Ventilation and BSL Flashcards
(33 cards)
Resus and life support
You see a pt in their bed. You call their name and get no answer.
How do you confirm they are unresponsive and not breathing normally?
- Call name
- Try to rouse patient calling name and moving them/
- Trapezius squeeze
- Call for help
- Look, listen, feel for breathing - HTCL, feeling carotid pulse, look for rise and fall of chest, listen for breath.
You have found a patient unresponsive and not breathing normally.
Describe steps of advaced adult life support
- Start CPR
- Help arrives –> 2222, adult cardiac arrest, location, bring resus trolley
- CPR 30:2, attach defib pads
- assess rhythm
- decide whether it is shockable or non-shockable and shock or continue CPR as required.
- Aim is ROSC.
While carrying out advanced life support, what should you ensure is done alongside chest compressions?
there are lots !
- give oxygen
- minimise interruptions to compressions
- Get IV or IO access
- Give adrenaline every 3-5 mins
- Give amiodarone after 3 shocks
- ID and treat reversible causes
- In advanced life support, how often should you give adrenaline?
- After how many shocks is amiodarone given?
- every 3-5 mins
- 3 shocks
reversible causes cardiac arrest
What are 4Hs and 4Ts to consider during cardiac arrest?
- Hypoxia
- Hypovolaemia
- Hypo-/hyperkalaemia/ metabolic
Consider - Hypo/hyperthermia
- Thrombosis – coronary or pulmonary
- Tension pneumothorax
- Tamponade – cardiac
- Toxins
After ROSC, what needs to be done for patient?
ABCDE
A = A-E assessment is needed to review pt
B = Bloods need to be taken to id causes, find any underlying infection / electrolyte abnormalities
C = CXR required - to assess trauma from CPR and also check for causes e.g tension pneumothorax
D = drugs - what medications are they on, what drugs do you need to add, what drugs do you need to stop, what drugs were a cause of cardiac arrest
E = ECG is required to assess heart rhythym.
What are shockable rhythms?
VF and pulseless VT
what are non-shockable rhythms?
PEA and asystole
You find a shockable rhythm when assessing rhythm for resus. What do you do next?
Shock once at 200J (then 300J, 360)
Immediately resume CPR for 2 mins.
You find a non-shockable rhythm when assessing rhythm for resus. What do you do next?
Immediately resume CPR for 2 mins
Give 1:10000 1mg (10ml prefilled syringe in resus meds box) adrenaline
What are causes of airway obstruction?
- contents - vomit, blood, gastric contents, foreign body
- constriction - bronchospasm
- odema - from burns, inflam or anaphylaxis
- compression - tumour.
In airway obstruction, air entry can be noisy.
What noises can be made and what do they suggest?
- Inspiratory stridor - caused by obstruction at the laryngeal level or above.
- Expiratory wheeze - suggests obstruction of the lower airways, which tend to collapse and obstruct during expiration.
- Gurgling - suggests the presence of liquid or semisolid foreign material in the upper airways.
- Snoring - arises when the pharynx is partially occluded by the tongue or palate.
- Crowing or stridor - is the sound of laryngeal spasm or obstruction.
What are basic manoeuvres to open airway?
HTCL
Jaw thrust - in C spine fractures.
What are oropharyngeal and nasopharyngeal airways designed to do?
to overcome the soft palate obstruction and backward tongue displacement
Describe insertion technique of oropharyngeal airway
- measure up airway size - corresponding to the vertical distance between the patient’s incisors and the angle of the jaw
- open mouth, ensure foreign material moved out with suction
- insert airway in ‘upside down position’ as far as the junction between the hard and soft palate
- at this point, rotate it 180 and advance airway.
Why is oropharyngeal airway inserted upside down?
It minimises the chance of pushing the tongue backwards and downwards (therefore worsening obstruction)
When are nasopharyngeal airways used over oropharyngeal airways?
when pt is semi-conscious
when are nasopharygeal airways contraindicated?
Basal skull fracture
how is nasopharyngel airway inserted?
- check patency of nostirl - is there epistaxis, septal deviation, nasal polyps
- lubricate airway
- insert bevel end first. in right nostril, bevel can point toward septum. In left nostril, point bevel laterally then rotate once past nasal septum.
*left = point laterally!
Why are high inflation / ventilation pressures avoided in resus?
increases the risk of gastric inflation and regurgitation/ aspiration
Why is a laryngeal mask airway used in resus?
- efficient
- easire than bag-mask apparatus
- gastric inflation is minimised
- used when tracheal intubation has been tried but failed.
Describe the technique for laryngeal mask airway insertion
- maintain chest compressions throught insertion attempt
- select appropriate size for patient - usually men are size 5, women are size 4.
- lubricate airway cuff
- HTCL
- holding LMA like a pen, insert it into the mouth.
- Advance tip behind upper incisiors with upper surface applied to the palate until posterior pharyngeal wall is reached.
- press mask around corner of pharynx until feel resistance (jaw thrust can help this)
- inflate the cuff with air. As it inflates, the tube wil lift a few cms as cuff finds correct poisiton and larynx is pushed forwards.
- insert bite block along tube and tape LMA into place
What are limitations of laryngeal mask airway?
- can leak around cuff leading to hypoventilation. (this is higher risk if pt has pulm odema, bronchospasm, COPD)
- can interrupt chest compressions
- becuase LMA does not sit in the larynx itself, there may be a risk of aspiriation of stomach contents
- If pt is not deeply unconscious = could cause coughing, straining or laryngeoal spasm
- needs someone appropriately experienced
What are the benefits of igel compared to LMA?
- Does not require inflation
- has it’s own bite block incorporated.
- easy to insert
- needs minimal training.
