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REVALIDATIONREVALIDATIONREVALIDATIONREVALIDATIONREVALIDATIONREVALIDATIONREVALIDATIONREVALIDATION
PRACTICE PRACTICE PRACTICE PRACTICE PRACTICE PRACTICE PRACTICE PRACTICE
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PHARMACOLOGY
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1. What is meant by the term
“Indications”?
PHARMACOLOGY
2. What is meant by the term
“Contra Indications”?
When the drug should be usedWhen the drug should be usedWhen the drug should be usedWhen the drug should be used
3. What is meant by the term
“Physiological action”?
When the drug should When the drug should When the drug should When the drug should NOTNOTNOTNOT be usedbe usedbe usedbe used
How does the drug workHow does the drug workHow does the drug workHow does the drug work
4. Name, order of absorption, the differentRoutes that a drug can be administered by
IIIIntavenousntavenousntavenousntavenous 30 to 60 Sec30 to 60 Sec30 to 60 Sec30 to 60 Sec
IIIInhalationnhalationnhalationnhalation 3 3 3 3 minsminsminsmins
EEEEndotrachaelndotrachaelndotrachaelndotrachael 3 3 3 3 minsminsminsmins
SSSSublingualublingualublingualublingual 3 to 5 3 to 5 3 to 5 3 to 5 minsminsminsmins
RRRRectalectalectalectal 5 to 30 5 to 30 5 to 30 5 to 30 minsminsminsmins
IIIIntramuscularntramuscularntramuscularntramuscular 10 to 20 10 to 20 10 to 20 10 to 20 minsminsminsmins
OOOOralralralral 30 to 90 30 to 90 30 to 90 30 to 90 minsminsminsmins
IIESRIOIIESRIOIIESRIOIIESRIO
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1. What is the full name of Cardiprin?
ASPIRIN
AAAAspirinspirinspirinspirin
2. What effect does Aspirin have? Antipyretic, Antipyretic, Antipyretic, Antipyretic,
3. What is the correct dosage of Aspirin? 300mg300mg300mg300mg given orallygiven orallygiven orallygiven orally
4. Name 3 alternative names for Aspirin? SSSSolprinolprinolprinolprin, , , ,
5. What are the 3 contra-indications for Aspirin?a.a.a.a. AAAAllergicllergicllergicllergic
b.b.b.b. GGGGastrointestinal Bleedingastrointestinal Bleedingastrointestinal Bleedingastrointestinal Bleeding
c.c.c.c. AAAAsthmatic with previous worsening sthmatic with previous worsening sthmatic with previous worsening sthmatic with previous worsening
of asthma after aspirin or nonof asthma after aspirin or nonof asthma after aspirin or nonof asthma after aspirin or non----steroidal antisteroidal antisteroidal antisteroidal anti----inflammatory drugs.inflammatory drugs.inflammatory drugs.inflammatory drugs.
AGAAGAAGAAGA
AAAAAAAAAAAAAAAA Analgesic,Analgesic,Analgesic,Analgesic,
AntiAntiAntiAnti----inflammatory, inflammatory, inflammatory, inflammatory, AAAAntintintinti----platelet effectsplatelet effectsplatelet effectsplatelet effects
AAAAspecspecspecspec, , , ,
CCCCartiaartiaartiaartia, , , ,
CCCCardiprin, ardiprin, ardiprin, ardiprin,
AAAAsprosprosprospro, , , , EEEEcotrincotrincotrincotrin DDDDisprinisprinisprinisprin
SACCAEDSACCAEDSACCAEDSACCAED
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1. What is Entonox?
ENTONOX
2. When would you give Entonox?
AAAAnalgesic gas made up of nalgesic gas made up of nalgesic gas made up of nalgesic gas made up of 50% Nitrous 50% Nitrous 50% Nitrous 50% Nitrous
Oxide and 50% Oxygen.Oxide and 50% Oxygen.Oxide and 50% Oxygen.Oxide and 50% Oxygen.
3. Name 4 contra-indications of Entonox? a.a.a.a. Anyone who has been Anyone who has been Anyone who has been Anyone who has been SSSSCUBA CUBA CUBA CUBA
Diving in the last 24 hours or has Diving in the last 24 hours or has Diving in the last 24 hours or has Diving in the last 24 hours or has
suspected decompression illness.suspected decompression illness.suspected decompression illness.suspected decompression illness.
b.b.b.b. Anyone who is unable to Anyone who is unable to Anyone who is unable to Anyone who is unable to OOOObey bey bey bey
commands.commands.commands.commands.
c.c.c.c. Anyone with a suspected Anyone with a suspected Anyone with a suspected Anyone with a suspected PPPPneumothorax. neumothorax. neumothorax. neumothorax. (Enlarges)(Enlarges)(Enlarges)(Enlarges)
d.d.d.d. Anyone with a current diagnosed Anyone with a current diagnosed Anyone with a current diagnosed Anyone with a current diagnosed
BBBBowel Obstruction.owel Obstruction.owel Obstruction.owel Obstruction.
�Given to anyone to Given to anyone to Given to anyone to Given to anyone to self administerself administerself administerself administer to to to to
themselves, themselves, themselves, themselves, �that is in that is in that is in that is in PPPPain, including Chest Pain with ain, including Chest Pain with ain, including Chest Pain with ain, including Chest Pain with
the exception of the contrathe exception of the contrathe exception of the contrathe exception of the contra----indications.indications.indications.indications.
3. When is it NOT contra-indicated? CCCChest Injuries as long as breathing is hest Injuries as long as breathing is hest Injuries as long as breathing is hest Injuries as long as breathing is
OKOKOKOK
SOPBSOPBSOPBSOPB
SPSPSPSP
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1. What is the generic name of GTN?
GTN
2. What does GTN do?
GGGGlyceryl Trinitrate.lyceryl Trinitrate.lyceryl Trinitrate.lyceryl Trinitrate.
3. What is preload?
� Widespread universal Widespread universal Widespread universal Widespread universal vasodilatorvasodilatorvasodilatorvasodilator
� used to used to used to used to decreasedecreasedecreasedecrease PreloadPreloadPreloadPreload and and and and
AfterloadAfterloadAfterloadAfterload on the heart and on the heart and on the heart and on the heart and
� therefore therefore therefore therefore decreasingdecreasingdecreasingdecreasing Cardiac Output Cardiac Output Cardiac Output Cardiac Output because of a decrease of Venous returnbecause of a decrease of Venous returnbecause of a decrease of Venous returnbecause of a decrease of Venous return
V, P, A, C/OV, P, A, C/OV, P, A, C/OV, P, A, C/O
� The amount of The amount of The amount of The amount of BBBBlood that returns back lood that returns back lood that returns back lood that returns back to the heartto the heartto the heartto the heart
� GTN affects preload byGTN affects preload byGTN affects preload byGTN affects preload by widespread widespread widespread widespread
VVVVasodilatationasodilatationasodilatationasodilatation therefore therefore therefore therefore
�IIIIncreasing venous poolingncreasing venous poolingncreasing venous poolingncreasing venous pooling andandandand
� RRRReducing the amount of blood that educing the amount of blood that educing the amount of blood that educing the amount of blood that returns back to the heartreturns back to the heartreturns back to the heartreturns back to the heart
B, V, I, RB, V, I, RB, V, I, RB, V, I, R
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GTN
5. What dosage of GTN do you administer
for cardiac chest pain?
0.8mg0.8mg0.8mg0.8mg sublingually every sublingually every sublingually every sublingually every 5555 minutes minutes minutes minutes
provided the systolic blood pressure provided the systolic blood pressure provided the systolic blood pressure provided the systolic blood pressure is >is >is >is >80808080mmHgmmHgmmHgmmHg
6. What dosage of GTN do you administer
for CHF?
0.40.40.40.4----8mg8mg8mg8mg sublingually every sublingually every sublingually every sublingually every 2222----5555 minutes minutes minutes minutes
provided the systolic blood pressure provided the systolic blood pressure provided the systolic blood pressure provided the systolic blood pressure
is >is >is >is >80808080mmHgmmHgmmHgmmHg
4. What afterload? � The amount of The amount of The amount of The amount of PPPPeripheral eripheral eripheral eripheral RRRResistance esistance esistance esistance
created by the created by the created by the created by the � SSSSystemic ystemic ystemic ystemic SSSSystem that the ystem that the ystem that the ystem that the
� VVVVentricles has to eject against.entricles has to eject against.entricles has to eject against.entricles has to eject against.
PR, SS, VPR, SS, VPR, SS, VPR, SS, V
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7. What are 2 contra-indications for GTN?
GTN
8. What are some of the side effects of GTN?
a.a.a.a. Patients who used Patients who used Patients who used Patients who used VVVViagra within the iagra within the iagra within the iagra within the
last 24 hourslast 24 hourslast 24 hourslast 24 hoursb.b.b.b. Systolic Systolic Systolic Systolic BBBBlood lood lood lood PPPPressure under ressure under ressure under ressure under
80mmHg80mmHg80mmHg80mmHg
DDDDizzinessizzinessizzinessizziness
HHHHeadacheseadacheseadacheseadaches
SlightSlightSlightSlight Increase in Increase in Increase in Increase in HHHHeart Rateeart Rateeart Rateeart RateHHHHypotensionypotensionypotensionypotension
PPPPalpitationsalpitationsalpitationsalpitations
DHHHPDHHHPDHHHPDHHHP
And the 2 “Use with cautions”?
a. If patient nearing a. If patient nearing a. If patient nearing a. If patient nearing 80808080mmHgmmHgmmHgmmHg
b. Known Hypersensitivity (b. Known Hypersensitivity (b. Known Hypersensitivity (b. Known Hypersensitivity (AAAAllergy)llergy)llergy)llergy)
V B/PV B/PV B/PV B/P
B/P AB/P AB/P AB/P A
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1. How does Salbutamol work?
SALBUTAMOL
2a. What are the 3 pathophysiological
components of asthma?
It is a It is a It is a It is a ““““BBBBeta2eta2eta2eta2 specific specific specific specific sypathomimeticsypathomimeticsypathomimeticsypathomimeticAAAAgonistgonistgonistgonist BBBBronchodilatorronchodilatorronchodilatorronchodilator”””” meaning:meaning:meaning:meaning:
3. What is the correct dosage of Salbutamol
For children 3 years old?
2.5mg 2.5mg 2.5mg 2.5mg via a nebuliser, Repeat PRNvia a nebuliser, Repeat PRNvia a nebuliser, Repeat PRNvia a nebuliser, Repeat PRN
a.a.a.a. BBBBronchoconstrictionronchoconstrictionronchoconstrictionronchoconstriction
b.b.b.b. BBBBronchospasmronchospasmronchospasmronchospasm
c.c.c.c. MMMMucous plugging which causes ucous plugging which causes ucous plugging which causes ucous plugging which causes
narrowing of the airwaysnarrowing of the airwaysnarrowing of the airwaysnarrowing of the airways
4. What age range does this child dose of
Salbutamol apply to?2.5mg2.5mg2.5mg2.5mg for ages for ages for ages for ages 0 to 60 to 60 to 60 to 6, repeated PRN, repeated PRN, repeated PRN, repeated PRN
BBMBBMBBMBBM
2. What are the contraindications
of Salbutamol?
�Hypersensitivity (Hypersensitivity (Hypersensitivity (Hypersensitivity (AAAAllergy)llergy)llergy)llergy)
�TTTThreatened abortionhreatened abortionhreatened abortionhreatened abortion
1a. What are the indications for it’s use? AAAAsthma, sthma, sthma, sthma,
AABCSAABCSAABCSAABCS
BABBABBABBAB
MBBMBBMBBMBB It It It It MMMMimicsimicsimicsimics the sympathetic nervous system the sympathetic nervous system the sympathetic nervous system the sympathetic nervous system by by by by dilatingdilatingdilatingdilating the the the the BBBBronchioles and therebyronchioles and therebyronchioles and therebyronchioles and therebyrelievingrelievingrelievingrelieving BBBBronchospasmronchospasmronchospasmronchospasm
AAAAnaphylaxis, naphylaxis, naphylaxis, naphylaxis, BBBBronchitis, ronchitis, ronchitis, ronchitis,
CCCCORD, ORD, ORD, ORD, SSSSmoke Inhalationmoke Inhalationmoke Inhalationmoke Inhalation
ATATATAT
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5. What is the correct dosage of
Salbutamol for adults?
SALBUTAMOL
6. What are some of the side effects
of Salbutamol?
5mg5mg5mg5mg repeated PRNrepeated PRNrepeated PRNrepeated PRN
7. Other than asthma, what other 2 reasons
would we give Salbutamol for?
1.1.1.1. SSSSmoke Inhalationmoke Inhalationmoke Inhalationmoke Inhalation
2.2.2.2. AAAAnaphylaxis when presented with a naphylaxis when presented with a naphylaxis when presented with a naphylaxis when presented with a
wheeze.wheeze.wheeze.wheeze.
a.a.a.a. TTTTremorsremorsremorsremors
b.b.b.b. Mild increase in Mild increase in Mild increase in Mild increase in HHHHeart rateeart rateeart rateeart ratec.c.c.c. HHHHeadacheeadacheeadacheeadache
8. What other procedure would you consider
in your treatment of an Asthma Patient?
a. a. a. a. IVIVIVIV access if not improvingaccess if not improvingaccess if not improvingaccess if not improving
b. b. b. b. APAPAPAP for administration of adrenalinefor administration of adrenalinefor administration of adrenalinefor administration of adrenaline
9. If respiratory arrest occurs, what should
you do?
VVVVentilate at rate of entilate at rate of entilate at rate of entilate at rate of 6 breaths/min6 breaths/min6 breaths/min6 breaths/min
THHTHHTHHTHH
SASASASA
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1. When would we administer Glucagon?
GLUCAGON
2. What is the normal blood sugar range?
Diabetes patient who:Diabetes patient who:Diabetes patient who:Diabetes patient who:a.a.a.a. Have a lowered Have a lowered Have a lowered Have a lowered LLLLOCOCOCOC
b.b.b.b. Have a Have a Have a Have a BBBBlood Sugarlood Sugarlood Sugarlood Sugar normally below normally below normally below normally below
3.5mmol/l3.5mmol/l3.5mmol/l3.5mmol/l
c.c.c.c. When the patient is unable toWhen the patient is unable toWhen the patient is unable toWhen the patient is unable to SSSSwallowwallowwallowwallow
drinks or fooddrinks or fooddrinks or fooddrinks or food
d.d.d.d. When When When When unableunableunableunable to obtainto obtainto obtainto obtain IIIIVVVV accessaccessaccessaccesse.e.e.e. It is It is It is It is unsafeunsafeunsafeunsafe to obtainto obtainto obtainto obtain IIIIVVVV access.access.access.access.
3. How does Glucagon work?
3.5 to 83.5 to 83.5 to 83.5 to 8 mmol/lmmol/lmmol/lmmol/l
2a. What is the upper range when we are
required to treat the patient and with what ?
a.a.a.a. 20202020mmol/lmmol/lmmol/lmmol/l
b.b.b.b. And the have anAnd the have anAnd the have anAnd the have an AAAAltered LOC ltered LOC ltered LOC ltered LOC orororor
TTTTachycardiaachycardiaachycardiaachycardia
GIVEGIVEGIVEGIVE::::a.a.a.a. 1000mls1000mls1000mls1000mls of 0.9% of 0.9% of 0.9% of 0.9% NaClNaClNaClNaCl as a bolusas a bolusas a bolusas a bolusb.b.b.b. GGGGive a further ive a further ive a further ive a further 20ml/Kg20ml/Kg20ml/Kg20ml/Kg enrouteenrouteenrouteenroute
a. a. a. a. RRRReleases all stored glycogen in the liver eleases all stored glycogen in the liver eleases all stored glycogen in the liver eleases all stored glycogen in the liver
and converts to glucose.and converts to glucose.and converts to glucose.and converts to glucose.
b. b. b. b. LLLLimited to the storage of glycogen in imited to the storage of glycogen in imited to the storage of glycogen in imited to the storage of glycogen in
the liver at that point of time.the liver at that point of time.the liver at that point of time.the liver at that point of time.c. c. c. c. GGGGluconeogenesis (converts glucose luconeogenesis (converts glucose luconeogenesis (converts glucose luconeogenesis (converts glucose
from amino acids).from amino acids).from amino acids).from amino acids).
LBSIILBSIILBSIILBSII
RLGRLGRLGRLG
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GLUCAGON
Adult:Adult:Adult:Adult: 1mg1mg1mg1mg
Child:Child:Child:Child: 0.5mg0.5mg0.5mg0.5mg
4. What are the adult and child dosages
of Glucagon?
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1. When would we administer I.V Dextrose
to a patient?
DEXTROSE
2. How much 10% Dextrose would we
Initially administer to a patient who is suffering
hypoglycemia and can not take oral fluids?
To a Hypoglycemic patient which has:To a Hypoglycemic patient which has:To a Hypoglycemic patient which has:To a Hypoglycemic patient which has:
a.a.a.a. An An An An altered LOCaltered LOCaltered LOCaltered LOC
b.b.b.b. UnableUnableUnableUnable to swallowto swallowto swallowto swallow
c.c.c.c. IV accessIV accessIV accessIV access CANCANCANCAN be gainedbe gainedbe gainedbe gained
Adults:Adults:Adults:Adults: 100mls100mls100mls100mls followed by a further followed by a further followed by a further followed by a further
100mls100mls100mls100mls, , , , depending on how the BM depending on how the BM depending on how the BM depending on how the BM reading are after 5 minutes.reading are after 5 minutes.reading are after 5 minutes.reading are after 5 minutes.Child:Child:Child:Child: 2mls/Kg2mls/Kg2mls/Kg2mls/Kg
3. What must you do to the IV cannula after
It is inserted and before you
administer Dextrose?
A running line of NaCl is required as A running line of NaCl is required as A running line of NaCl is required as A running line of NaCl is required as
dextrose is very sclerosing if injected into dextrose is very sclerosing if injected into dextrose is very sclerosing if injected into dextrose is very sclerosing if injected into
interstitial tissueinterstitial tissueinterstitial tissueinterstitial tissue
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AIRWAY MANAGEMENT
RESPIRATORY PROBLEMS
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RESPIRATORY PROBLEMS
1. What can cause
Shortness of BreathShortness of BreathShortness of BreathShortness of Breath (SOB) ?
1)1)1)1) RRRRespiratory Problemsespiratory Problemsespiratory Problemsespiratory Problems
2)2)2)2) CCCCardiac Problemsardiac Problemsardiac Problemsardiac Problems
3)3)3)3) SSSSepsisepsisepsisepsis
4)4)4)4) PPPPsychogenicsychogenicsychogenicsychogenic
2. What can cause RespiratoryRespiratoryRespiratoryRespiratoryShortness of Breath?
a)a)a)a) Upper AirwayUpper AirwayUpper AirwayUpper Airway� Foreign Body ObstructionForeign Body ObstructionForeign Body ObstructionForeign Body Obstruction
� CroupCroupCroupCroup
� EpiglottitisEpiglottitisEpiglottitisEpiglottitis
b)b)b)b) Lower AirwayLower AirwayLower AirwayLower Airway� AsthmaAsthmaAsthmaAsthma
� CORDCORDCORDCORD
� BronchioltisBronchioltisBronchioltisBronchioltis
c)c)c)c) Lung TissueLung TissueLung TissueLung Tissue� PneumoniaPneumoniaPneumoniaPneumonia
� Pulmonary EmbolismPulmonary EmbolismPulmonary EmbolismPulmonary Embolism
� CORDCORDCORDCORD
� Lung ContusionLung ContusionLung ContusionLung Contusion
d)d)d)d) Pleural CavityPleural CavityPleural CavityPleural Cavity� PneumothoraxPneumothoraxPneumothoraxPneumothorax
� HaemothoraxHaemothoraxHaemothoraxHaemothorax
� Pleural effusionPleural effusionPleural effusionPleural effusion
e)e)e)e) Chest WallChest WallChest WallChest Wall� Rib FracturesRib FracturesRib FracturesRib Fractures
RCSPRCSPRCSPRCSP
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RESPIRATORY PROBLEMS
Congestive Heart FailureCongestive Heart FailureCongestive Heart FailureCongestive Heart Failure with
Pulmonary edemaPulmonary edemaPulmonary edemaPulmonary edema3. What can cause CardiacCardiacCardiacCardiacShortness of Breath?
4. What can cause SepsisSepsisSepsisSepsisShortness of Breath?
Severe infectionSevere infectionSevere infectionSevere infection from any cause or
any site.
5. What can cause PsychogenicPsychogenicPsychogenicPsychogenicShortness of Breath?
HyperventilationHyperventilationHyperventilationHyperventilation of emotional of emotional of emotional of emotional
originoriginoriginorigin
6. What are the signs & Symptoms of a
patient suffering from HyperventilationHyperventilationHyperventilationHyperventilation?
� DizzinessDizzinessDizzinessDizziness
� Tingling of Fingers and LipsTingling of Fingers and LipsTingling of Fingers and LipsTingling of Fingers and Lips
� Spasm of hands and feetSpasm of hands and feetSpasm of hands and feetSpasm of hands and feet
7. How do you treat HyperventilationHyperventilationHyperventilationHyperventilation? � Lots of reassuranceLots of reassuranceLots of reassuranceLots of reassurance� Try and get patient to gain controlTry and get patient to gain controlTry and get patient to gain controlTry and get patient to gain control
8. What “caution” needs to be remembered
in treating a patient whom you believe is
suffering from HyperventilationHyperventilationHyperventilationHyperventilation?
� The diagnosis needs to be made The diagnosis needs to be made The diagnosis needs to be made The diagnosis needs to be made
after ALL other causes have been after ALL other causes have been after ALL other causes have been after ALL other causes have been
excludedexcludedexcludedexcluded
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RESPIRATORY PROBLEMS
� Ensure Personal and Patient Ensure Personal and Patient Ensure Personal and Patient Ensure Personal and Patient SSSSafetyafetyafetyafety
� PPPPrimary Surveyrimary Surveyrimary Surveyrimary Survey
� OOOOxygen by nonxygen by nonxygen by nonxygen by non----rebreather mask rebreather mask rebreather mask rebreather mask or
� Bag Mask if UnconsciousBag Mask if UnconsciousBag Mask if UnconsciousBag Mask if Unconscious
� If wheeze present If wheeze present If wheeze present If wheeze present –––– AdministerAdministerAdministerAdminister
SSSSalbutamolalbutamolalbutamolalbutamol as per Asthma proceduresas per Asthma proceduresas per Asthma proceduresas per Asthma procedures
9. What is the treatment of a patient
who is suffering from Smoke InhalationSmoke InhalationSmoke InhalationSmoke Inhalation?
10. What is the treatment of a patient
who is suffering from CORDCORDCORDCORD?
� PPPPrimary Surveyrimary Surveyrimary Surveyrimary Survey
If hypoxia is immediately life threateningIf hypoxia is immediately life threateningIf hypoxia is immediately life threateningIf hypoxia is immediately life threatening
or Oxygen Saturation is < 88%:or Oxygen Saturation is < 88%:or Oxygen Saturation is < 88%:or Oxygen Saturation is < 88%:
� AAAAdjust Oxygen Flow to keep djust Oxygen Flow to keep djust Oxygen Flow to keep djust Oxygen Flow to keep
Saturation @ 88 to 92%Saturation @ 88 to 92%Saturation @ 88 to 92%Saturation @ 88 to 92%
� Give 5mg Give 5mg Give 5mg Give 5mg SSSSalbutamol and repeat albutamol and repeat albutamol and repeat albutamol and repeat
PRNPRNPRNPRN
SPOSSPOSSPOSSPOS
PASPASPASPAS
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RESPIRATORY PROBLEMS
� PPPPrimary Surveyrimary Surveyrimary Surveyrimary Survey
� OOOOxygen by nonxygen by nonxygen by nonxygen by non----rebreather maskrebreather maskrebreather maskrebreather mask
� CCCCall for an AP all for an AP all for an AP all for an AP (for Nebulised Adrenaline)(for Nebulised Adrenaline)(for Nebulised Adrenaline)(for Nebulised Adrenaline)
11. What is the treatment of a patient
who is suffering from CroupCroupCroupCroup?
12. What causes
PULMONARY EDEMAPULMONARY EDEMAPULMONARY EDEMAPULMONARY EDEMA?
MMMMyocardial yocardial yocardial yocardial IIIIschemia or schemia or schemia or schemia or IIIInfarctionnfarctionnfarctionnfarction
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RESPIRATORY PROBLEMS13. What is the Pathophysiological
components of
PULMONARY EDEMAPULMONARY EDEMAPULMONARY EDEMAPULMONARY EDEMA?
The The The The LEFTLEFTLEFTLEFT VentricleVentricleVentricleVentricle can not eject the bloodcan not eject the bloodcan not eject the bloodcan not eject the blood
returned to it from the right Ventricle.returned to it from the right Ventricle.returned to it from the right Ventricle.returned to it from the right Ventricle.
(Normal circumstances RV=LV output)
L) L) L) L) VentricleVentricleVentricleVentricle
R) R) R) R) VentricleVentricleVentricleVentricle
L) L) L) L)
AtriumAtriumAtriumAtrium
RV=LV RV=LV RV=LV RV=LV OUTPUTOUTPUTOUTPUTOUTPUT
BACKBACKBACKBACK
PRESSUREPRESSUREPRESSUREPRESSURE
BLOODBLOODBLOODBLOOD
SERUMSERUMSERUMSERUMPulmonary Pulmonary Pulmonary Pulmonary
CapillariesCapillariesCapillariesCapillaries
Aorta
L) Pulmonary Artery
R) Pulmonary Artery
Superior Vena Cava
R) Atrium
Inferior Vena Cava
Pulmonary Pulmonary Pulmonary Pulmonary
CapillariesCapillariesCapillariesCapillaries
R) Pulmonary
Veins
L) Pulmonary
Veins
� Therefore the Therefore the Therefore the Therefore the pressure in the pressure in the pressure in the pressure in the LEFTLEFTLEFTLEFT AtriumAtriumAtriumAtrium
risesrisesrisesrises and the and the and the and the back pressure builds up into back pressure builds up into back pressure builds up into back pressure builds up into
the Lungsthe Lungsthe Lungsthe Lungs
� Blood SerumBlood SerumBlood SerumBlood Serum is forced from the pulmonary is forced from the pulmonary is forced from the pulmonary is forced from the pulmonary
capillaries causing capillaries causing capillaries causing capillaries causing PULMONARY PULMONARY PULMONARY PULMONARY
EDEMAEDEMAEDEMAEDEMA
� As this fluid in the As this fluid in the As this fluid in the As this fluid in the AlveoliAlveoliAlveoliAlveoli increases, oxygen increases, oxygen increases, oxygen increases, oxygen
exchange is affected and hypoxia occursexchange is affected and hypoxia occursexchange is affected and hypoxia occursexchange is affected and hypoxia occurs
� May produce May produce May produce May produce RalesRalesRalesRales (Sound like rustling (Sound like rustling (Sound like rustling (Sound like rustling
hair)hair)hair)hair) in some patients in some patients in some patients in some patients (because of the fluid
build up)
� Patients with CORD may have heart failure Patients with CORD may have heart failure Patients with CORD may have heart failure Patients with CORD may have heart failure
as wellas wellas wellas well
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RESPIRATORY PROBLEMS
14. What is the signs & symptoms of a patient
suffering from PULMONARY EDEMAPULMONARY EDEMAPULMONARY EDEMAPULMONARY EDEMA?� AAAApprehensionpprehensionpprehensionpprehension
� AAAAgitationgitationgitationgitation
� CCCCyanosisyanosisyanosisyanosis
� CCCConfusion (Hypoxia)onfusion (Hypoxia)onfusion (Hypoxia)onfusion (Hypoxia)
� Feeling of Feeling of Feeling of Feeling of DDDDrowningrowningrowningrowning
� Distended Distended Distended Distended JJJJugular Veins ugular Veins ugular Veins ugular Veins when lying when lying when lying when lying
downdowndowndown
� PPPPinkinkinkink sputum sputum sputum sputum ---- Advanced stage
� Cold, very Cold, very Cold, very Cold, very SSSSweaty Skinweaty Skinweaty Skinweaty Skin
� Severe Severe Severe Severe SSSSOBOBOBOB
AACCDJPSSAACCDJPSSAACCDJPSSAACCDJPSS
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RESPIRATORY PROBLEMS
15. What is the treatment of a patient
who is suffering from
PULMONARY EDEMAPULMONARY EDEMAPULMONARY EDEMAPULMONARY EDEMA?
� PPPPrimary Surveyrimary Surveyrimary Surveyrimary Survey
� OOOOxygen to Maintain Sats @ >95%xygen to Maintain Sats @ >95%xygen to Maintain Sats @ >95%xygen to Maintain Sats @ >95%
� Determine Cardiac Determine Cardiac Determine Cardiac Determine Cardiac RRRRhythmhythmhythmhythm
� Allow to Allow to Allow to Allow to SSSSit it it it (Helps to pull excess fluid in feet not lungs)
Give:Give:Give:Give:
� 0.8mg 0.8mg 0.8mg 0.8mg GGGGTN provided the systolic TN provided the systolic TN provided the systolic TN provided the systolic
B/P >80mmHgB/P >80mmHgB/P >80mmHgB/P >80mmHgNoteNoteNoteNote::::
� CautionCautionCautionCaution & consider reducing dose if patient is elderly, small or hypotensive.
� Extreme CautionExtreme CautionExtreme CautionExtreme Caution if patient has taken Viagra in
last 24hrs (Prolonged Hypotension can occur)
� Gain Gain Gain Gain IIIIV accessV accessV accessV access
� IIIIPPV if necessary PPV if necessary PPV if necessary PPV if necessary (Increases Intrathorasic (Increases Intrathorasic (Increases Intrathorasic (Increases Intrathorasic
Pressure, thereby decreasing Venus return and Pressure, thereby decreasing Venus return and Pressure, thereby decreasing Venus return and Pressure, thereby decreasing Venus return and
therefore, Preload)therefore, Preload)therefore, Preload)therefore, Preload)
� Repeat 0.4 to 0.8mg of Repeat 0.4 to 0.8mg of Repeat 0.4 to 0.8mg of Repeat 0.4 to 0.8mg of GGGGTN every 2 TN every 2 TN every 2 TN every 2
to 5 minutes if B/P >80mmHgto 5 minutes if B/P >80mmHgto 5 minutes if B/P >80mmHgto 5 minutes if B/P >80mmHg
� LLLLOAD & GOOAD & GOOAD & GOOAD & GO
� UUUUrgent AP Backup rgent AP Backup rgent AP Backup rgent AP Backup (for Frusemide and/or
Morphine)
PORSGIIGLUPORSGIIGLUPORSGIIGLUPORSGIIGLU
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RESPIRATORY PROBLEMS
16. Why do we use IPPVIPPVIPPVIPPV in the treatment of
a patient suffering from
PULMONARY EDEMAPULMONARY EDEMAPULMONARY EDEMAPULMONARY EDEMA?
� Increases IIIIntrantrantrantratttthorasic horasic horasic horasic PPPPressure,ressure,ressure,ressure,
� thereby decreasing VVVVenus enus enus enus RRRReturneturneturneturn
� and therefore, PPPPreloadreloadreloadreloadItP, VR, PItP, VR, PItP, VR, PItP, VR, P
17. What does the letters IPPVIPPVIPPVIPPV stand for?� IIIIntermittentntermittentntermittentntermittent
� PPPPositiveositiveositiveositive
� PPPPressureressureressureressure
� VVVVentilationentilationentilationentilation
18. What is PreloadPreloadPreloadPreload? BBBB � The amount of The amount of The amount of The amount of BBBBlood that returns back lood that returns back lood that returns back lood that returns back to the heartto the heartto the heartto the heart
V, I, RV, I, RV, I, RV, I, RWidespread Widespread Widespread Widespread VVVVasodilatationasodilatationasodilatationasodilatation therefore therefore therefore therefore
�IIIIncreasing venous poolingncreasing venous poolingncreasing venous poolingncreasing venous pooling andandandand� RRRReducing the amount of blood that educing the amount of blood that educing the amount of blood that educing the amount of blood that returns back to the heartreturns back to the heartreturns back to the heartreturns back to the heart
GTN affects preload by:GTN affects preload by:GTN affects preload by:GTN affects preload by:
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RESPIRATORY PROBLEMS
19. What is AfterloadAfterloadAfterloadAfterload?
PR, SS, VPR, SS, VPR, SS, VPR, SS, V
� The amount of PPPPeripheral eripheral eripheral eripheral RRRResistanceesistanceesistanceesistance
� created by the SSSSystemic ystemic ystemic ystemic SSSSystem ystem ystem ystem
� that the VVVVentricles entricles entricles entricles has to eject against.
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1. What is the generic name of GTNgeneric name of GTNgeneric name of GTNgeneric name of GTN?
REVIEW OF GTN
2. What does GTNGTNGTNGTN do?
GGGGlyceryl Trinitrate.lyceryl Trinitrate.lyceryl Trinitrate.lyceryl Trinitrate.
3. What is PreloadPreloadPreloadPreload?
� Widespread universal Widespread universal Widespread universal Widespread universal vasodilatorvasodilatorvasodilatorvasodilator
� used to used to used to used to decreasedecreasedecreasedecrease PreloadPreloadPreloadPreload and and and and
AfterloadAfterloadAfterloadAfterload on the heart and on the heart and on the heart and on the heart and
� therefore therefore therefore therefore decreasingdecreasingdecreasingdecreasing Cardiac Output Cardiac Output Cardiac Output Cardiac Output because of a decrease of Venous returnbecause of a decrease of Venous returnbecause of a decrease of Venous returnbecause of a decrease of Venous return
V, P, A, C/OV, P, A, C/OV, P, A, C/OV, P, A, C/O
� The amount of The amount of The amount of The amount of BBBBlood that returns back lood that returns back lood that returns back lood that returns back to the heartto the heartto the heartto the heart
BBBB � The amount of The amount of The amount of The amount of BBBBlood that returns back lood that returns back lood that returns back lood that returns back to the heartto the heartto the heartto the heart
GTN affects preload by:GTN affects preload by:GTN affects preload by:GTN affects preload by:
Widespread Widespread Widespread Widespread VVVVasodilatationasodilatationasodilatationasodilatation therefore therefore therefore therefore
�IIIIncreasing venous poolingncreasing venous poolingncreasing venous poolingncreasing venous pooling andandandand� RRRReducing the amount of blood that educing the amount of blood that educing the amount of blood that educing the amount of blood that returns back to the heartreturns back to the heartreturns back to the heartreturns back to the heart
V, I, RV, I, RV, I, RV, I, R
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REVIEW OF GTN
5. What dosage of GTN do you administer
for CARDIAC CHEST PAINCARDIAC CHEST PAINCARDIAC CHEST PAINCARDIAC CHEST PAIN?
0.8mg0.8mg0.8mg0.8mg sublingually every sublingually every sublingually every sublingually every 5555 minutes minutes minutes minutes
provided the systolic blood pressure provided the systolic blood pressure provided the systolic blood pressure provided the systolic blood pressure is >is >is >is >80808080mmHgmmHgmmHgmmHg
6. What dosage of GTN do you administer
for CHFCHFCHFCHF?0.40.40.40.4----8mg8mg8mg8mg sublingually every sublingually every sublingually every sublingually every 2222----5555 minutes minutes minutes minutes
provided the systolic blood pressure provided the systolic blood pressure provided the systolic blood pressure provided the systolic blood pressure
is >is >is >is >80808080mmHgmmHgmmHgmmHg
4. What is AfterloadAfterloadAfterloadAfterload?
PR, SS, VPR, SS, VPR, SS, VPR, SS, V
� The amount of PPPPeripheral eripheral eripheral eripheral RRRResistanceesistanceesistanceesistance
� created by the SSSSystemic ystemic ystemic ystemic SSSSystem ystem ystem ystem � that the VVVVentricles entricles entricles entricles has to eject against.
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7. What are 2 CONTRACONTRACONTRACONTRA----INDICATIONSINDICATIONSINDICATIONSINDICATIONSfor GTN?
REVIEW OF GTN
8. What are some of the
SIDE EFFECTSSIDE EFFECTSSIDE EFFECTSSIDE EFFECTS of GTN?
a.a.a.a. Patients who used Patients who used Patients who used Patients who used VVVViagra within the iagra within the iagra within the iagra within the
last 24 hourslast 24 hourslast 24 hourslast 24 hoursb.b.b.b. Systolic Systolic Systolic Systolic BBBBlood Pressure under lood Pressure under lood Pressure under lood Pressure under
80mmHg80mmHg80mmHg80mmHg
DDDDizzinessizzinessizzinessizziness
HHHHeadacheseadacheseadacheseadaches
SlightSlightSlightSlight Increase in Increase in Increase in Increase in HHHHeart Rateeart Rateeart Rateeart RateHHHHypotensionypotensionypotensionypotension
PPPPalpitationsalpitationsalpitationsalpitations
DHHHPDHHHPDHHHPDHHHP
And the 2
““““USE WITH CAUTIONSUSE WITH CAUTIONSUSE WITH CAUTIONSUSE WITH CAUTIONS””””?a. If patient nearing a. If patient nearing a. If patient nearing a. If patient nearing 80808080mmHgmmHgmmHgmmHg
b. Known Hypersensitivity (b. Known Hypersensitivity (b. Known Hypersensitivity (b. Known Hypersensitivity (AAAAllergy)llergy)llergy)llergy)
V B/PV B/PV B/PV B/P
B/P AB/P AB/P AB/P A
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1. What is the treatment for a
Conscious Adult or Child Patient with an
airway obstruction?
FOREIGN BODY AIRWAY OBSTRUCTION
�Give 5 Give 5 Give 5 Give 5 BBBBack Blowsack Blowsack Blowsack BlowsFollow by:Follow by:Follow by:Follow by:
� 5 5 5 5 AAAAbdominal Thrusts if blows failbdominal Thrusts if blows failbdominal Thrusts if blows failbdominal Thrusts if blows fail�In very obese or pregnant patients use In very obese or pregnant patients use In very obese or pregnant patients use In very obese or pregnant patients use
CCCChest Trusts instead of abdominal thrustshest Trusts instead of abdominal thrustshest Trusts instead of abdominal thrustshest Trusts instead of abdominal thrusts
�CCCContinue cycle until either obstruction is ontinue cycle until either obstruction is ontinue cycle until either obstruction is ontinue cycle until either obstruction is
relieved or the patient becomes relieved or the patient becomes relieved or the patient becomes relieved or the patient becomes
unconsciousunconsciousunconsciousunconscious
� Under direct vision try to find andUnder direct vision try to find andUnder direct vision try to find andUnder direct vision try to find and
remove the foreign body with yourremove the foreign body with yourremove the foreign body with yourremove the foreign body with your
FFFFingersingersingersingers
� Give Give Give Give CCCChest Trusts if the above failshest Trusts if the above failshest Trusts if the above failshest Trusts if the above fails
� Open the airway and try andOpen the airway and try andOpen the airway and try andOpen the airway and try and
ventilate using a manual ventilationventilate using a manual ventilationventilate using a manual ventilationventilate using a manual ventilation
BBBBagagagag
� Call for an Call for an Call for an Call for an AAAAP URGENTLY!!!!P URGENTLY!!!!P URGENTLY!!!!P URGENTLY!!!!
2. What is the treatment for a
Unconscious Patient with an airway obstruction?
BACCBACCBACCBACC
FCBAFCBAFCBAFCBA
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3. Conscious Infant Patient with an
airway obstruction?
FOREIGN BODY AIRWAY OBSTRUCTION
�Give 5 Give 5 Give 5 Give 5 BBBBack Blowsack Blowsack Blowsack BlowsFollow by:Follow by:Follow by:Follow by:
� 5 5 5 5 CCCChest Thrusts if blows failhest Thrusts if blows failhest Thrusts if blows failhest Thrusts if blows fail�CCCContinue cycle until either obstruction is ontinue cycle until either obstruction is ontinue cycle until either obstruction is ontinue cycle until either obstruction is
relieved or the patient becomes relieved or the patient becomes relieved or the patient becomes relieved or the patient becomes
unconsciousunconsciousunconsciousunconscious
BCCBCCBCCBCC
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NASOPHARYNGEAL AIRWAY
1. What are the indications for the insertion
of a Nasopharyngeal Airway?
�To provide an alternative airway for To provide an alternative airway for To provide an alternative airway for To provide an alternative airway for patients with patients with patients with patients with TTTTrismus, in which an rismus, in which an rismus, in which an rismus, in which an oropharyngeal airway placement is not oropharyngeal airway placement is not oropharyngeal airway placement is not oropharyngeal airway placement is not possiblepossiblepossiblepossible�To provide airway assistant where an To provide airway assistant where an To provide airway assistant where an To provide airway assistant where an OOOOrorororoppppharyngeal airway will not be toleratedharyngeal airway will not be toleratedharyngeal airway will not be toleratedharyngeal airway will not be tolerated�To provide a portal for airway suction To provide a portal for airway suction To provide a portal for airway suction To provide a portal for airway suction and and and and RRRRemoval of debrisemoval of debrisemoval of debrisemoval of debris
2. What are the pre-cautions for
the use of a Nasopharyngeal Airway?
�Vascular Vascular Vascular Vascular AAAAbnormalities of the nosebnormalities of the nosebnormalities of the nosebnormalities of the nose�BBBBleeding disordersleeding disordersleeding disordersleeding disorders�IIIInfection in the nosenfection in the nosenfection in the nosenfection in the nose�TTTTrauma to the noserauma to the noserauma to the noserauma to the nose�Patient on antiPatient on antiPatient on antiPatient on anti----coagulant coagulant coagulant coagulant ((((warfrinwarfrinwarfrinwarfrin/aspirin)/aspirin)/aspirin)/aspirin)
3. What are the complications in the
use of a Nasopharyngeal Airway?
�AAAAirway Obstruction, may kink or clogirway Obstruction, may kink or clogirway Obstruction, may kink or clogirway Obstruction, may kink or clog
�EEEEpistaxispistaxispistaxispistaxis
�Coughing Coughing Coughing Coughing LLLLaryngospasmaryngospasmaryngospasmaryngospasm
�VVVVagal stimulation if the tube is too longagal stimulation if the tube is too longagal stimulation if the tube is too longagal stimulation if the tube is too long
�GGGGaggingaggingaggingagging�VVVVomiting, difficult to suction throughomiting, difficult to suction throughomiting, difficult to suction throughomiting, difficult to suction through
ABITABITABITABIT
TOpRTOpRTOpRTOpR
AELVGVAELVGVAELVGVAELVGV
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NASOPHARYNGEAL AIRWAY
4. What is the better airway Oropharyngeal
Or Nasopharyngeal?
�Neither. Neither. Neither. Neither.
�An OP is preferableAn OP is preferableAn OP is preferableAn OP is preferable
�The placement of an The placement of an The placement of an The placement of an EndotrachelEndotrachelEndotrachelEndotrachel TTTTubeubeubeubeis the only method of providing a secure is the only method of providing a secure is the only method of providing a secure is the only method of providing a secure
airwayairwayairwayairway5. What sizes of Nasopharyngeal
Airway that are used by this service?
�8.58.58.58.5 Large AdultLarge AdultLarge AdultLarge Adult�7.57.57.57.5 Medium AdultMedium AdultMedium AdultMedium Adult�6.56.56.56.5 Small AdultSmall AdultSmall AdultSmall Adult
6. How do you choose the correct size
of Nasopharyngeal Airway?�Measure the airway by placing the Measure the airway by placing the Measure the airway by placing the Measure the airway by placing the
airway next to the patients face.airway next to the patients face.airway next to the patients face.airway next to the patients face.
�The airway should extend from the tip of The airway should extend from the tip of The airway should extend from the tip of The airway should extend from the tip of
the patients nose to the tip of the patients the patients nose to the tip of the patients the patients nose to the tip of the patients the patients nose to the tip of the patients
earlobeearlobeearlobeearlobe
�The diameter should be so the airway The diameter should be so the airway The diameter should be so the airway The diameter should be so the airway
can fit inside the patient nostril without can fit inside the patient nostril without can fit inside the patient nostril without can fit inside the patient nostril without
blanching the skin at the side of the nostrilblanching the skin at the side of the nostrilblanching the skin at the side of the nostrilblanching the skin at the side of the nostril
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NASOPHARYNGEAL AIRWAY
7. How do you insert the Airway?�Measure the airwayMeasure the airwayMeasure the airwayMeasure the airway
�Select the biggest nostrilSelect the biggest nostrilSelect the biggest nostrilSelect the biggest nostril
�Lubricate the airway, using KY JellyLubricate the airway, using KY JellyLubricate the airway, using KY JellyLubricate the airway, using KY Jelly
�Insert the airway into the nostril and aim Insert the airway into the nostril and aim Insert the airway into the nostril and aim Insert the airway into the nostril and aim
directly to the floor of the nose directly to the floor of the nose directly to the floor of the nose directly to the floor of the nose (aim towards (aim towards (aim towards (aim towards
the ear, not the top of the head)the ear, not the top of the head)the ear, not the top of the head)the ear, not the top of the head) straight back straight back straight back straight back
into the nasopharynxinto the nasopharynxinto the nasopharynxinto the nasopharynx
�If resistance is met rotate the airway gently If resistance is met rotate the airway gently If resistance is met rotate the airway gently If resistance is met rotate the airway gently
as you continue to insert it. as you continue to insert it. as you continue to insert it. as you continue to insert it.
�If you still can’t insert the airway, remove it If you still can’t insert the airway, remove it If you still can’t insert the airway, remove it If you still can’t insert the airway, remove it
and try the other nostril.and try the other nostril.and try the other nostril.and try the other nostril.
�You may feel it “give” as it turns the corner You may feel it “give” as it turns the corner You may feel it “give” as it turns the corner You may feel it “give” as it turns the corner
into the pharynxinto the pharynxinto the pharynxinto the pharynx
�When correctly inserted the flange of the When correctly inserted the flange of the When correctly inserted the flange of the When correctly inserted the flange of the
airway will lie against the flare of the nostrilairway will lie against the flare of the nostrilairway will lie against the flare of the nostrilairway will lie against the flare of the nostril
�Check that air is flowing through the airway, Check that air is flowing through the airway, Check that air is flowing through the airway, Check that air is flowing through the airway,
inhalation and exhalationinhalation and exhalationinhalation and exhalationinhalation and exhalation
�Check that insertion has not caused bleeding Check that insertion has not caused bleeding Check that insertion has not caused bleeding Check that insertion has not caused bleeding
–––– Suction if requiredSuction if requiredSuction if requiredSuction if required
�Maintain a Head TiltMaintain a Head TiltMaintain a Head TiltMaintain a Head Tilt
�If gagging or choking withdraw the airway If gagging or choking withdraw the airway If gagging or choking withdraw the airway If gagging or choking withdraw the airway
slightly and reassess for patencyslightly and reassess for patencyslightly and reassess for patencyslightly and reassess for patency
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NASOPHARYNGEAL AIRWAY
8. What position should you have your
patient in after insertion?�Recover Position if ableRecover Position if ableRecover Position if ableRecover Position if able
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LARYNGEAL MASK AIRWAY
1. What are the indications for the insertion
of a LMA?�The airway is still poor despite other The airway is still poor despite other The airway is still poor despite other The airway is still poor despite other
airways being used (OP or NPA) and jaw airways being used (OP or NPA) and jaw airways being used (OP or NPA) and jaw airways being used (OP or NPA) and jaw
thrust thrust thrust thrust
orororor
�When bag/Mask ventilation is difficultWhen bag/Mask ventilation is difficultWhen bag/Mask ventilation is difficultWhen bag/Mask ventilation is difficult
orororor
�When the patient needs to be When the patient needs to be When the patient needs to be When the patient needs to be intubatedintubatedintubatedintubated
and no one is available to do soand no one is available to do soand no one is available to do soand no one is available to do so
orororor
�Intubation attempts have failedIntubation attempts have failedIntubation attempts have failedIntubation attempts have failed
2. What are the relative contraindications forthe use of a LMA?
�VomitingVomitingVomitingVomiting
�TrismusTrismusTrismusTrismus
3. What size mask do we use in this
service?
�Size 4Size 4Size 4Size 4
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LMA MASK AIRWAY
4. How do you insert the Airway?
�Remove the airway from it’s packageRemove the airway from it’s packageRemove the airway from it’s packageRemove the airway from it’s package
�Fully deflate the cuff with the bowl of the cuff Fully deflate the cuff with the bowl of the cuff Fully deflate the cuff with the bowl of the cuff Fully deflate the cuff with the bowl of the cuff
pressed down on a flat surfacepressed down on a flat surfacepressed down on a flat surfacepressed down on a flat surface
�Lubricate the airway, using KY JellyLubricate the airway, using KY JellyLubricate the airway, using KY JellyLubricate the airway, using KY Jelly
�Hold the LMA using fingers and thumb (like holding Hold the LMA using fingers and thumb (like holding Hold the LMA using fingers and thumb (like holding Hold the LMA using fingers and thumb (like holding
a pen) at the cuff end of the LMAa pen) at the cuff end of the LMAa pen) at the cuff end of the LMAa pen) at the cuff end of the LMA
�Extend the neck gently and open the mouth Extend the neck gently and open the mouth Extend the neck gently and open the mouth Extend the neck gently and open the mouth
�Hold the LMA with the hole in the cuff facing the Hold the LMA with the hole in the cuff facing the Hold the LMA with the hole in the cuff facing the Hold the LMA with the hole in the cuff facing the
patient’s feet.patient’s feet.patient’s feet.patient’s feet.
�Press the cuff into the mouth and manoeuvre it past Press the cuff into the mouth and manoeuvre it past Press the cuff into the mouth and manoeuvre it past Press the cuff into the mouth and manoeuvre it past
the teeth keeping the tip firmly pressed against the the teeth keeping the tip firmly pressed against the the teeth keeping the tip firmly pressed against the the teeth keeping the tip firmly pressed against the
hard palatehard palatehard palatehard palate
�Once the cuff is past the teeth, grasp the LMA at the Once the cuff is past the teeth, grasp the LMA at the Once the cuff is past the teeth, grasp the LMA at the Once the cuff is past the teeth, grasp the LMA at the
proximal end between the thumb and fingersproximal end between the thumb and fingersproximal end between the thumb and fingersproximal end between the thumb and fingers
�Push the LMA into the pharynx in one smooth Push the LMA into the pharynx in one smooth Push the LMA into the pharynx in one smooth Push the LMA into the pharynx in one smooth
movement. Push directly downwards (backwards) so movement. Push directly downwards (backwards) so movement. Push directly downwards (backwards) so movement. Push directly downwards (backwards) so
that the LMA follows the curve of the posterior that the LMA follows the curve of the posterior that the LMA follows the curve of the posterior that the LMA follows the curve of the posterior
pharyngeal wall. Stop pushing when you begin to feel pharyngeal wall. Stop pushing when you begin to feel pharyngeal wall. Stop pushing when you begin to feel pharyngeal wall. Stop pushing when you begin to feel
some resistance.some resistance.some resistance.some resistance.
�Inflate the LMA with 30mls of airInflate the LMA with 30mls of airInflate the LMA with 30mls of airInflate the LMA with 30mls of air
�Connect the bag ventilator to the LMAConnect the bag ventilator to the LMAConnect the bag ventilator to the LMAConnect the bag ventilator to the LMA
�Check it’s patencyCheck it’s patencyCheck it’s patencyCheck it’s patency
�Insert a OP airway between the teethInsert a OP airway between the teethInsert a OP airway between the teethInsert a OP airway between the teeth
�Secure the LMA, using tapeSecure the LMA, using tapeSecure the LMA, using tapeSecure the LMA, using tape
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LMA MASK AIRWAY
5. What is now required? �Backup is required by an APBackup is required by an APBackup is required by an APBackup is required by an AP
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CPR
DEFIBRILLATION
ECG
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1. What is the compression/inflation ratio for
Child CPR?
CPR
2. What is the neonatal compression/inflation
ratio for CPR <44 weeks gestation?
Ages 1 to 8Ages 1 to 8Ages 1 to 8Ages 1 to 8
5:15:15:15:1 with depth of 3cm, using heal of one handwith depth of 3cm, using heal of one handwith depth of 3cm, using heal of one handwith depth of 3cm, using heal of one hand
< 1 year< 1 year< 1 year< 1 year
5:15:15:15:1 using 2 fingers between the nipple lineusing 2 fingers between the nipple lineusing 2 fingers between the nipple lineusing 2 fingers between the nipple line
All at a rate of 100/minAll at a rate of 100/minAll at a rate of 100/minAll at a rate of 100/min
3. At what heart rate would you initiate CPR
for a newborn?
<60beats/min commence CPR @ 3:1<60beats/min commence CPR @ 3:1<60beats/min commence CPR @ 3:1<60beats/min commence CPR @ 3:1
3:13:13:13:1 with depth of 2cm, with depth of 2cm, with depth of 2cm, with depth of 2cm, using 2 thumbsusing 2 thumbsusing 2 thumbsusing 2 thumbs
between the nipple line,between the nipple line,between the nipple line,between the nipple line, at a rate of at a rate of at a rate of at a rate of
100/min100/min100/min100/min
4. What is the ventilation rate used if an
asthmatic patient arrests?
6/min 6/min 6/min 6/min
5. What is the compression/inflation ratio for
an adult CPR two person and one person?
15:215:215:215:2 with a depth of 4cmwith a depth of 4cmwith a depth of 4cmwith a depth of 4cmFor Intubated Patients changes to For Intubated Patients changes to For Intubated Patients changes to For Intubated Patients changes to 5:15:15:15:1
Both at a rate of 100/minBoth at a rate of 100/minBoth at a rate of 100/minBoth at a rate of 100/min
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DEFIBRILLATION
1. What joules would we administer the first 3
shocks in a VT/Vf cardiac arrest?
� 1111stststst Two Shocks @ 200 JoulesTwo Shocks @ 200 JoulesTwo Shocks @ 200 JoulesTwo Shocks @ 200 Joules
� 3333rdrdrdrd Shocks @ 360 JoulesShocks @ 360 JoulesShocks @ 360 JoulesShocks @ 360 JoulesThen:Then:Then:Then:
� Repeat @ 360 Joules in lots of 3 Repeat @ 360 Joules in lots of 3 Repeat @ 360 Joules in lots of 3 Repeat @ 360 Joules in lots of 3
shocks every two to three minutesshocks every two to three minutesshocks every two to three minutesshocks every two to three minutesIf the patient reverts and then reIf the patient reverts and then reIf the patient reverts and then reIf the patient reverts and then re----arrests:arrests:arrests:arrests:
� use the last successful settinguse the last successful settinguse the last successful settinguse the last successful setting
2. What joules would we set the first shock
for a 14 year old cardiac arrest?
2 x weight 2 x weight 2 x weight 2 x weight therefore:therefore:therefore:therefore:
14 x 3 = 42kgs x 2 = 84 rounded off to 14 x 3 = 42kgs x 2 = 84 rounded off to 14 x 3 = 42kgs x 2 = 84 rounded off to 14 x 3 = 42kgs x 2 = 84 rounded off to 80808080
Joules, for 1Joules, for 1Joules, for 1Joules, for 1stststst Two shocks, Two shocks, Two shocks, Two shocks, followed by:followed by:followed by:followed by:
160160160160 for 3for 3for 3for 3rdrdrdrd and subsequent Shocksand subsequent Shocksand subsequent Shocksand subsequent Shocks
3. If a patient presents in VT and has a GCSless than or equal to 10 and your Advanced
Paramedic backup is 40 minutes away,
what could you do?
CardiovertCardiovertCardiovertCardiovert at 2 shocks of 100 Joules at 2 shocks of 100 Joules at 2 shocks of 100 Joules at 2 shocks of 100 Joules followed by: 200 Joulesfollowed by: 200 Joulesfollowed by: 200 Joulesfollowed by: 200 Joules
4. How would you know that a patient
needed to be Cardioverted?
The patient is:The patient is:The patient is:The patient is:
�In VTIn VTIn VTIn VT�GCS less than or equal to 10 GCS less than or equal to 10 GCS less than or equal to 10 GCS less than or equal to 10
�and your AP is more than 40 and your AP is more than 40 and your AP is more than 40 and your AP is more than 40 minsminsminsmins awayawayawayaway
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ECG
1. What does the “P” wave represent
in an ECG?
DepolarizationDepolarizationDepolarizationDepolarization of the Atrium. (AV Node of the Atrium. (AV Node of the Atrium. (AV Node of the Atrium. (AV Node
shortly after) shortly after) shortly after) shortly after)
2. What does the “R” wave represent
in an ECG?DepolarizationDepolarizationDepolarizationDepolarization of the Ventriclesof the Ventriclesof the Ventriclesof the Ventricles
4. What does the “T” wave represent in an ECG?
RepolerisationRepolerisationRepolerisationRepolerisation of the Ventriclesof the Ventriclesof the Ventriclesof the Ventricles
5. What is the Isoelectric Line in an ECG The line shown on the ECG showing no The line shown on the ECG showing no The line shown on the ECG showing no The line shown on the ECG showing no
electrical activityelectrical activityelectrical activityelectrical activity
6. How fast does the ECG paper move at? 25mm/Sec25mm/Sec25mm/Sec25mm/Sec
7. What does one small square on the
ECG paper represent?1mm and 0.04 seconds1mm and 0.04 seconds1mm and 0.04 seconds1mm and 0.04 seconds
8. What does one large square on the ECG
paper represent?
5mm and 0.20 seconds5mm and 0.20 seconds5mm and 0.20 seconds5mm and 0.20 seconds
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ECG
9. What 5 things do we look for to interpret
an ECG?
RRRRegularegularegularegular
RRRRateateateate
PPPP WavesWavesWavesWaves
PRPRPRPR Interval Interval Interval Interval (should be .12 to .2 seconds (should be .12 to .2 seconds (should be .12 to .2 seconds (should be .12 to .2 seconds
–––– 3 to 5 squares)3 to 5 squares)3 to 5 squares)3 to 5 squares)
QRSQRSQRSQRS Complex Complex Complex Complex
RRPPrQRSRRPPrQRSRRPPrQRSRRPPrQRS
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ECG
10. What do we look for on an ECG whenwe are looking at the “QRS COMPLEX”?
PPPPresent or resent or resent or resent or AAAAbsentbsentbsentbsent
RRRRelationship to P waveelationship to P waveelationship to P waveelationship to P wave
RRRRelationship to other QRS Complexeselationship to other QRS Complexeselationship to other QRS Complexeselationship to other QRS Complexes
WWWWidth: .1 to .12 Seconds (3 squares)idth: .1 to .12 Seconds (3 squares)idth: .1 to .12 Seconds (3 squares)idth: .1 to .12 Seconds (3 squares)
PRRWPRRWPRRWPRRW
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ECG
11. What is + deflection on an ECG? Upward movement above (^) the Base Upward movement above (^) the Base Upward movement above (^) the Base Upward movement above (^) the Base
line (Isoelectric Line)line (Isoelectric Line)line (Isoelectric Line)line (Isoelectric Line)
12. What is - deflection on an ECG? Downward movement (v) below the Downward movement (v) below the Downward movement (v) below the Downward movement (v) below the
Base line (Isoelectric Line)Base line (Isoelectric Line)Base line (Isoelectric Line)Base line (Isoelectric Line)
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ECG
13. What 6 things have to be present in13. What 6 things have to be present in13. What 6 things have to be present in13. What 6 things have to be present in
a PVC?a PVC?a PVC?a PVC?
1.1.1.1. WWWWide and bizarreide and bizarreide and bizarreide and bizarre
2.2.2.2. PPPPrematurerematurerematureremature
3.3.3.3. NNNNo P Waveo P Waveo P Waveo P Wave
4.4.4.4. CCCConstant Couplingonstant Couplingonstant Couplingonstant Coupling
5.5.5.5. CCCCompensatory Pauseompensatory Pauseompensatory Pauseompensatory Pause
6.6.6.6. DDDDeflection opposite to last beateflection opposite to last beateflection opposite to last beateflection opposite to last beat
14. Where should the electrodes be 14. Where should the electrodes be 14. Where should the electrodes be 14. Where should the electrodes be
positioned on the patients chest?positioned on the patients chest?positioned on the patients chest?positioned on the patients chest?
White:White:White:White: (Is right)Right Right Right Right ---- 2222ndndndnd intercostalintercostalintercostalintercostal, mid , mid , mid , mid clavicularclavicularclavicularclavicular
Red:Red:Red:Red:Left Left Left Left ---- 6666thththth––––7777thththth IntercostalIntercostalIntercostalIntercostal, mid , mid , mid , mid clavicularclavicularclavicularclavicular
Black:Black:Black:Black:Left Left Left Left ---- 2222ndndndnd intercoastalintercoastalintercoastalintercoastal, mid , mid , mid , mid clavicularclavicularclavicularclavicular
15. Name 5 common artifacts causes seen 15. Name 5 common artifacts causes seen 15. Name 5 common artifacts causes seen 15. Name 5 common artifacts causes seen
on an ECG?on an ECG?on an ECG?on an ECG?
1.1.1.1. 50505050 cycle Interferencecycle Interferencecycle Interferencecycle Interference
2.2.2.2. MMMMuscle uscle uscle uscle tremourtremourtremourtremour
3.3.3.3. WWWWandering base line (movement)andering base line (movement)andering base line (movement)andering base line (movement)4.4.4.4. LLLLoose Electrodesoose Electrodesoose Electrodesoose Electrodes
5.5.5.5. TTTThick Base line (oil, hair, etc)hick Base line (oil, hair, etc)hick Base line (oil, hair, etc)hick Base line (oil, hair, etc)
50MWLT50MWLT50MWLT50MWLT
WPNCCDWPNCCDWPNCCDWPNCCD
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ECG
16. Name the Electrical Conduction 16. Name the Electrical Conduction 16. Name the Electrical Conduction 16. Name the Electrical Conduction
System of the Heart?System of the Heart?System of the Heart?System of the Heart?
SA NodeSA NodeSA NodeSA Node
Internodal Atrial Internodal Atrial Internodal Atrial Internodal Atrial PathwaysPathwaysPathwaysPathways
AV JunctionAV JunctionAV JunctionAV Junction
AV NodeAV NodeAV NodeAV Node
Bundle of HisBundle of HisBundle of HisBundle of His
Left Bundle BranchLeft Bundle BranchLeft Bundle BranchLeft Bundle Branch
Right Bundle BranchRight Bundle BranchRight Bundle BranchRight Bundle Branch
Purkinje FibersPurkinje FibersPurkinje FibersPurkinje Fibers
Purkinje NetworkPurkinje NetworkPurkinje NetworkPurkinje Network
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IV CANNULATION
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IV CANNULATION
1. What is the procedure the insertion
of a IV Cannula?
•Inform PatientInform PatientInform PatientInform Patient
•Where possible gain there permissionWhere possible gain there permissionWhere possible gain there permissionWhere possible gain there permission
•Prepare the equipmentPrepare the equipmentPrepare the equipmentPrepare the equipment•Select and check the correct fluidSelect and check the correct fluidSelect and check the correct fluidSelect and check the correct fluid
•Prime the IV SetPrime the IV SetPrime the IV SetPrime the IV Set
•Put on glovesPut on glovesPut on glovesPut on gloves
•Apply venous tourniquetApply venous tourniquetApply venous tourniquetApply venous tourniquet
•Select veinSelect veinSelect veinSelect vein
•Swab siteSwab siteSwab siteSwab site•Stabile the veinStabile the veinStabile the veinStabile the vein
•Puncture skin with bevel upPuncture skin with bevel upPuncture skin with bevel upPuncture skin with bevel up
•Decrease cannula angle and enter vein Decrease cannula angle and enter vein Decrease cannula angle and enter vein Decrease cannula angle and enter vein
lumenlumenlumenlumen
•Advance cannula down needleAdvance cannula down needleAdvance cannula down needleAdvance cannula down needle
•Tamponade vein and remove needleTamponade vein and remove needleTamponade vein and remove needleTamponade vein and remove needle•Remove tourniquetRemove tourniquetRemove tourniquetRemove tourniquet
•Connect IV and set drip rate or connect Connect IV and set drip rate or connect Connect IV and set drip rate or connect Connect IV and set drip rate or connect
luerluerluerluer
•Flush the luer with salineFlush the luer with salineFlush the luer with salineFlush the luer with saline
•Secure Set/LuerSecure Set/LuerSecure Set/LuerSecure Set/Luer
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IV CANNULATION
2. What do you need to check at regular
Intervals?
•InfiltrationInfiltrationInfiltrationInfiltration
•Other ComplicationsOther ComplicationsOther ComplicationsOther Complications
•Flow RateFlow RateFlow RateFlow Rate
3. What do you need to do when you haveHave finished the procedure?
•Dispose of all equipment correctlyDispose of all equipment correctlyDispose of all equipment correctlyDispose of all equipment correctly•Document the procedure on the Patient Document the procedure on the Patient Document the procedure on the Patient Document the procedure on the Patient
ReportReportReportReport
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IV FLUIDS
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2. What is the fluid rate for children suffering hypervolemia?
IV FLUIDS
3. What is the targeted systolic blood
Pressure for an adult patient suffering Penetrating trauma?
20mls/Kg20mls/Kg20mls/Kg20mls/Kg20 x age x 2 + 8 or 20 x age x 2 + 8 or 20 x age x 2 + 8 or 20 x age x 2 + 8 or 20 x age x 320 x age x 320 x age x 320 x age x 3E.g.: 9 year old = 20 x (9 x 3 = 27) = 540mlsE.g.: 9 year old = 20 x (9 x 3 = 27) = 540mlsE.g.: 9 year old = 20 x (9 x 3 = 27) = 540mlsE.g.: 9 year old = 20 x (9 x 3 = 27) = 540mlsDextrose 2ml/KgDextrose 2ml/KgDextrose 2ml/KgDextrose 2ml/Kg
4. What is the targeted systolic for an adult head injury patient who is unable to
obey commands?
Anyone patient that:Anyone patient that:Anyone patient that:Anyone patient that:• Is unable to Is unable to Is unable to Is unable to obey commandsobey commandsobey commandsobey commands
• Has a Has a Has a Has a Systolic B/P <= 120mmHgSystolic B/P <= 120mmHgSystolic B/P <= 120mmHgSystolic B/P <= 120mmHg
80mmHg80mmHg80mmHg80mmHg
5. What criteria must the patient meet to run
0.9% Nacl for a head injury patient?
120mmHg120mmHg120mmHg120mmHg
No Fluids, No Fluids, No Fluids, No Fluids, but an AP might if giving AP might if giving AP might if giving AP might if giving
adrenaline diluted in 1000mls of NaCladrenaline diluted in 1000mls of NaCladrenaline diluted in 1000mls of NaCladrenaline diluted in 1000mls of NaCl
1. How much fluids would you run for an adult
patient suffering severe asthma?
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6. What is the targeted systolic blood
pressure for an adult patient sufferingblunt trauma?
IV FLUIDS
7. When would we administer fluids to a
burns patient?
8. At what stage can we run fluids for a
hypotensive patient in cardiogenic shock?
� If Systolic If Systolic If Systolic If Systolic B/PB/PB/PB/P < 80mmHg< 80mmHg< 80mmHg< 80mmHg
� Has Has Has Has NNNNOOOO SOB SOB SOB SOB � Has Has Has Has NNNNO Significant crackles in chestO Significant crackles in chestO Significant crackles in chestO Significant crackles in chest
� Rate:Rate:Rate:Rate:� 500ml of NaCl as a fluid challenge500ml of NaCl as a fluid challenge500ml of NaCl as a fluid challenge500ml of NaCl as a fluid challenge
STOP FLUID IF patient becomes SOBSTOP FLUID IF patient becomes SOBSTOP FLUID IF patient becomes SOBSTOP FLUID IF patient becomes SOB
� If improvement with 1If improvement with 1If improvement with 1If improvement with 1stststst Bolus Repeat Bolus Repeat Bolus Repeat Bolus Repeat
500mls500mls500mls500mlswith the same precautions (SOB)with the same precautions (SOB)with the same precautions (SOB)with the same precautions (SOB)
Burn is >= 15%Burn is >= 15%Burn is >= 15%Burn is >= 15%
Rate:Rate:Rate:Rate:Adults:Adults:Adults:Adults: 1000mls NaCl as a Bolus1000mls NaCl as a Bolus1000mls NaCl as a Bolus1000mls NaCl as a Bolus
Repeated enrouteRepeated enrouteRepeated enrouteRepeated enroute
Child:Child:Child:Child: 20ml/Kg as a Bolus20ml/Kg as a Bolus20ml/Kg as a Bolus20ml/Kg as a Bolus
Repeated enrouteRepeated enrouteRepeated enrouteRepeated enroute
100mmHg100mmHg100mmHg100mmHg
9. When should you NOT give fluids to a
patient in cardiogenic shock?
If the patient has pulmonary edemaIf the patient has pulmonary edemaIf the patient has pulmonary edemaIf the patient has pulmonary edema
Use GTN but with extreme cautionUse GTN but with extreme cautionUse GTN but with extreme cautionUse GTN but with extreme caution
B/PNNB/PNNB/PNNB/PNN
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IV FLUIDS
10. A patient has a Cardiac Arrest after
overdosing on antidepressants.
What fluid should you administer?
1000mls NaCl as a Bolus, repeated.1000mls NaCl as a Bolus, repeated.1000mls NaCl as a Bolus, repeated.1000mls NaCl as a Bolus, repeated.
11. What fluid should be given to a person
who is suffering from Hyperthermia?
1000mls NaCl as a Bolus, repeated.1000mls NaCl as a Bolus, repeated.1000mls NaCl as a Bolus, repeated.1000mls NaCl as a Bolus, repeated.
12. What fluid should be given to a person
who is suffering from the “Bends”?
1000mls NaCl as a Bolus, repeated.1000mls NaCl as a Bolus, repeated.1000mls NaCl as a Bolus, repeated.1000mls NaCl as a Bolus, repeated.
13. What fluid should be given to a person
who is suffering from Hypovolaemic Shock”?1000mls NaCl as a Bolus, repeated 1000mls NaCl as a Bolus, repeated 1000mls NaCl as a Bolus, repeated 1000mls NaCl as a Bolus, repeated
PRN is B/P under 100mmHgPRN is B/P under 100mmHgPRN is B/P under 100mmHgPRN is B/P under 100mmHg
NoteNoteNoteNote::::
Remember your B/P Targets forshock associated with PenetratingPenetratingPenetratingPenetratingTraumaTraumaTraumaTrauma and shock associated withBrain InjuryBrain InjuryBrain InjuryBrain Injury
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SHOCK
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SHOCK
3. At what stage can we run fluids for a
hypertensive patient in cardiogenic shock?
4. When should you NOT give fluids to a
patient in cardiogenic shock?
If the patient has pulmonary edemaIf the patient has pulmonary edemaIf the patient has pulmonary edemaIf the patient has pulmonary edema
Use GTN but with extreme cautionUse GTN but with extreme cautionUse GTN but with extreme cautionUse GTN but with extreme caution
� If Systolic If Systolic If Systolic If Systolic B/PB/PB/PB/P < 80mmHg< 80mmHg< 80mmHg< 80mmHg� Has Has Has Has NNNNOOOO SOB SOB SOB SOB � Has Has Has Has NNNNO Significant crackles in chestO Significant crackles in chestO Significant crackles in chestO Significant crackles in chest� Rate:Rate:Rate:Rate:� 500ml of NaCl as a fluid challenge500ml of NaCl as a fluid challenge500ml of NaCl as a fluid challenge500ml of NaCl as a fluid challengeSTOP FLUID IF patient becomes SOBSTOP FLUID IF patient becomes SOBSTOP FLUID IF patient becomes SOBSTOP FLUID IF patient becomes SOB� If improvement with 1If improvement with 1If improvement with 1If improvement with 1stststst Bolus RepeatBolus RepeatBolus RepeatBolus Repeatwith the same precautions (SOB)with the same precautions (SOB)with the same precautions (SOB)with the same precautions (SOB)
1. What are the types of Shock? Hypovolaemic shock Hypovolaemic shock Hypovolaemic shock Hypovolaemic shock – Fluid lossCardiogenic Shock Cardiogenic Shock Cardiogenic Shock Cardiogenic Shock - Pump failureNeurogenicNeurogenicNeurogenicNeurogenic ShockShockShockShock - Fluid
2. What are the Signs and Symptoms of
Hypovolaemic Shock? Patient “Shut down”Patient “Shut down”Patient “Shut down”Patient “Shut down”TachycardicTachycardicTachycardicTachycardic
Remember: some exceptionsRemember: some exceptionsRemember: some exceptionsRemember: some exceptionsBeta-blocker = No Tachycardia
Shocked + Bradycardic = ? Ruptured Ectopic Pregnancy
B/PNNB/PNNB/PNNB/PNN
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SHOCK
5. What is the treatment for a patient withcardiogenic shock?
� PPPPrimary surveyrimary surveyrimary surveyrimary survey
� OOOOxygen via nonxygen via nonxygen via nonxygen via non----rebreather Maskrebreather Maskrebreather Maskrebreather Mask
� Determine Determine Determine Determine RRRRhythmhythmhythmhythm
� Gain Gain Gain Gain IIIIV accessV accessV accessV access
� If patient has pulmonary edema, If patient has pulmonary edema, If patient has pulmonary edema, If patient has pulmonary edema,
treat as pulmonary edema proceduretreat as pulmonary edema proceduretreat as pulmonary edema proceduretreat as pulmonary edema procedure
� using GTN with extreme cautionusing GTN with extreme cautionusing GTN with extreme cautionusing GTN with extreme caution
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IM INJECTIONS
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1. What are the sites for an IM Injection?
IM INJECTIONS
2. What is the procedure for giving an
IM Injection?
•Inform PatientInform PatientInform PatientInform Patient
•Where possible gain there permissionWhere possible gain there permissionWhere possible gain there permissionWhere possible gain there permission
•Draw drug into syringeDraw drug into syringeDraw drug into syringeDraw drug into syringe•Select site for injectionSelect site for injectionSelect site for injectionSelect site for injection
•Cleanse surface with alcohol swabCleanse surface with alcohol swabCleanse surface with alcohol swabCleanse surface with alcohol swab
•Expel residue air from syringeExpel residue air from syringeExpel residue air from syringeExpel residue air from syringe
•Flatten skin with 2 fingersFlatten skin with 2 fingersFlatten skin with 2 fingersFlatten skin with 2 fingers
•Penetrate the skin in on movement @ a Penetrate the skin in on movement @ a Penetrate the skin in on movement @ a Penetrate the skin in on movement @ a
90 degree angle90 degree angle90 degree angle90 degree angle•Pull back syringe, checking for bloodPull back syringe, checking for bloodPull back syringe, checking for bloodPull back syringe, checking for blood
•If blood, withdraw slightlyIf blood, withdraw slightlyIf blood, withdraw slightlyIf blood, withdraw slightly
•Inject the drug slowlyInject the drug slowlyInject the drug slowlyInject the drug slowly
•Remove needle at same angleRemove needle at same angleRemove needle at same angleRemove needle at same angle
•Apply firm pressure to injection siteApply firm pressure to injection siteApply firm pressure to injection siteApply firm pressure to injection site
•Rub siteRub siteRub siteRub site•Dispose of equipmentDispose of equipmentDispose of equipmentDispose of equipment
•Record drug on patient reportRecord drug on patient reportRecord drug on patient reportRecord drug on patient report
•Buttock Buttock Buttock Buttock (Upper outer quadrant of Gluteus Muscle)(Upper outer quadrant of Gluteus Muscle)(Upper outer quadrant of Gluteus Muscle)(Upper outer quadrant of Gluteus Muscle)
•Mid Lateral ThighMid Lateral ThighMid Lateral ThighMid Lateral Thigh
•Deltoid MusclesDeltoid MusclesDeltoid MusclesDeltoid Muscles
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GENERAL
CSR PRACTICE QUIZCSR PRACTICE QUIZCSR PRACTICE QUIZCSR PRACTICE QUIZCSR PRACTICE QUIZCSR PRACTICE QUIZCSR PRACTICE QUIZCSR PRACTICE QUIZ
1. What is the expected weight of a 6 year
old from our procedures?
GENERAL
2. What is the weight calculation for a 14 yearold from our procedures?
Age x 2 +8Age x 2 +8Age x 2 +8Age x 2 +8 (for 1(for 1(for 1(for 1----8 yr olds) 8 yr olds) 8 yr olds) 8 yr olds) Therefore:Therefore:Therefore:Therefore:
6x2 = 12 + 8 = 6x2 = 12 + 8 = 6x2 = 12 + 8 = 6x2 = 12 + 8 = 20Kgs20Kgs20Kgs20Kgs
3. What would be the suspected normalsystolic for a 10 year old?
Calculation:Calculation:Calculation:Calculation: 80mmHg + 2 x age 80mmHg + 2 x age 80mmHg + 2 x age 80mmHg + 2 x age Therefore:Therefore:Therefore:Therefore:
80 + 2 x 10 = 80 + 2 x 10 = 80 + 2 x 10 = 80 + 2 x 10 = 100mmHg100mmHg100mmHg100mmHg
Age x 3Age x 3Age x 3Age x 3 (for 9(for 9(for 9(for 9----15 yr olds) 15 yr olds) 15 yr olds) 15 yr olds) Therefore:Therefore:Therefore:Therefore:
14x3 = 14x3 = 14x3 = 14x3 = 42Kgs42Kgs42Kgs42Kgs
4. What criteria would you look at when not
fitting a C-Collar to a patient?a.a.a.a. If the patient is If the patient is If the patient is If the patient is AAAAlert andlert andlert andlert andb.b.b.b. CCCCooperative ooperative ooperative ooperative andandandand
c.c.c.c. No No No No NNNNeck or eck or eck or eck or
d.d.d.d. UUUUpper back Tenderness on palpation pper back Tenderness on palpation pper back Tenderness on palpation pper back Tenderness on palpation
or movement or movement or movement or movement andandandand
e.e.e.e. No significant No significant No significant No significant DDDDistracting injury or istracting injury or istracting injury or istracting injury or
condition condition condition condition andandandand
f.f.f.f. Normal Normal Normal Normal PPPPeripheral sensation anderipheral sensation anderipheral sensation anderipheral sensation and
g.g.g.g. MMMMotor power.otor power.otor power.otor power.
ACNUDPMACNUDPMACNUDPMACNUDPM
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5. What is the Systolic Blood Pressure?
GENERAL
6. What is the Diastolic Blood Pressure?
Ventricles ContractingVentricles ContractingVentricles ContractingVentricles Contracting
Ventricles at RestVentricles at RestVentricles at RestVentricles at Rest