Airways
What airways adjuncts are often used in emergent situations that anyone can place?
What are OPA and NPAs.
What should you do if there is continuous bubbling on a chest tube?
What is look for a leak and contact the physician.
What retractions indicate the most severe work of breathing?
Tracheal tugging/suprasternal retractions.
What is the minimum time you must count a respiratory rate on a child?
What is 30-60 seconds
What do you have to keep in mind when you are pushing Succinylcholine?
What is malignant hypothermia and Potassium levels.
This can be placed without direct visualization of the vocal cords.
What is a LMA or King Tube.
What immediate action is required if a chest tube is pulled out?
What is occlude the hole with a three-sided dressing and call the physician.
What treatment options are available for patient with an increased WOB?
Heated High Flow Nasal Cannula or BiPAP
What should you do if you observe stridor? How long do we need to observe pt after?
Keep child calm and consider racemic epinephrine. 2 hours minimum.
Pretreat, induction, and paralysis.
Where do you find the emergent equipment in the event you need to cric a child or adult. (What drawer)
In the 3rd drawer of the airway cart.
Where is the chest tube insertion kit located in the ER?
What is the chest tube cart.
Why do patients with COPD tripod and pursed lip breathe?
They are trying to stent their airways open and create their own back pressure (PEEP)
What is the most common reason for pediatric deterioration?
Respiratory Failure.
What is the most important thing to look at when assessing a blood gas and why?
pH
What supplies, at a minimum, do you need to intubate a patient with?
ETT, stylet, syringe, blade &handle/glidescope, suction, EtCO2, ambu bag.
What are the 2 locations of chest tube placement?
What are the 2nd intercostal space midclavicular and 4/5th intercostal space midaxillary.
What are some of the reasons a patient can have wheezing or diminished breath sounds?
Bronchospasm (treat with bronchodilator) or Fluid overload (tx with diuretic)
What are treatment option for severe asthma?
Albuterol and ipatropium (up to continuous 20mg), magnesium, im epinephrine, steroids, terbutaline.
What is the most important thing you should do before and during movement of an intubated patient from one bed to another?
Hold the tube in place and verify appropriate placement after.
What should you have ready and available for all intubation especially difficult intubation?
Bougie and cric kit
How do you know what pressure to set the oasis to and what do you set the wall pressure to?
What is the physician order and 80-100 wall suction.
When listening to breathe sounds what is the process? Why is there a systematic process for listening to breathe sounds?
Front top one side then the other, front bottom one side then the other, followed by back from side to side and top to bottom.
Because you have to compare one side to the other as well as tops to bottoms.
What should you look up for a child being treated with asthma at St. Luke's?
Pediatric Respiratory Protocol: Asthma/ Reactive Airway Protocol and High Flow Protocol.
PC895
What do you do when a patients O2 saturation drops below 90% in the emergency room?
Place pt on oxygen and verify sats improved, place O2 protocol order in Epic as urgent protocol, notify provider and document provider notification. Reassess patient and document full set of vitals with SpO2 and device. Don't forget to click that initiate button.