Skill Station Prep

Question 1

D of the DOPE mnemonic (4)

Answer 1

Dislodged ETT
Disconnected circuit
Demand
Deflated ETT cuff pressure

Question 2

O of the DOPE mnemonic (5)

Answer 2

Obstruction:
change in compliance,
bronchospasm,
requires deep/oral suctioning,
kinked ETT circuit,
under-sedated/dysynchrony

Question 3

P of the DOPE mnemonic (1)

Answer 3

Pneumothorax

Question 4

E of the DOPE mnemonic (3)

Answer 4

Equipment:
loose connections,
ventilator settings (PEEP vs nonPEEP compensated), tight alarm settings

Question 5

Risks of recruitment maneuver (6)

Answer 5

1. Tachy-brady arrhythmia
2. Hypotension due to preload reduction
3. Desaturation due to shunt physiology
4. Pneumothorax
5. Increased ICP
6. Cardiac arrest

Question 6

Equipment and drugs for recruitment maneuver

Answer 6

BVM, PEEP, O2
Patent IV with charged IV line
Phenylephrine
ACLS meds
Defib pads
Chest decompression equipment
Paralytics
Sedation drugs

Question 7

Measured EPOC parameters (11)

Answer 7

pH
pCO2
pO2
Na+
K+
Ca++
Lactate
Glucose
Hematocrit
Creatinine
Cl-

Question 8

Calculated EPOC parameters (10)

Answer 8

Hemoglobin
Actual bicarbonate (cHCO3-)
Total CO2 (cTCO2)
Base excess of extra cellular fluid (BEecf)
Base excess of blood (BEb)
Oxygen saturation
Estimated GFR
Estimated GFR if African American
Anion Gap
Anion Gap, K+

Question 9

Equipment for arterial line insertion

Answer 9

PPE
Secure surface/arm board
Roller gauze, sterile 4x4, tape
clorohexadine swab
500 mL NS, pressure infuser
pressure monitoring set with VAMP
radial artery catheterization set
securing device/Tegaderm/suture set
1% lidocaine solution % SQ needle/syringe
ultrasound, gel

Question 10

Indications for arterial line insertion (3)

Answer 10

1. requires continuous monitoring of arterial blood pressure
2. evaluation of arterial waveform patterns to predict fluid responsiveness
3. need for frequent blood sampling

Question 11

Contraindications for arterial line insertion (7)

Answer 11

1. localized infection
2. thrombus at insertion site
3. distorted anatomy
4. burns
5. severe PVD of selected artery
6. active Reynaud’s syndrome
7. known thrombocytopenia with platelet count <50

Question 12

Complications of arterial line insertion (8)

Answer 12

1. bruising, pain, swelling
2. hematoma
3. bleeding, iatrogenic blood loss
4. vasospasm
5. thrombus formation
6. embolism
7. dissection/psueudoaneurysm
8. infection

Question 13

Characteristics of overdamped waveform (6)

Answer 13

1. low amplitude waveform
2. loss of dichrotic notch
3. falsely low SBP reading
4. falsely high DBP reading
5. falsely high MAP reading
6. no oscillations after square waveform test

Question 14

Causes of overdamped waveform

Answer 14

1. Anything that absorbs the pulse wave: overcompliant tubing, long tubing, air bubbles in line
2. Anything that reduces the magnitude of the pulse wave: fluid leaks from the connections, low pressure in the transducer line, catheter tip resting against the arterial inner wall, blood clots, kinked tubing.

Question 15

Troubleshooting measures to correct overdamping (5)

Answer 15

1. modify wrist position to reduce kinking and catheter occlusion
2. remove air or clots from the system
3. ensure appropriate back pressure exists (300 mmHg)
4. ensure connections are tight and transducer stopcock is fully off to the vent cap
5. change the catheter and/or site of arterial monitoring

Question 16

Characteristics of an underdamped waveform (5)

Answer 16

1. over-estimated SBP
2. falsely reduced DBP
3. deep dichrotic notch
4. non-physiological oscillations during diastolic phase
5. multiple post-oscillations after square waveform test

Question 17

Causes of an underdamped waveform (3)

Answer 17

1. Artifact
2. Stiff, non-compliant pressure tubing (frozen lines or too many stopcocks)
3. Catheter whip (excessive movement of catheter within the artery causing resonance, increased heart rates)

Question 18

Troubleshooting measures to correct underdamping (3)

Answer 18

1. reduce catheter movement
2. keep lines at normal temperatures when transitioning patient through colder environments
3. eliminate number of stopcocks in the line

Question 19

Name 2 locations other than the phlebostatic axis where a transducer may need to be secured and for what purpose

Answer 19

1. tragus of the ear to measure ICP via an EVD (correlates to the Foramen of Munroe)
2. Intersect of the iliac cres and mid-axillary line to measure IAP (approximately the level of the bladder)

Question 20

What change do you anticipate in the IBP reading if the transducer is too low or falls to the ground?

Answer 20

Abnormally high reading. For every 10 cm below phlebostatic axis, IBP reading will increase by 7.4 mmHg.

Question 21

What change do you anticipate in the IBP reading if the transducer is too high above the phlebostatic axis?

Answer 21

Abnormally low BP reading.

Question 22

Equipment required to conduct a blood draw from a radial arterial line

Answer 22

PPE
Arterial blood sampling kit
VAMP needleless shielded cannula
EPOC blood analysis system
10 cc syringe
alcohol or clorohexadine swabs
sharps container

Question 23

Indications for obtaining an arterial blood sample (3)

Answer 23

Need to assess:
1. arterial oxygenation
2. arterial acid-base status
3. electrolyte levels

Question 24

Troubleshooting and recognizing potential test failures for EPOC (6)

Answer 24

1. Test card out of date
2. Test card damaged
3. Too fast or too slow insertion of test card into reader
4. Test cards and Reader must be at similar temperature
5. Reader contains heater that maintains sensor temperature at 37 C +/- 0.15 degrees C
6. Battery failure. Reader must be charged