Paramedic National Registry Practical Exam

Front 1

Key points for Ventilatory Management

Back 1

Takes or verbalizes bsi

Front 2

Opens the airway manually

Back 2

Elevates tongue, inserts simple adjunct (opa, npa)

Front 3

Note: examiner now informs candidate no gag reflex is present and pt accepts adjunct.

Back 3

***ventilates pt immediately with bvm unattached to o2

Ventilates pt on room air

Front 4

NOTE: Examiner now informs candidate that ventilation is being performed without difficulty and that pulse oximetry indicates the patient’s blood oxygen saturation is 85%

Back 4

Attaches oxygen reservoir to bag-valve-mask device and connects to high flow oxygen regulator [12-15 L/minute] 1

Front 5

Ventilates patient at a rate of 10-12/minute with appropriate volumes

Back 5

NOTE: After 30 seconds, examiner auscultates and reports breath sounds are present, equal bilaterally and medical direction has ordered intubation. The examiner must now take over ventilation.

Front 6

Directs assistant to pre-oxygenate patient

Back 6

Identifies/selects proper equipment for intubation

Front 7

Checks equipment for: -Cuff leaks (1 point) -Laryngoscope operational with bulb tight (1 point)

Back 7

NOTE: Examiner to remove OPA and move out of the way when candidate is prepared to intubate

Front 8

Positions head properly

Back 8

Inserts blade while displacing tongue 1

Front 9

Elevates mandible with laryngoscope

Back 9

Introduces ET tube and advances to proper depth 1

Front 10

Inflates cuff to proper pressure and disconnects syringe 1

Back 10

Directs ventilation of patient 1

Front 11

Confirms proper placement by auscultation bilaterally over each lung and over epigastrium 1

Back 11

NOTE: Examiner to ask, “If you had proper placement, what should you expect to hear?”

Front 12

Secures ET tube [may be verbalized] 1

Back 12

NOTE: Examiner now asks candidate, “Please demonstrate one additional method of verifying proper tube
placement in this patient.”

Front 13

Identifies/selects proper equipment 1

Back 13

Verbalizes findings and interpretations [compares indicator color to the colorimetric scale or EDD recoil and states findings] 1

Front 14

NOTE: Examiner now states, “You see secretions in the tube and hear gurgling sounds with the patient’s exhalation.”

Back 14

Identifies/selects a flexible suction catheter 1

Front 15

Pre-oxygenates patient 1

Back 15

Marks maximum insertion length with thumb and forefinger 1

Front 16

Inserts catheter into the ET tube leaving catheter port open 1

Back 16

At proper insertion depth, covers catheter port and applies suction while withdrawing catheter 1

Front 17

Ventilates/directs ventilation of patient as catheter is flushed with sterile water 1

Back 17

Critical Fails:

Front 18

Failure to take or verbalize body substance isolation precautions
If used, stylette extends beyond end of ET tube

Back 18

Uses teeth as a fulcrum
Failure to assure proper tube placement by auscultation bilaterally and over the epigastrium

Front 19

Failure to provide adequate volumes per breath [maximum 2 errors/minute permissible]
Failure to pre-oxygenate patient prior to intubation and suctioning

Back 19

Failure to voice and ultimately provide high oxygen concentrations [at least 85%]
Failure to ventilate patient at a rate of 10 - 12 / minute

Front 20

Failure to initiate ventilations within 30 seconds after applying gloves or interrupts ventilations for greater than 30 seconds at any time

Back 20

Failure to successfully intubate within 3 attempts
Failure to disconnect syringe immediately after inflating cuff of ET tube

Front 21

Inserts catheter into the ET tube leaving catheter port open 1

Back 21

At proper insertion depth, covers catheter port and applies suction while withdrawing catheter 1

Front 22

Ventilates/directs ventilation of patient as catheter is flushed with sterile water 1

Back 22

Critical Fails:

Front 23

Failure to take or verbalize body substance isolation precautions
If used, stylette extends beyond end of ET tube

Back 23

Uses teeth as a fulcrum
Failure to assure proper tube placement by auscultation bilaterally and over the epigastrium

Front 24

Failure to provide adequate volumes per breath [maximum 2 errors/minute permissible]
Failure to pre-oxygenate patient prior to intubation and suctioning

Back 24

Failure to voice and ultimately provide high oxygen concentrations [at least 85%]
Failure to ventilate patient at a rate of 10 - 12 / minute

Front 25

Failure to initiate ventilations within 30 seconds after applying gloves or interrupts ventilations for greater than 30 seconds at any time

Back 25

Failure to successfully intubate within 3 attempts
Failure to disconnect syringe immediately after inflating cuff of ET tube