NCTI- Skills- Finals Testing

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NCTI- Skills- Finals Testing
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2010-05-13 23:47:44
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NCTI Skills Finals Testing
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NCTI- Skills- Finals Testing
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  1. Intubation- Endotracheal Intubation (Adult)
    Test Sheet
    • Pts Score Performance Steps Additional Information
    • 1 Take body substance isolation. Selection: gloves, goggles, mask, gown, booties, N95
    • 1 Opens airway manually Head-Tilt/Chin-Lift or Jaw Thrust
    • 1 Insert airway adjunct Oropharyngeal or Nasopharyngeal
    • 1 Ensures patient is adequately ventilated using a BVM, ventilates at a rate of 1 every 3-5 secs to pre-oxygenate the patient Verifies bilateral chest rise and fall, watches for possible skin color changes
    • 1 Selects proper equipment for patient: ET tube, stylette, laryngoscope blade and handle, 10 cc syringe, secondary detection device, tube securing device, suction device, Magill forceps Ensure sizing of all equipment based upon patient size and/or age. Insert stylette to 1 inch back from end of tube and leave 10 cc syringe attached
    • 1 Checks equipment for cuff leaks, operational laryngoscope light
    • 1 Positions head properly Head-Tilt/Chin-Lift or Jaw Thrust
    • 1 Inserts blade while displacing the tongue, sweeping from right to left
    • 1 Elevates mandible with laryngoscope Upward angle and toward the chest, not rocked back against the teeth
    • 1 Introduces ET tube and advances to proper depth Black line should pass the glottic opening. Announce depth marking that is level with the teeth for ease in detecting tube dislodgement throughout patient contact
    • 1 Inflates cuff to proper pressure and disconnects syringe Minimally occlusive volume (approx 10-15 cc depending on the tube)
    • 1 Directs ventilation of the patient Rate and volume dependent upon age and condition
    • 2 • Confirms proper placement by auscultating bilaterally over each lung and over epigastrium• Apply secondary confirmation devise Auscultation should be performed bilaterally over the mid-clavicular line and the anterior axillary line. Secondary confirmation devise=capnography, ETCO2, EDD
    • 1 Secure ET tube Confirm depth markings
    • 1 Reconfirm tube placement with auscultation bilaterally over each lung and over epigastrium
    • 1 Monitor patient for effects
    • 17 Total




    • INTUBATION – ENDOTRACHEAL TUBE (ADULT) continued Critical Failure Criteria
    • ____ Failure to take or verbalize BSI appropriate to the skill prior to performing the skill
    • ____ Failure to initiate ventilations within 30 seconds after applying gloves or interrupts ventilations for greater than 30 seconds
    • ____ Failure to voice and ultimately apply high flow oxygen concentrations
    • ____ Failure to ventilate patient at a rate appropriate to patient age
    • ____ Failure to provide adequate tidal volume per breath
    • ____ Failure to pre-oxygenate patient prior to intubation attempt
    • ____ Failure to successfully intubate within 3 attempts
    • ____ Failure to disconnect syringe immediately after inflating cuff of ET tube
    • ____ Uses teeth as fulcrum
    • ____ Failure to assure proper tube placement by auscultation bilaterally and over the epigastrium
    • ____ Fails to use secondary confirmation device
    • ____ If used, stylette extends beyond end of tube
    • ____ Any procedure that would have harmed the patient
    • ____ Points awarded < 13

    • Additional verbal items (check if answered correctly):
    • ____ List additional methods that may be utilized to verify tube placement (condensation in tube, bilateral chest rise and fall, color improvement, EDD, visualization of tube passing vocal cords, End Tidal CO2 detector, Capnography reading above zero)
    • ____ Identify the two types of laryngoscope blades and method of insertion for each (curved MacIntosh blade is inserted into vallecula between epiglottis and tongue to raise epiglottis using anatomy, straight Miller blade is inserted into the trachea below the epiglottis and lifts epiglottis out of sight)
    • ____ List additional methods that may be utilized to assist in the visualization of the trachea and vocal cords (cricoid pressure, pull back slightly on blade, padding under head or shoulders)INCLUDED IN THE PARAMEDIC SKILLS FINAL AND NATIONAL REGISTRY
  2. Intubation- Endotracheal Tube (Adult)
    Study Card
    • bsi
    • heat tilt chin lift/ jaw thrust
    • opa/npa
    • bvm 1/3-5sec
    • proper equipment: et tube, stylet, laryngoscope blade and handle, syringe, secondary device, securing device, suction device, magill forceps
    • check cuff leaks, white tight bright
    • position head
    • insert blade displace tongue
    • elev. mandible/ stay off the teeth!/ assistant hold forehead and cric. pressure
    • et tube to proper depth/ pass black line/ # at the teeth?
    • inflate proper
    • direct ventilations
    • auscultate/ capnography
    • secure ET/ dont let go of tube while securing!
    • reconfirm
    • monitor for effects
  3. Intravenous (IV) setup
    Test Sheet
    • 1 Take body substance isolation. Selection: gloves, goggles, mask, gown, booties, N95
    • 1 Check intravenous fluid for 6 Rights/DDICE See 6 Rights/DDICE skill sheet
    • 1 Select Macro-drip or Micro-drip tubing Based upon patient need
    • 1 Remove tubing and solution bag from protective wrapping
    • 1 Close flow adjuster on tubing
    • 1 Pull tab/cap from solution bag and remove protective cap from tubing Maintaining aseptic technique
    • 1 Insert piercing spike into solution set with a twisting motion
    • 1 Squeeze drip chamber until half full
    • 1 Flush tubing without removing protective cap from end of tubing until all large columns of air are removed Fluid will flow around intact cap
    • 1 Close flow adjuster Leave protective cap on end of tubing until needed for connection to established venipuncture
    • 10 Total

    • Critical Failure Criteria
    • ____ Failure to take or verbalize BSI appropriate to the skill prior to performing the skill
    • ____ Failure to maintain aseptic technique throughout skill
    • ____ Failure to flush tubing of air
    • ____ Any procedure that would have harmed the patient
    • ____ Points awarded < 7

    • Additional verbal items (check if answered correctly):
    • ____ List the solutions approved for prehospital use in California (0.9% Sodium Chloride)
  4. Intravenous (IV) setup
    Study Card
    • bsi
    • 6 Rights CIA DDICE
    • select macro/micro
    • remove from package
    • close flow adjuster
    • remove caps
    • spike bag
    • sqeeze chamber 1/2 full
    • flush all bubbles out
    • close flow
  5. Intravenous (IV) Cannulation Using a Catheter-Over-Needle
    Test Sheet
    • 1 Take body substance isolation. Selection: gloves, goggles, mask, gown, booties, N95
    • 1 Explain procedure to patient
    • 1 Prepare choice of securing devices Tear Transpore tape to size or open prepackaged adhesive devices
    • 1 Select appropriate sized catheter Based upon chief complaint/patient
    • 1 Apply constricting band to proximal site to distend the veins See Application of Constricting Band skill sheet
    • 1 Prepare site using aseptic technique Utilize betadine in concentric circles that do not over lap and alcohol as needed
    • 1 Stabilize the vein Pull slightly on distal end to apply traction to skin surface above vein
    • 1 Hold the device with bevel up and pierce the skin Swift motion without dragging needle across skin
    • 1 Adjust angle of device and advance needle slightly into vein, watching for a “flash” of blood in the device Maintain traction throughout procedure
    • 1 Lock back needle into catheter handle after advancing the catheter With locking devices, lock needle into handle for safe disposal
    • 1 Tamponade over vein past the end of the needle to obstruct blood flow
    • 1 Remove catheter handle from hub and immediately dispose of needle into appropriate container
    • 1 Release constricting band
    • 1 Attach IV tubing
    • 1 Open IV flow to ensure patency Must continue to hold catheter in place manually
    • 1 Secure catheter with tape or retail securing device Avoid encircling limb, taping connection sites and taping over injection sites
    • 1 Secure IV tubing to arm with tape or retail securing device
    • 1 Adjust IV flow rate as needed for patient chief complaint
    • 1 Recheck puncture site and manage as needed Watch for extravasation or thrombosis
    • 19 Total

    • Critical Failure Criteria
    • ____ Failure to take or verbalize BSI appropriate to the skill prior to performing the skill
    • ____ Contaminates equipment or site without appropriately correcting situation
    • ____ Performs any improper technique resulting in the potential for uncontrolled hemorrhage, catheter shear, or air embolism
    • ____ Failure to adjust IV flow to appropriate rate
    • ____ Failure to dispose of equipment into appropriate container
    • ____ Points awarded < 14
  6. Intravenous (IV) Cannulation Using a Catheter-Over-Needle
    Study Card
    • bsi
    • explain
    • ready the tape
    • size catheter
    • const. band
    • prepare aseptic
    • stabilize vein
    • bevel up
    • angle/ advance/ watch for flash
    • lock needle after catheter advance
    • tamponade
    • remove handle and sharps it
    • release constricting band
    • attach tube
    • open iv to ensure patency
    • tape catheter and dont let go of it
    • tape tube securely x2
    • adjust flow
    • recheck site for extravasation
  7. MEDICATION ADMINISTRATION – INTRAVENOUS PUSH (IVP)
    Test Sheet
    • 1 Take body substance isolation. Selection: gloves, goggles, mask, gown, booties, N95
    • 1 Ask the patient for allergies
    • 1 Explains procedure to patient
    • 1 Check medication for 6 Rights/DDICE See 6 Rights/DDICE skill sheet
    • 1 Draws up appropriate amount of medication or opens box and puts together preload medication See Withdrawing medication from a vial or ampule
    • 1 Expels air and adjusts medication to appropriate calibration mark If using a preload medication
    • 1 Selects injection site closest to patient and swab with alcohol wipe Remove needle tip if using needleless system
    • 1 Recheck medication for 6 Rights/DDICE See 6 Rights/DDICE skill sheet
    • 1 Puncture prepared site or screw into needleless site
    • 1 Crimp off line above injection site Medications will follow path of least resistance – that will be toward the IV bag if not prevented by blocking the proximal line. This may need to be intermittently opened to allow medication to infuse
    • 1 Ensure IV patency Draw back for blood return
    • 1 Inject correct dosage over correct time frame Medication specific. May need to intermittently open line to allow medication to infuse
    • 1 Check syringe to ensure correct amount was administered
    • 1 Dispose of equipment in appropriate container
    • 1 Readjust drip rate as necessary
    • 1 Observe patient for desired effect/adverse side effects, Document
    • 16 Total

    • Critical Failure Criteria
    • ____ Failure to take or verbalize BSI appropriate to the skill prior to performing the skill
    • ____ Failure to ask patient for medication allergies (relative criteria)
    • ____ Injects improper drug or dosage (wrong drug, incorrect amount, or pushes at inappropriate rate)
    • ____ Failure to flush IV tubing after injecting medication
    • ____ Recaps needle or failure to dispose of syringe and needle in proper container
    • ____ Contaminates equipment or site without appropriately correcting situation
    • ____ Technique utilized would have resulted in medication being deposited into incorrect tissue
    • ____ Any procedure that would have harmed the patient
    • ____ Points awarded < 12

    • Additional verbal items (check if answered correctly):
    • ____ List indications and contraindications for medication administered
  8. MEDICATION ADMINISTRATION – INTRAVENOUS PUSH (IVP)
    Study Card
    • bsi
    • explain
    • 6 rights CIA DDICE
    • draw appropriate amount
    • air out/ appropriate mark
    • 6 rights cia ddice double check
    • swab port
    • puncture/screw port
    • pinch
    • aspirate
    • push/ over correct time frame
    • check syringe for proper amount injected
    • dispose/sharps
    • readjust drip rate if needed
    • observe/reassess
  9. CPR – ADULT AND CHILD, ONE AND TWO RESCUER
    Test Sheet
    • 1 Take body substance isolation. Selection: gloves, goggles, mask, gown, booties, N95
    • 1 Tap and shout to determine unresponsiveness If you are not functioning in a 9-1-1 capacity, have someone call 9-1-1 and get an AED if possible
    • 1 Open the airway and clear any debris Head-Tilt/Chin-Lift or Jaw Thrust but if unable to open with a Jaw Thrust, use the Head-Tilt method (an open airway is more important)
    • 1 Look, listen and feel for normal breathing 5-10 seconds
    • 1 If inadequate or no breathing, give 2 slow rescue breaths (1-2 seconds) allowing lungs to deflate in between Using appropriate barrier device, and only enough to see the chest rise
    • 1 Check for signs of circulation Carotid pulse, movement, coughing, breathing –5-10 seconds
    • 1 If no signs of circulation, begin 30 chest compressions (if performing two rescuer CHILD CPR, use 15 chest compressions) Mid sternum, rate of 100/minute, third to half of the chest wall in depth allowing for full recoil in between (if performing two rescuer option, keep 2 fingers on carotid pulse to verify compression effectiveness)
    • 1 Give 2 slow rescue breaths Using appropriate barrier device, and only enough to see the chest rise
    • 1 Perform 5 cycles of chest compressions and ventilations (approximately 2 minutes) before checking for spontaneous return of breathing and/or pulse 10 cycles for 15-2. Maximum length of time with no chest compressions is 10 seconds
    • 9 Total
  10. CPR – ADULT AND CHILD, ONE AND TWO RESCUER
    Study Card
    • bsi
    • avpu
    • airway
    • look, listen, feel
    • 2 rescue breaths
    • circulation (check no more than 10 secs)
    • 30 compressions to 2 breaths (if child and 2 rescuers do 15 comps: 2 breaths)
    • 2 rescue breaths
    • 5 cycles/2mins (or 10 cycles/2mins for 2 rescuer child)
  11. DEFIBRILLATION
    Test Sheet
    • 1 Take body substance isolation. Selection: gloves, goggles, mask, gown, booties, N95
    • 1 Apply (hands-free) pads Place on the patient’s upper right chest (mid-clavicular line) and mid-axillary line on the patient’s left chest (4th or 5th intercostal space)
    • 1 Identify/Confirm the rhythm and confirm no pulse Clear all bystanders and crew away from the patient to get an accurate reading of the rhythm (Ventricular Fibrillation or Pulseless Ventricular Tachycardia)
    • 1 Select appropriate Joule value On the biphasic machine, 120-150J for the 1st and 2nd shocks and increased to 200J for the 3rd and subsequent shocks
    • 1 Press “Charge” button and allow machine to charge Clear all bystanders and crew away from the patient to prevent injury
    • 1 Reconfirm rhythm
    • 1 CLEAR patient, Press “Shock” button “I’m clear, you’re clear, everyone is clear”Visualize patient while defibrillating
    • 1 Reassess patient If needed, start CPR again for both conversion and non-conversion
    • 8 Total

    • Critical Failure Criteria
    • ____ Failure to take or verbalize BSI appropriate to the skill prior to performing the skill
    • ____ Any procedure that would have harmed the patient
    • ____ Points awarded < 6

    • Additional verbal items (check if answered correctly):
    • ____ State the criteria for immediate defibrillation upon confirmation of a shockable rhythm (witnessed cardiac arrest or effective CPR being performed prior to your arrival)
    • ____ State the criteria for delaying defibrillation upon confirmation of a shockable rhythm (uncertain down-time or ineffective CPR being performed prior to your arrival)
    • ____ Identify the physiology of not checking for return of a pulse prior to beginning CPR after defibrillation (patient will not be perfusing for 30-40 seconds even with a return of a pulse – chest compressions will ensure perfusion assistance until effective gas exchange can be accomplished)
  12. DEFIBRILLATION
    Study Card
    • bsi
    • pads
    • identify/confirm rhythm
    • appropriate joule
    • charge
    • reconfirm rhythm
    • clear/shock
    • reassess
  13. BLEEDING CONTROL/SHOCK MANAGEMENT
    Test Sheet
    • 1 Take body substance isolation. Selection: gloves, goggles, mask, gown, booties, N95
    • 1 Using a sterile bandage, apply direct pressure to wound
    • 1 Apply additional sterile bandages as necessary if bleeding soaks through original bandage Do not remove the old ones as it may cause additional bleeding
    • 1 Apply pressure bandage to wound To maintain direct pressure
    • 1 Splint extremity as necessary To reduce movement
    • 1 Apply tourniquet immediately proximal to wound, tight enough to control the bleeding and allow other measures to succeed Only if bleeding not controlled with above measures. Write the letter “T” on the forehead with the time as reminder
    • 1 Properly positions patient “Shock” position – lower extremities elevated as appropriate
    • 1 Administers high-concentration oxygen
    • 1 Initiates steps to prevent heat loss
    • 1 Indicates need for immediate transportation (trauma center as indicated) Patient is still critical even if bleeding is now controlled
    • 10 Total

    • Critical Failure Criteria
    • ____ Failure to take or verbalize BSI appropriate to the skill prior to performing the skill
    • ____ Any procedure that would have harmed the patient
    • ____ Points awarded < 7
  14. BLEEDING CONTROL/SHOCK MANAGEMENT
    Study Card
    • bsi
    • bandage pressure
    • additional bandages
    • pressure bandages
    • splint
    • tourniquet/ mark T and time on the forehead
    • position/ shock position
    • o2
    • heat loss
    • transport to trauma if necessary
  15. SPLINTING – HARE TRACTION SPLINT
    Test Sheet
    • 1 Take body substance isolation. Selection: gloves, goggles, mask, gown, booties, N95
    • 1 Visualize the injury and control any bleeding as necessary See Bleeding Control skill sheet
    • 1 Verify presence of distal functions after removing socks and shoes Circulation, sensory and motor responses
    • 1 Apply sterile dressing as appropriate to open wounds
    • 1 Set up splint by using uninjured leg Splint should be 8-12 inches longer than leg, and should have 2 open straps above the knee and 2 open straps below the knee; Unroll the ankle hitch strapping in preparation
    • 1 Explain to procedure to patient as necessary
    • 1 Apply ankle hitch
    • 1 Apply manual traction and lift leg Must have one hand under leg above the knee and one at the ankle; pull with hand at the knee first, and keep hands in same position until leg is resting on splint
    • 1 Instruct assistant to place splint firmly against the ischial tuberosity At the crease of the buttock and thigh
    • 1 Lower limb onto splint May now move both hands to ankle to continue traction
    • 1 Attach groin strap at an angle toward the patient’s head
    • 1 Attach ankle hitch to ratchet and tighten ratchet until manual traction is overcome and patient feels some pain relief
    • 1 Fasten 2 straps above the knee One above the fracture site and one below the fracture site
    • 1 Fasten 2 straps below the knee Spread out for support
    • 1 Reconfirm distal functions Circulation, sensory and motor responses
    • 1 Place patient onto long board and secure Required to complete the principles of splinting
    • 1 Recheck traction Loss is common upon movement
    • 1 Reconfirm distal functions Circulation, sensory and motor responses
    • 18 Total

    • Critical Failure Criteria
    • ____ Failure to take or verbalize BSI appropriate to the skill prior to performing the skill
    • ____ Loss of traction at any point after it is applied
    • ____ Failure to check distal functions before and after application of splint
    • ____ The foot was excessively rotated or extended after the splint was applied
    • ____ Did not secure the ischial strap before taking traction
    • ____ Final immobilization failed to support the femur or prevent rotation of the injured leg
    • ____ Secured the leg to the splint before applying mechanical traction
    • ____ Points awarded < 13

    • Additional verbal items (check if answered correctly):
    • ____ State contraindications for traction splint (not mid-shaft, injuries distal or proximal to femur)
    • ____ State the principles of splinting (what must be immobilized with every suspected fracture?)
  16. SPLINTING – HARE TRACTION SPLINT
    Practice Card
    • bsi
    • control bleeding/expose
    • pmsc
    • dress wounds
    • set splint along uninjured/ 8-12" passed, 2 straps above knee and 2 below
    • explain
    • apply ankle device
    • lift + traction simultanous/ 1hand above knee and 1 at the ankle
    • splint up against ischial/ 2 hands @ ankle
    • lower limb/ still hold traction
    • groin strap angle towards head
    • ankle to ratchet/ and tighten
    • 2 straps above knee/ above and below injury site
    • 2 straps below knee
    • pmsc
    • move patient to long board and secure
    • recheck traction
    • redo pmsc
  17. SPLINTING – SAGER TRACTION SPLINT
    Test Sheet
    • 1 Take body substance isolation. Selection: gloves, goggles, mask, gown, booties, N95
    • 1 Visualize the injury and control any bleeding as necessary See Bleeding Control skill sheet
    • 1 Verify presence of distal functions after removing socks and shoes Circulation, sensory and motor responses
    • 1 Apply sterile dressing as appropriate to open wounds
    • 1 Set up splint along side injured leg Splint should extend to the bottom of the foot: “wheel past the heel”
    • 1 Explain to procedure to patient as necessary
    • 1 Apply ankle hitch Splint may be applied medially or laterally
    • 1 Place padding inside groin and along splint along injured leg as necessary Important for both placement positions
    • 1 Attach groin strap at an angle toward the patient’s head
    • 1 Pull appropriate traction 10% of patient’s body weight in pounds up to a maximum of 15 pounds, or until patient experiences significant relief
    • 1 Fasten longest strap over fracture site Pull strap against splint for patient comfort
    • 1 Fasten one short strap on the knee Pull strap against splint for patient comfort
    • 1 Fasten last short strap over length control device below the knee Pull strap against splint for patient comfort
    • 1 Reconfirm distal functions Circulation, sensory and motor responses
    • 1 Place patient onto long board and secure Required to complete the principles of splinting
    • 1 Recheck traction Loss is common upon movement
    • 1 Reconfirm distal functions Circulation, sensory and motor responses
    • 17 Total

    • Critical Failure Criteria
    • ____ Failure to take or verbalize BSI appropriate to the skill prior to performing the skill
    • ____ Loss of traction at any point after it is applied
    • ____ Failure to check distal functions before and after application of splint
    • ____ The foot was excessively rotated or extended after the splint was applied
    • ____ Did not secure the ischial strap before taking traction
    • ____ Final immobilization failed to support the femur or prevent rotation of the injured leg
    • ____ Secured the leg to the splint before applying mechanical traction
    • ____ Points awarded < 13

    • Additional verbal items (check if answered correctly):
    • ____ State contraindications for traction splint (not mid-shaft, injuries above or below the femur)
    • ____ State the principles of splinting (what must be immobilized with every suspected fracture?)
  18. SPLINTING – SAGER TRACTION SPLINT
    Practice Card
    • bsi
    • visualize/expose/control bleeding
    • pmsc
    • dress wounds
    • set up along injured leg/ wheel passed the heel
    • explain
    • ankle device apply
    • pad the groin and all along the splint
    • groin strap towards head
    • traction/ 10% weight or 15 lbs or pain relief
    • long strap over fx/ pull against splint
    • short strap over knee
    • short strap over lock
    • pmsc
    • board and secure
    • check traction
    • pmsc
  19. CERVICAL SPINE IMMOBILIZATION – SEATED (KENDRICK EXTRICATION DEVICE)
    Test Sheet
    • 1 Take body substance isolation. Selection: gloves, goggles, mask, gown, booties, N95
    • 1 Ensure scene safety (If patient is in a vehicle, secure the vehicle) Gear shift placed in park, brake set, chocks behind wheels as necessary
    • 1 Maintain c-spine immobilization in neutral alignment
    • 1 Verify presence of distal function in all four extremities Circulation, sensory, and motor responses
    • 1 Measure and properly place rigid cervical collar
    • 1 Ease the patient forward and slide device in behind Use 2 people, pushing forward from the lower back to reduce curling motion. Do not ask or allow the patient to move themselves
    • 1 Check the back while in this position
    • 1 Pull out leg straps
    • 1 Lift device securely into place centered under the arms of the patient
    • 1 Move patient back
    • 1 Secure Torso Straps Use a feed and pull method, DO NOT TUGBottom, Middle, Top. Leave top loose for easy respirations
    • 1 Secure leg straps Starting from the outside of the patient’s leg, sliding strap under to position in between legs, then snap to buckle on same sid
    • 1 Pad behind the head and secure the head to the device May use 2 inch cloth tape
    • 1 Reassess distal functions in all four extremities Circulation, sensory, and motor responses
    • 1 Have patient take deep breath and cinch top body strap
    • 1 Remove patient from current position using handles on device and hands under thighs Keep legs in seated position during movement
    • 1 Transfer to long board
    • 1 Position patient supine, release leg straps
    • 1 Loosen top body strap and secure patient to long board, leaving device in place Head to be secured last
    • 1 Reconfirm distal functions in all four extremities Circulation, sensory, and motor responses
    • 20 Total

    • Critical Failure Criteria
    • ____ Failure to take or verbalize BSI appropriate to the skill prior to performing the skill
    • ____ Did not immediately direct, or take, manual immobilization of the head
    • ____ Released, or ordered release of, manual immobilization before it was maintained mechanically
    • ____ Device moved excessively up, down, left, or right on the patient’s torso
    • ____ Head immobilization allows for excessive movement
    • ____ Upon completion of immobilization, head is not in the neutral position
    • ____ Torso fixation inhibits chest rise, resulting in respiratory compromise
    • ____ Securing head to device or long board prior to torso
    • ____ Patient manipulated, or moved excessively, causing potential spinal compromise
    • ____ Failure to check distal functions before and after immobilization
    • ____ Points awarded <15

    • Additional verbal items (check if answered correctly):
    • ____ List other reasons that the KED could be used other than extrication from a seated position (patient requires immobilization but cannot tolerate lying supine)
    • ___ Discuss importance of delegation and scene control
  20. CERVICAL SPINE IMMOBILIZATION – SEATED (KENDRICK EXTRICATION DEVICE)
    Practice Card
    • bsi
    • ss/ secure vehicle
    • maintain cspine
    • pmsc x4
    • collar rigid cervical
    • pt forward
    • check back while leaning forward and place device behind
    • pullout leg straps
    • center under arms
    • move pt back
    • torso/ top keep loose for now/ feed all strap no tugging!
    • legs
    • pad head and secure inline
    • pmsc x4
    • breathe in and secure top strap/
    • use handles to remove patient
    • transport to longboard
    • supine and release leg straps
    • loosen top/ secure torse/ then legs/ and secure head last
    • pmsc
  21. CERVICAL SPINE IMMOBILIZATION – SUPINE WITH LONG BOARD
    Test Sheet
    • 1 Take body substance isolation. Selection: gloves, goggles, mask, gown, booties, N95
    • 1 Maintain c-spine immobilization in neutral alignment
    • 1 Verify presence of distal function in all four extremities Circulation, sensory, and motor responses
    • 1 Measure and properly place rigid cervical collar Assess neck, prior to placement of collar
    • 1 Bring in long board next to patient, higher than the patient’s head
    • 1 One team member will kneel at patient’s torso, placing one hand on the patient’s shoulder and one hand low on the pelvis
    • 1 One team member will kneel at patient’s thighs, placing one hand high on the pelvis and one hand at the knees
    • 1 In a simultaneous motion, roll patient away from the backboard, maintaining spinal axis alignment
    • 1 Check the back while in this position, using the pelvis hand of the team member at the torso Maintaining 3 points of contact on the body throughout
    • 1 Slide long board in to patient, higher than the patient’s head
    • 1 In a simultaneous motion, roll patient onto long board
    • 1 Using one motion, center the patient on the long board by sliding patient up and over Will not compress and then elongate the spine if one motion is used instead of two
    • 1 Strap patient to long board Torso must be strapped first, do not strap over abdomen
    • 1 Secure head to long board, using padding to maintain neutral alignment
    • 1 Reconfirm distal function in all four extremities Circulation, sensory, and motor responses
    • 5 Total

    • Critical Failure Criteria
    • ____ Failure to take or verbalize BSI appropriate to the skill prior to performing the skill
    • ____ Did not immediately direct, or take, manual immobilization of the head
    • ____ Released, or ordered release of, manual immobilization before it was maintained mechanically
    • ____ Patient manipulated, or moved excessively, causing potential spinal compromise
    • ____ Patient moves excessively up, down, left or right on device
    • ____ Head immobilization allows for excessive movement
    • ____ Upon completion of immobilization, head is not in the neutral position
    • ____ Failure to check distal functions before and after immobilization
    • ____ Immobilized head to the board before securing the torso
    • ____ Points awarded < 12

    • Additional verbal items (check if answered correctly):
    • ____ List other positions that the patient could be placed in should supine be inappropriate
    • ____ Discuss importance of delegation and scene control
  22. CERVICAL SPINE IMMOBILIZATION – SUPINE WITH LONG BOARD
    Practice Card
    • bsi
    • cspine
    • pmsc
    • assess neck/ apply rigid cspine collar
    • board higher than head
    • rescue 1 has one hand at shoulder one low pelvis
    • rescue 2 has one hand high pelvis and hand on the knees
    • roll
    • check back (torso guy)
    • slide board into patient above head
    • roll on to
    • one motion center patient
    • strap patient torso first
    • secure head
    • pmsc
  23. NEEDLE CRICOTHYROTOMY
    Test Sheet
    • 1 Take body substance isolation. Selection: gloves, goggles, mask, gown, booties, N95
    • 1 Prepare equipment using an aseptic technique Use of a prepackaged catheter setup or choosing a 14 gauge catheter, a 3 cc syringe and a 7.5 ET tube cap
    • 1 Position patient supine If no suspected trauma, extend the neck. If suspected trauma, maintain in-line stabilization in neutral position
    • 1 Identify landmarks by locating the prominence of the superior aspect of the thyroid cartilage and follow the midline down to the soft cricothyroid membrane
    • 1 Stabilize the larynx by holding the cricothyroid membrane between the thumb and forefinger
    • 1 Cleanse the site with Betadine
    • 1 Insert needle at a 90* angle
    • 1 Slowly advance the needle with plastic catheter approximately ½ to ¾ inches towards the feet
    • 1 Attempt to aspirate free air If unable to aspirate free air, continue withdrawing on syringe while withdrawing the needle and catheter 1 cm at a time
    • 1 Direct the tip of the needle towards the sternal notch and advance the catheter over the needle until you reach the hub Hub should rest against neck
    • 1 Remove needle and attach BVM to the catheter hub If using separate equipment, attach ET cap to 3 cc syringe and attach syringe to catheter hub. BVM can now be attached to the ET cap
    • 1 Dispose of needle in appropriate container
    • 1 Secure catheter with cloth tape or securing device Continually monitor site for displacement
    • 1 Ventilate patient at appropriate rate Reassess vital signs frequently
    • 14 Total

    • Critical Failure Criteria
    • ____ Failure to take or verbalize BSI appropriate to the skill prior to performing the skill
    • ____ Contaminates equipment or site without appropriately correcting situation
    • ____ Failure to verify proper placement following insertion
    • ____ Failure to reassess patient status following insertion
    • ____ Any procedure that would have harmed the patient
    • ____ Points awarded < 11

    • Additional verbal items (check if answered correctly):
    • ____ List the indications for this procedure (Inability to ventilate by any other means)
    • ____ List the contraindications for this procedure (inability to locate anatomical landmarks, underlying anatomical abnormalities, valid pre-hospital DNR order, age less than 9)
    • ____ List the possible complications for this procedure (severe bleeding, subcutaneous emphysema, laryngeal nerve damage, thyroid gland damage)
  24. NEEDLE CRICOTHYROTOMY
    Practice Card
    • bsi
    • prepare equip/ 14 gauge, 3cc syringe, 7.5 et tube cap
    • pos pt supine/ traum in line extension
    • identify/ superior aspect thyroid cartilage- follow that midline to the (soft) cricothyroid membrane
    • stabilize larynx/ hold cricothyroid membrane between thumb and forefinger
    • betadine
    • insert at 90 deg
    • slow advance 1/2-3/4" towards the feet
    • aspirate
    • direct top of syringe toward chin and holding the needle in place advance the catheter towards the feet til the hub rests against the skin
    • remove needle/sharps/ attach capnography and BVM
    • secure without letting go/ monitor for displacement
    • ventilate appropriately/ reassess vitals

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