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Skills Flashcards

1
Q

OG tube indication/contraindication

A

Indication - pts getting bagged and you need to empty/decompress

Contraindication - gag reflex/awake, caustic ingestion, esophagela disease/structure/varices, no adult adv airway in place

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2
Q

Pediatric Gastric tube sizes

A

Kg = 3, 16, 25

Size = 6, 12, 18

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3
Q

How to measure a Gastric tube?

A

1/2 way between naval and xiphoid process, up around ear, to corner of mouth

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4
Q

How to confirm placement of a gastric tube

A

Draw use 60 cc syringe & inject 5-20ml air into stomach & listen for gurgling in stomach

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5
Q

Once you have a gastric tube inserted, how do you set your suction? When to discontinue it?

A

Low non-continuous suctioning. Stop when no more coming out of stomach.

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6
Q

How to secure gastric tube after insertion

A

Lightly tap to pt’s cheek

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7
Q

Indications/contraindications of King airway

A

Indications = Cardiac arrest. Respiratory insufficiency/failure/arrest

Contraindications = sophageal disease, caustic substance ingestions, <4ft height

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8
Q

How to place your King airway? How much to inflate?

A

Lift jaw, insert sideways 45-90 degrees, rotate down w/ insertion until hub at lip line

Inflate 60cc’s (or specs on side of tube)

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9
Q

5 ways to confirm airway placement

A

Bag to butt (good compliance, ETc02, chest rise, lung sounds, negative epigastric)

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10
Q

What rate to ventilate an advanced airway?

A

12-16 breaths per min. Maintain ETCO2 35-45

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11
Q

Indications / contraindications of Endotracheal intubation

A 
Indication = resp insufficency, failure, arrest	
Contraindications = None
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12
Q

How long to pre-oxygenate pt

A

30s

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13
Q

When intubating, how many seconds per attempt? How many attempts total per pt?

A

15s, 2 attempts max

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14
Q

What do you do if you intubate and hear diminished lung sounds unilaterally?

A

Deflate cuff, retract 1-2cm and re-assess

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15
Q

Indications/ contraindications for facilitated intubation

A

Indication = respiratory insufficiency/failre/arrest that needs airway mgmt in pts w/ consciousness, gag reflex, jaw clenching

Contraindications = allergy to any of the meds

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16
Q

What meds & doses for facilitated intubation

A

Fentanyl 2mcg/kg IVP

Etomidate 0.3mg/kg SIVP

Midazolam 2.5mg (2 max)

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17
Q

Indications/contraindications of surgical cric? What age?

A

Indictions = age >10yrs, all other airway attempts fail

Contraindications - Age < 10 years, cant find landmarks

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18
Q

What length incision over what membrane when you’re doing a cric

A

3cm vertical incision over cricothyroid membrane w/ scalpel

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19
Q

What size ETT for a cric?

A

6.0 ETT

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20
Q

Indications/contraindications of defibrillation

A

Indication = vfib, pvtach, polymorphinc Vtach

Contraindications = hazardous environment, valid DNR

21
Q

How does pad placement differ on adult vs ped w/ defib pads?

A

Adult = anterior-anterior

Peds = anterior - posterior

22
Q

What do you say before you shock a pt

A

Im clear, your clear, oxygen clear

23
Q

What’s a vector change and when can you do it?

A

Vector change = after 3 shocks of adult refractory V-fib, and after antiarrhythmic therapy, you use new pads + new placement AND get OLMC

24
Q

How do you perform a vector change?

A

Get OLMC

Apply new pads to sternum & posterior

Switch MRX to new set of pads

25
Indications/contraindications of Transcutaneous pacing
Indications = unstable bradycardia contraindications = hazardous environment
26
Steps to pace on a phillips
1. Apply limb leads & select Lead w/ R wave 2. Apply pads 3. Turn pacer knob & verify R wave markers on waveform 4. Start pacer rate @ 60bpm, output at 60mAp (titrate up amps until capture) 5. Mechanical capture 6. Increase rate by 10bpm to 90 max PRN 7. Consider epi drip
27
Indications and contraindications of synchronized cardioversion
Indications = unstable tachycardia Contraindications = hazardous environment
28
How to synchronized Cardiovert
1. Turn knob to monitor & press sync 2. Set joules 3. Charge, clear, HOLD shock button
29
What Joules to cardiovert for regular vs irregular rhythms?
Regular = 100,120,150,170 Irregular narrow = 120,150,170 Irregular wide = DEFIB 150J
30
IO indications vs contraindications
Indications - cardiac arrest, cant get IV access in red pt’s Contraindications - bone fractured, no landmarks, area infection, IO at site <48hr prior, hx ortho procedure at site
31
What are the approved IO sites
Proximal tibial plateau, proximal hural head, distal tibia, proximal to medial malleolus
32
What age do you hand bore, not drill an IO?
Peds < 1yr
33
How do you confirm placement of an IO? How do you know it’s infiltrated
Aspiration of bone marrow = good Site swelling/ fluids not running = bad
34
If your IO pt is conscious, how much lidocaine and how fast to inject it?
2% lidocainE Adults = 30mg SIVP Peds = 0.5mg/kg - max 30 SIVP
35
What do you do once you insert and aspirate an IO?
Label placement time/operator name and tape it to limb Secure IO w/ device
36
Indications & contraindications of Needle Thoracostomy
Indications = suspected pneumothorax w/ bad shock, traumatic arrest w/ chest or ab injury Contra = simple pneumothorax
37
What is the primary vs secondary site of a needle thoracostomy in an adult? What size needle?
Adult = main = lateral 5th intercostal… secondary = 2nd intercostal mid clavicular 10g, 3.25in
38
What is the primary vs secondary perferred site of a needle thoracostomy in peds? What needle size?
``` Main = lateral 4th intercostal anterior axillary Second = 2nd intercostal mid clavicular ``` 16g, 1.16in
39
How do you know if your needle decompress works? How often to reassess
Rush of air from catheter Improved ventilations Equal chest rise again Reassess lungs & vitals every 5min
40
Indications contraindications of pediatric intubation
Indication - resp insufficiency/failure/arrest Contraindication - effective bagging
41
While assembling all your equipment for intubation, what other piece should you have nearby
Suction
42
What age CANT you inflate an ETT
<13
43
What rate to bag kids with ICP
20
44
After inserting an ETT on a Ped, what must you verbalize
Need to insert OG tube
45
When do you reconfirm tube placement on a pediatric ETT
Throughout contact and on arrival at ED
46
Needle cric indications contraindications
Indications- ped up to 10yrs, all other methods failed Contra - can’t find landmarks. Neck tumor obstructs landmarks
47
What size iv catheter and ETT do you need for a needle cric
3.0 ETT 14g
48
How do you position the head on a needle cric
Slightly hyperextended
49
What side of pt do you stand on if you’re r handed in a needle cric
Patients left side

ALS Protocols (4 decks)

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