lines
NTK is a part of MSKs CAUTI bundle and should be done once per shift, and additionally at this time
After every patient bowel movement or “clean up” when soiled
Which of the following medications used for sedation provides the most prolonged sedation?
Diazepam
Lorazepam
Propofol
Midazolam
What is Diazepam. Onset is 2 to 5 mins but the half life ranges from 20 to 120 hrs with prolonged sedation. Ativan onset is 5 to 20mins with a half life of 8 to 15 hours. Prop onset is 1 to 2min with a half life of 2 to 8mins for short term sedation and 26hr –32hrs when continuously administered. Versed: onset 2-5mins and half life ranges from 3-11hr
How long can an IO stay in place after placement?
What is 24 hours?
Your patient has a history of symptomatic bradycardia, which sedatives are you avoiding?
What is Propofol, precedex?
In which situation do you want good lung down?
What is pneumonia? (think more blood flow to better lung= better oxygenation)
This should be done EVERY time you connect new tubing to a CVC
what is change the needless connector (clave)
What do you give before and after Amphotericin b and why? What is it compatible with NS or D5W?
what is a fluid bolus! It is extremely harsh on the kidneys and can cause severe creatinine bumps if not hydrated before and flushed after. Must be with D5W
How do you get to the timeout form on Epic?
What is drop down menu to the left of the wrench icon-> Timeout Note Sidebar
What rhythms can you shock?
pulseless vtach/vfib
In which situation do you want bad lung down?
What is bleeding in lung? (think bronchial blocker)
This is a part of our daily CLABSI bundle, but is a best practice to additionally perform any time a CVC is manipulated (line changes, dressing changes, culture collection)
What is CHG line care?
Name 4 medications which need a filter and what color filter?
Amio (white)
Lipids (blue)
TPN (white)
Cresmba (blue)
What products are in the MTP cooler. How many of them each? What comes outside the cooler and why?
4 pRBCs, 2 FFPs, 1 PLT outside the cooler cannot be cooled- the change in temperature causes them to cluster and change shape, rendering them ineffective. Also the PLTs cannot be pressure bagged- they can be crushed and ineffective.
What are the steps to cardioversion?
Turn Zoll to defibrillate, sync button ON, charge to desired jules, clear, hit button, wait until Zoll says shock delivered
What is Heliox and if an example of a patient who would benefit from using it
-it is a mix of oxygen and helium.
-upper airway blockages with the patient presenting with stridor
-ordered in a ratio ex 80:20, 80% helium, 20% oxygen
what technique should you be using when drawing blood cultures?
what is sterile technique?
Your patient is on the following infusion: propofol, fentanyl, nimbex, and levophed. The pt vitals are: BP 90/40, HR 80s, RR 12 (ventilator set to 12), SpO2 94% on 80% FiO2, temp 36.2C. Your provider wants to switch to versed for sedation, what are your next steps?
What is assess BIS values and measurement reliability, assess TOF, and administer versed bolus and initiate continuous versed infusion before weaning propofol?
When is a femoral CVC appropriate?
What is an emergency, venous obstructions, anatomical problems. Avoid at all costs and advocate for an IJ!
The attending wants to transvenous pace your patient. What supplies do you need and where can you find them?
What is the transvenous pacing box located in B pod and batteries from the UA desk?
What PF ratio indicates the need to prone?
What is <150?
your patient has a R IJ CVC, L fem A line, foley, OGT, ETT, 20g x2 on the L arm. How are you going to set your IV pole and tubing?
L side – A line, OGT, ETT/vent circuit, PIV tubing/pump. R side – CVC tubing/pump, foley cath secured with cath secure
You have a patient on the following infusions: ketamine, propofol, fentanyl, insulin (glucocare), nimbex, octreotide, levophed, and vasopression. How many IVs/ lumens do you need to safely administer all these medications? And how would you y-site each medication in your opinion
ketamine + fent + propofol, nimbex + octreotide, levo + vaso, insulin (4 lines)
Insulin is technically compatible with nimbex and octreotide but boluses of insulin/ frequent changes in the rate require its own access point
What leads would you see ST elevations in an lateral MI?
V5-V6, AVL, I
What leads would you see ST elevations in an anterior MI?
precordial leads v1-v4
Your patient is in ARDS. we are going to prone. what BIS and TOF settings must be achieved in order to be considered sedated and paralyzed appropriately.
what is BIS 40-60, TOF 2/4 at the ulnar location. hemodynamically stable.