cannot be distinguished)
  3. Pierce with angiocath at 30 degree angle caudad;
  4. Remove needle while inserting catheter hub-to-skin;
  5. Attach partially-depleted 10 cc NS preload and spirate air to confirm placement;
  6. Attach PNT circuit and secure with tape;
    * The Walls Manual of Emergency Airway Management, Fifth Edition, 2018, p. 306 (adaptation by Scott Berdan)*
36
Q

In order to prevent breath-stacking and barotrauma during BMV of a percutaneous needle tracheostomy, the operator must allow for full expiration through the patient’s ___ and not through the catheter. This can be accomplished by watching for ___.

A
  1. Glottis;
  2. The chest to fall after inspiration;
    * The Walls Manual of Emergency Airway Management, Fifth Edition, 2018, p. 306*
37
Q

Name the four basic components of a percutaneous needle trachesostomy airway circuit (as adapted from The Walls Manual of Emergency Airway Management).

A
  1. Neonatal or pediatric BVM (with pop-off valve closed);
  2. BVM adapter from2.5 mm ID ET Tube;
  3. Final 6” section of an I.V. administration set (cut-off);
  4. 14G IV catheter;
38
Q

Generally speaking, nasal intubation may be performed ___ or with ___ assistance.

A
  1. Blind;
  2. Fiberoptic;
    * https://litfl.com/nasal-intubation/*
39
Q

Nasal intubation should be considered when _(general condition)_. Give two (of three listed) examples).

A
  1. Oral intubation is not feasible;
  2. Swollen tongue (Glossitis; e.g., angioedema);
  3. Mechanical obstructions to mouth opening (e.g., mandibular fixation and trismus);
  4. Fixed neck contracture and limited mouth opening;
    * https://litfl.com/nasal-intubation/*

Note: “It is best in patients who are not critically hypoxic and in whom there is obvious oral pathology making intubation and ventilation through the mouth problematic.”

https://epmonthly.com/article/nasal-intubation/

40
Q

Dr. Rich Levitan describes his method of performing blind nasal intubation with these five words: ___.

A
  1. Spray - Trumpet - Spray - Tube - Spray;

Note: Spray consists of 5-10 cc of 4% topical lidocaine with oxymetazoline.

https://litfl.com/nasal-intubation/

41
Q

Describe the seven general steps of the Berdan Method of Prehospital Blind Nasal Intubation.

A
  1. Sedate patient with Ketamine (2 mg/kg IV/IO or 4 mg/kg IM) and support oxygenation with BVM;
  2. Apply 2-3 sprays of Oxymetazoline into each naris;
  3. Lubricate two nasal trumpets with 2% lidocaine jelly, insert, remove from target naris after one minute;
  4. Place nasal cannula at 15 lpm in secondary naris (or mouth) for passive / apneic oxygenation;
  5. Lubricate tracheal tube with 2% lidocaine jelly (as large as will fit into the naris and be tolerated, generally at least 7.0 mm ID), attach BAAM whistle and insert (keeping the proximal end of the tube directed toward the patient’s contralateral nipple) until loud breath sounds are audible (approximately 15 cm);
  6. Pass tracheal tube through cords during inhalation, confirm placement and secure in place;
  7. Administer Rocuronium (1 mg/kg IV/IO);
    * https://litfl.com/nasal-intubation/ (as adapted by Scott Berdan)*
42
Q

Singluar form of the word “nares.” This word translates to the layman’s term ___.

A
  1. Naris;
  2. Nostril;
    * https://www.medicinenet.com/script/main/art.asp?articlekey=25480*
43
Q

When passing a nasal trumpet or nasotracheal tube, ensure the _(tube feature)_ faces the _(body structure)_ laterally. Ensure the tube is advanced along both the _(body structure)_ medially and the ___ of the nasal cavity (which is _(geometrical term)_ to the plane of the face).

A
  1. Bevel;
  2. Turbinates;
  3. Septum;
  4. Floor;
  5. Perpindicular;
    * https://litfl.com/nasal-intubation/*
44
Q

Tracheal tubes utilized for nasotracheal intubation should typically be placed ___ cm at the nose for women and ___ cm at the nose for men.

A
  1. 26;
  2. 28;
    * https://litfl.com/nasal-intubation/*
45
Q

Generally speaking (although not allowed by written order through the PCPs), with regard to ___ intubation, “topicalization is essential not only for patient comfort, but also to ensure proper placement. Without proper topicalization, the patient will gag, cough, and swallow the tube, preventing it from going into the trachea.”

A
  1. Nasal;

https://epmonthly.com/article/nasal-intubation/

46
Q

According to Dr. Levitan, with regard to nasal intubation, “conscious sedation for intubation, using a combination of _(drug)_ and _(drug)_, may be appropriate and improve patient comfort, depending on the situation. In the patient is too agitated to permit the procedure, small aliquots of _(drug)_ (10 mg IV, repeated up to 40-50 mg total, although more can be given if needed) with _(drug)_ works magically well to facilitate the procedure.

A
  1. Fentanyl;
  2. Midazolam;
  3. Ketamine;
  4. Midazolam;
    * https://epmonthly.com/article/nasal-intubation/*
47
Q

What does BAAM stand for with regard to a BAAM whistle?

A

BAAM

B - Beck

A - Airflow

A - Airway

M - Monitor

https://epmonthly.com/article/nasal-intubation/

48
Q

Successful tracheal passage during nasotracheal intubation will induce laryngeal reflexes (e.g., coughing), loss of phonation, and air movement throught the tube. If not already done, it may be necessary to ___ because passage of the tube may elicit arm movement, head turning, and other efforts to remove the tube.

A
  1. Restrain the patient’s arms;

https://epmonthly.com/article/nasal-intubation/

EMS Procedures (1 decks)

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