Nurses Duo
One Shot Revision
Identify the Instrument
Airway & Respiratory:
Guedel airway
● Use only in unconscious patients.
● Never use if gag reflex is present.
● Measure: corner of mouth → angle of mandible.
● Insert upside down in adults, rotate 180°.
Nasopharyngeal airway
● Can be used in conscious or semi-conscious patients.
● Lubricate before insertion.
● Avoid in basilar skull fracture.
● Exam trap: Facial trauma = contraindicated.
LMA: Laryngeal Mask Airway
● Supraglottic airway device
● Sits above the vocal cords
● Does not require visualization of the vocal cords
● Does not provide definitive protection from aspiration
● Used as a rescue airway in difficult intubation
ET tube
● ET tube = Definitive airway
● Passes through the vocal cords into the trachea
● Protects against aspiration better than an LMA
● Waveform capnography is the best bedside method to confirm placement
● Equal bilateral breath sounds = correct placement
● Absent left breath sounds → suspect right mainstem intubation
PARTS:
● Tube with centimeter markings
● Cuff – seals the trachea
● Pilot balloon – indicates cuff inflation
● 15-mm connector – connects to Ambu bag or ventilator
● Murphy eye – side opening to reduce complete obstruction
Cuff Pressure
● Maintain 20–30 cm H₂O.
● Too high → tracheal ischemia.
● Too low → aspiration risk and air leak.
Tracheostomy tube
Imp Points:
● Keep the obturator at the bedside.
● Keep a spare tracheostomy tube (same size and one size smaller) at the
bedside.
● Provide humidified oxygen.
● Suction only when clinically indicated, not routinely.
● Clean or replace the inner cannula according to protocol.
● Monitor cuff pressure (20–30 cm H₂O if cuffed).
Emergency Management
● If the tube becomes blocked:
Suction first.
Remove and clean/replace the inner cannula (if present).
● Administer oxygen.
● If accidental decannulation occurs:
Fresh tracheostomy (<7 days): Medical emergency—do not force reinsertion.
Mature tracheostomy: A trained provider may reinsert an appropriate tube
if indicated
Ambu bag
Venturi mask
● Works on the Venturi (Bernoulli) principle.
● Color-coded adapters (jets) entrain a fixed amount of room air with oxygen,
delivering an accurate FiO₂.
● Delivers accurate FiO₂
● Best for COPD
● Reduces risk of oxygen-induced hypercapnia
● Less affected by changes in breathing pattern
● Best oxygen device for COPD: Venturi mask
Type: High-flow oxygen delivery system
Provides: Fixed oxygen concentration
Normal flow rates: Approximately 4–15 L/min, depending on the adapter
used.
Non-rebreather mask
● Highest FiO₂ without intubation: Non-rebreather mask
● Flow rate: 10–15 L/min
● Reservoir bag must stay partially inflated at all times.
● Do not use for precise oxygen control in COPD—a Venturi mask is preferred
for controlled oxygen delivery.
CPAP/BiPAP mask
● CPAP = One pressure = Best for Obstructive Sleep Apnea
● BiPAP = Two pressures (IPAP + EPAP) = Best for COPD with hypercapnic
respiratory failure
● Both are non-invasive ventilation (NIV).
● If the patient cannot maintain the airway or deteriorates despite NIV,
endotracheal intubation and mechanical ventilation may be required.
Peak flow meter
Incentive Spirometer
● Best method to prevent postoperative atelectasis.
● Use slow, deep breaths—do not blow into the device.
● Hold the breath briefly at maximum inspiration.
● Encourage coughing after exercises.
Common Mistakes
● Blowing into the device instead of inhaling.
● Rapid, shallow inhalation.
● Using it only occasionally instead of regularly
Obstetrics and Gynaecology
Sim’s Speculum
Cusco’s Speculation
Anterior Vaginal Wall Retractor
Vulsellum
Uterine sound
Tenaculum
Hegar dilator
Manual Vacuum Aspirator and Karman cannula
Ovum forceps
Green Armytage forceps
Doyen’s Retractor
Episiotomy scissors
Pap Smear Kit
Bonney myomectomy clamp
Veress needle
Trocar Cannula
Hysteroscope
Placental abnormalities
Battledore Placenta
Placenta Succenturiata
Placenta bilobata
Circumvallente Placenta
Circummarginate Placenta
Twin Pregnancy
● DCDA: thick membrane
● MCDA: thin membrane
● MCMA: No membrane
Surgical Instruments (Very Frequently Asked)
Mayo scissors
Metzenbaum scissors
Artery forceps
Kocher forceps
Allis forceps
Babcock forceps
Needle holder
Sponge holder
Scalpel with blade
Orthopedics
Cervical collar
Thomas splint
Buck's traction
Skeletal traction
Halo Vest
CPM machine
Pavlik Harness
Abduction Pillow
Orthopedic Image Questions Repeated in Exams
● Buck's traction → Weights hang freely.
● Skeletal traction → Pin-site care.
● Halo vest → Never lift by the vest.
● Axillary crutches → 2–3 finger widths below the axilla.
● Weight through hands, not axillae when using crutches.
● Fiberglass cast → Dries faster than POP.
● Hip replacement → Abduction pillow; don't cross legs.
● SCD → DVT prevention.
● Walker → Move walker first, then step.
● Cervical collar → Maintain spinal alignment.
● Thomas splint → Temporary immobilization for femur fractures.
● CPM machine → Commonly used after total knee replacement.
Feeding & GI
NG (Ryle's) tube
● Single lumen
Used for:
● Enteral feeding
● Medication administration
● Gastric aspiration
● Gastric lavage
Salem Sump Tube
● Double lumen
● One lumen drains gastric contents.
● Blue air vent (pigtail) prevents the tube from sticking to the stomach wall.
Dobhoff tube
● Small-bore, soft, weighted tip
● Used for long-term enteral feeding
● More comfortable than a Ryle's tube.
PEG tube
● PEG tube → Abdomen to stomach (long-term)
● Long-term enteral feeding (>4–6 weeks)
Chest & Drains
Wound Drainage
Urinary
Foley catheter
Three-way Foley
Silicone catheter
Red Rubber Catheter
Condom catheter
Suprapubic catheter
IV Therapy & Infusion
Infusion pump & Syringe pump
PICC line
Central line
Port-a-cath
Huber needle
Blood administration set
Microdrip/Macrodrip set
Burette set
One-Liners to Memorize
● Infusion pump → High-alert medications.
● Syringe pump → Small-volume, precise infusions.
● PICC tip → Superior vena cava.
● No BP or venipuncture on the PICC arm unless specifically indicated.
● Central line → Air embolism is a major complication.
● Trendelenburg position reduces air embolism risk during central line
insertion/removal.
● Port-a-Cath is completely implanted under the skin.
● Huber needle is used to access a Port-a-Cath.
● Blood transfusion tubing contains a 170–260 μm filter.
● Prime blood tubing with Normal Saline only.
● Never add medications to blood products.
● Microdrip = 60 gtt/mL.
● Macrodrip = 10, 15, or 20 gtt/mL.
● Burette set is preferred for pediatric patients.
● 0.22 μm filter → TPN (without lipids); 1.2 μm filter → Lipid emulsions.
CARDIAC
ECG machine
AED
Defibrillator
Temporary pacemaker
Holter monitor
Monitoring Devices
Pulse oximeter
Glucometer
Capnography
Arterial line
CVP manometer
Quick Review Pointers:
Airway:
● OPA: Use only in an unconscious patient (no gag reflex).
● NPA: Avoid in suspected basilar skull fracture.
● LMA: Does not protect against aspiration.
● ET tube: Gold standard airway; cuff pressure 20–30 cm H₂O.
● Venturi mask: Delivers the most accurate FiO₂ (best for COPD).
● Non-rebreather mask: Highest FiO₂ without intubation (≈60–90%).
● CPAP: One continuous pressure.
● BiPAP: Two pressures (IPAP + EPAP); IPAP improves ventilation/CO₂ removal.
Chest Tube:
Tidaling = normal.
Continuous bubbling in water seal = air leak.
Clamp only briefly if specifically ordered or during system change.
Keep drainage system below chest level.
IV Therapy:
● PICC tip ends in the SVC.
● Never use a PICC for BP measurement or venipuncture.
● Huber needle is used only for implanted ports.
● Microdrip = 60 gtt/mL.
● Macrodrip = 10–20 gtt/mL.
● Blood transfusion tubing has a 170–260 micron filter.
● Prime blood tubing with 0.9% normal saline only.
Urinary Catheters:
● Inflate Foley balloon only after urine return.
● Secure catheter to prevent urethral trauma.
● Keep drainage bag below bladder.
● Never break a closed drainage system.
NG/PEG
● X-ray is the gold standard to confirm NG placement initially.
● Check tube position before feeds/medications.
● Keep head of bed 30–45° during feeding and for 30–60 minutes afterward.
Orthopedics
● Buck's traction: Temporary skin traction.
● Bryant traction: Child <2 years or <13–15 kg.
● Halo vest: Never lift by the halo frame.
● External fixator: Pin-site care is a priority.
● Assess the 6 Ps after fractures/casts:
1. Pain
2. Pallor
3. Pulselessness
4. Paresthesia
5. Paralysis
6. Poikilothermia
Wound Care
● Hydrocolloid: Low-to-moderate exudate.
● Alginate: Heavy exudate.
● Hydrogel: Dry wounds.
● Transparent film: Stage I pressure injury.
● VAC dressing: Promotes granulation tissue.
Cardiology
● AED: Analyze rhythm before shock.
● Synchronized cardioversion: Has synchronization mode ON.
● Defibrillation: Synchronization OFF.
● Permanent pacemaker: Avoid strong magnets.
Dialysis
● Never take BP, blood samples, or IVs from an AV fistula arm.
● Assess AV fistula for thrill (palpate) and bruit (auscultate)
Surgical Drains
● JP drain = closed suction.
● Hemovac = closed suction for orthopedic surgery.
● Penrose = open drain (higher infection risk).
● T-tube = common bile duct drainage after biliary surgery.
Infection Control
● N95 required for airborne diseases.
● Surgical mask for droplet precautions.
● Alcohol hand rub if hands are not visibly soiled.
● Soap and water for Clostridioides difficile.
Other Imp points
● Never add medications to blood.
● Normal saline is the only compatible fluid with PRBCs.
● Trendelenburg is no longer recommended for shock.
● Left lateral position for pregnant women with hypotension.
● Right main bronchus is the most common site of aspiration.
● Air embolism: Clamp catheter, place patient in left lateral Trendelenburg,
administer 100% oxygen.
● Compartment syndrome: Pain out of proportion is the earliest sign.
● Compromised airway always takes priority (ABCs).