Skill stations

Currently available skill stations are:

Mechanical ventilation I-IV

Non invasive ventilation
Airway management
Advanced cardiac life support
Trauma
Assessment
Metabolic and electrolyte disturbances. NB There is no lecture on metabolic &
electrolyte disturbance so we recommend that you include this skill station in
your course
Arterial blood gases
Central venous catheterization
Paediatrics

Mechanical ventilation 1
Objectives

To demonstrate generic parts of ventilator

To teach participants how to set a ventilator for a patient with normal lungs
To help participants understand that there is no fixed recipe for ventilating
patients and that ventilator settings need to be tailored to patients needs

Equipment required

Ventilator
Test lung
Heat and moisture exchange filter
Heated humidifier
Catheter mount
Case scenarios (provided in downloaded material)

Mechanical ventilation 2
Teaching points

Whenever there is a problem look at the patient first. Does he/she need
immediate resuscitation, is the chest moving etc?
Determinants of airway pressure and therefore causes of high airway pressure
Causes of high airway pressure in volume preset modes are the same as causes
of low tidal volume in pressure preset modes
High airway pressure alarm also associated with hypoventilation due to
premature inspiratory to expiratory cycling when alarm limit is reached
Use of manual ventilation to distinguish between ventilator/circuit problems
and ETT/patient problems

Equipment

Ventilator capable of displaying waveforms

Lung model with variable resistance and compliance.
Case scenarios (provided in downloaded material)

Mechanical ventilation 3
Teaching points

Large difference between peak airway pressure and inspiratory pause pressure
when resistance is high
In terms of barotrauma and cardiovascular effects it is alveolar pressure that is
important, not airway pressure

High risk of gas trapping in asthma. Can be estimated from Pplat and PEEPi

Effect of respiratory rate, I:E ratio, pause time on absolute expiratory time and
hence gas trapping

Effect of respiratory rate and I:E ratio on inspiratory flow rate and hence peak
airway pressure

No perfect recipe for ventilating all patients needs to be constantly

adjusted for the individual patient

Methods of improving oxygenation

Cardiovascular effects of mechanical ventilation

Equipment

Ventilator capable of displaying waveforms

Lung model with variable resistance.
Case scenarios (provided in downloaded material0

Mechanical ventilation 4
Teaching points

Pros and cons of sedation and paralysis for transport

How to check and set a transport ventilator
Significance of low pressure alarm
Recognition of accidental extubation
Difficulties of working in moving ambulance

Equipment

Portable ventilator with circuitry.

Test lung
O2 cylinder, with appropriate outlet, flowmeter and connection tubing.
Lung model capable of spontaneous breathing (if possible).

Non-invasive ventilation
Teaching points:

Before commencing NIV it is important to consider whether the patients

condition is likely to respond (correct indication) and any contraindications to
the technique. If the patient is likely to require intubation then this should not
be delayed. Waiting until the patient is in extremis will result in a high-risk
intubation.
It is important to have a backup plan (Plan B) in case NIV fails
In patients that are at risk of deterioration NIV should be performed in a
location that is staffed and equipped to ensure that the patient can be intubated
rapidly and safely (e.g. Critical Care)
The art and psychology of setting up NIV.
o The mask should have the correct size and provide a good seal (a small
leak is beneficial in ventilators with leak compensation).
o Initially NIV can be very uncomfortable for patients. This can have a
negative impact on their compliance and may cause them to fail
NIV. It is therefore important to recognise this, explain the technique
to patients, reassure them, have someone stay by the bedside for a
while and increase pressures gradually.
If possible all candidates should be given the opportunity to attached
themselves to an NIV ventilator and experience the effects of various flowrates and pressure settings of NIV.

Equipment:

Non-invasive ventilator(s)
Tubing and masks/interfaces provide a large variety of types and sizes
Case scenarios

Advanced cardiac life support

Teaching points

In hospital management of ventricular fibrillation (based on 2005 ILCOR

guidelines) with an emphasis on team work

Equipment

ACLS manikin with rhythm generator

Defibrillator with cardiac monitor
Stethoscope
Downloaded case scenario and assessment sheets

Trauma
Teaching points

Identify and treat immediately life threatening problems first

Remember to fill in the gaps later

Initial assessment may be misleading and patient should be repeatedly

reassessed
Cervical spine injury cannot be excluded on the basis of plain radiology alone
in a multiple trauma patient
Mechanism of injury and velocity of impact (blunt trauma) give important
clues to likely injuries and severity of injury
Teamwork and importance of having a team leader

Equipment

Computer to display images

Downloaded Trauma Skill Station Powerpoint presentation

Assessment
Teaching points

History taking, examination and resuscitation often have to be carried out

concurrently
Decision making often based on limited information and is made on best
guess basis
In emergency setting obtain only the information that is necessary to make the
next step. Obtaining superfluous information wastes precious time.
Decision to intubate and ventilate a patient is complex and is based on many
factors. There are no well defined clinically useful indications.
Assessment of the compensatory response important. Decompensation
indicates very severe disease (particularly in young fit patients). Beware of
patients who are at limit of their ability to compensate.

Equipment

Downloaded case scenarios

Metabolic & electrolyte disturbance

Teaching points

Importance of serum osmolality and volume status in diagnosing the cause of

hyponatraemia
Relationship between serum and urine osmolality in diabetes insipidus
Indications for hypertonic saline in hyponatraemia
Appropriate rate of correction of hyponatraemia
Management of diabetic ketoacidosis

Equipment

Downloaded case scenarios

Arterial blood gases

Teaching objectives

Diagnosis of respiratory failure

Diagnosis of simple and complex acid-base disturbances

Equipment

Downloaded case scenarios

Calculator

Central venous cannulation

Teaching objectives

Indications for central venous cannulation

Pros and cons of internal jugular, subclavian and femoral insertion sites
Practical experience of Seldinger technique for internal jugular and subclavian
cannulation
ultrasound identification of internal jugular vein

Equipment

Central venous cannulation mannikin

Central venous cannulation sets (preferably sets that do not require dilator)
ultrasound device