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ACP Skills and Review > Airway Skills > Flashcards

Airway Skills Flashcards

1
Q

List the indications for Digital Intubation

A

Cramped quarters, awkward position, poor lighting, upright patient, inability to visualize vocal cords, copious oral secretions or vomitus, suspected cervical spine trauma, laryngoscope unavailable or malfunctioning

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2
Q

List the contraindications for Digital Intubation

A

Gag reflex, inability to open mouth due to trauma, fracture, dislocation or pathologic condition

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3
Q

List complications for Digital Intubation

A

Trauma to airway, being bitten, esophageal intubation, right mainstream bronchial intubation

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4
Q

List the indications for Nasotracheal Intubation

A

Awake intubation technique, long term intubation, laryngoscope unavailable or malfunctioning, laryngoscopy not possible, unable to open mouth

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5
Q

List the contraindications for Nasotracheal Intubation

A

Apnea, basilar skull fractures, CSF rhinorrhea, foreign body in the upper airway, severe facial fractures, inability to pass tube through nostril

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6
Q

List the relative contraindications for Nasotracheal Intubation

A

Bleeding disorders, Combative patient

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7
Q

List complications for Nasotracheal Intubation

A

Epistaxis, Increased ICP, esophageal intubation, hypoxia, submucosal dissection, nasotracheal trauma, infections

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8
Q

List the indications for Endotracheal Intubation

A

Inability to protect/maintain airway or inadequate ventilation (not reversible), blood gases
indicate need for intubation (decompensation)

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9
Q

List the contraindications for Endotracheal Intubation

A

Intact gag reflex, caustic ingestion, esophageal disease/trauma, tracheal fracture or disruption,
Do Not Resuscitate (DNR)/Do Not Intubate (DNI) orders

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10
Q

List complications for Endotracheal Intubation

A

Esophageal intubation, bronchial intubation, dental/pharyngeal/ airway trauma, inadequate ventilation, laryngospasm, aspiration/vomiting of gastric contents, hypertension

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11
Q

How long should you preoxygenate someone before endotracheal intubation? How?

A

Pre-oxygenate the patient for 2 - 3 minutes with BVM and high flow nasal cannula (both at 15 LPM)

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12
Q

What does BURP stand for? When is it used?

A

Backwards, upwards, rightwards, posterior pressure. It applies pressure to the thyroid cartilage to bring the vocal cords into view during intubation.

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13
Q

What is a percutaneous cricothyrotomy?

A

AKA Needle Cricothyrotomy. When you cric using a 14-16g IV cath, and then connect to a 3mL syringe (without plunger) and a 15mm BVM connector robbed from a #7 ETT tube. #MacGyver

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14
Q

What are the indications for a percutaneous (needle) cricothyrotomy?

A

Inability to intubate/unsuccessful intubation, airway obstruction, temporary airway

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15
Q

List the contraindications for a percutaneous cricothyrotomy

A

Ability to secure an airway by other means, larynx/cricoid/trachea trauma

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16
Q

List complications of a percutaneous (needle) cricothyrotomy

A

Hemorrhage, barotrauma, subcutaneous emphysema, infection, tracheal/esophageal injury, cannula misplacement, bleeding

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17
Q

At what angle do you insert the cath in a percutaneous (needle) cricothyrotomy?

A

Stabilize the larynx and insert the needle into the cricothyroid membrane at a 45 degree angle toward the feet.

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18
Q

List the indications for a cricothyrotomy

A

Failed airway/inability to oxygenate, airway obstruction, temporary airway

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19
Q

List the contraindications for a cricothyrotomy

A

Ability to secure an airway by other means, inability to landmark, child younger than 8

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20
Q

List the complications for cricothyrotomy

A

Incorrect/ unsuccessful tube placement, tracheal/esophageal injury/swelling/trauma, asphyxia,
hemorrhage, infection, subcutaneous emphysema, tube occlusion

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21
Q

How big of an incision do you make for a cricothyrotomy? Where?

A

1-2 cm vertical incision over the cricothyroid membrane then puncture the cricothyroid membrane and make a horizontal cut 1 cm in each direction from the
midline, using the index finger as a guide.

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22
Q

What are the indications for a needle thoracostomy (AKA needle decompression)?

A

Tension pneumothorax with at least 2/3 of signs:

  • Respiratory distress/ central cyanosis
  • Loss of radial pulse
  • Decreasing level of consciousness
23
Q

What are the contraindications for a needle thoracostomy?

A

None in presence of tension pneumothorax

24
Q

What are some complications with needle thoracostomy?

A

Failure to decompress/improper placement, bleeding, pneumothorax, lung laceration, infection

25
Q

Where do you insert the decompression needle anteriorly? How?

A

Insert the decompression needle into the second intercostal space at a 90 °angle to the superior
border of the third rib, advancing until air released. Hold needle in place, advance catheter to the hub and remove needle. Cover with a commercial one-way valve.

26
Q

What are the indications for a mechanical ventilator?

A

Patient transport (prolonged transport requiring accurate ventilation settings)

27
Q

What are some complications with mechanical ventilation?

A

Hypotension, barotraumas, lung injury/infections/sepsis, patient anxiety, malfunctioning equipment/alarms, displaced tube

28
Q

How long should you monitor a patient on a ventilator prior to initiating transport?

A

Closely monitor the patient and ventilator for at least 10 minutes prior to transporting to ensure adequate ventilation. Adjust parameters as needed as per blood gases.

29
Q

Your patient is on a ventilator and not responding appropriately. What do you do?

A

The patient should be taken off the ventilator immediately and connected to an alternate method of ventilation. If patient is still not responding appropriately, assess DOPEGS.

30
Q

What are the ideal bodyweight formulas?

A

Male: 50 + [(Height in inches – 60) x 2.3]
Female: 45.5 + [(Height in inches -60) x 2.3]

Male: 88 - (Height in cm x 0.9)
Female: 92 - (Height in cm x 0.9)

31
Q

What should the respirator rate be set at with a ventilator? (generally speaking and not without exception)

A

Adult, 16-18
Child, 14 to 24
Infant, 20 to 40

32
Q

What should tidal volume be set at on a ventilator?

A

Standard Range: 6 - 8 ml/kg
Lung protective: 4 to 6 ml/kg

*Ideal bodyweight used for each calculation

33
Q

What is the sensitivity for Ptrig usually set to?

A

-1 cmH20

34
Q

How should PEEP be set?

A

Generally start with 5 cmH20 and work up from there.

35
Q

Where should the high PAW alarm limit be set on a ventilator?

A

Set 10 cmH20 higher than the peak inspiratory pressure

36
Q

What should also be connected to a ventilator breathing circuit?

A

Ensure there is an HME (Heat and Moisture Exchanger) and a side stream ETC02 between the ventilator breathing circuit and the patient.

37
Q

What are some complications to look for when monitoring chest tubes?

A

Tube pulled out/blockage, air leaks, airway obstruction, atelectasis, pneumothorax/tension pneumothorax, infection, bleeding.

38
Q

What suggests a leakage in a chest tube system?

A

Persistent, unexplained bubbling at the water seal chamber.

39
Q

How do you handle a suspected leak in a chest tube system?

A

Clamp the tube as close to the patient as possible using padded clamps for 1-2 seconds. If the bubbling stops, the leak is on the patient side. Remove the clamp and ensure the chest tube has not been dislodged and attempt to make a better seal at the insertion site. If the bubbling continues, the leak is on the chest drainage system side. Seal all connections with tape.

40
Q

What are the indications for use of a bougie tube?

A

Difficult airway or high LEMON score, inability to view/swollen cords

41
Q

List the contraindications for use of a bougie tube.

A

Gag reflex, inability to open mouth due trauma, fracture, dislocation or pathologic condition

42
Q

What are some complications with use of a bogie tube?

A

Tracheal/esophageal injury/perforation, bleeding, infection

43
Q

What are the suction settings for Suction beyond oropharynx (endotracheal tube suctioning)?

A

Adult: 120mmHg
Pediatric: 80-120mmHg
Neonate: 80-100mmHg

44
Q

How long should endotracheal suctioning be limited to?

A

Adult: 15 seconds in an adult
Pediatric: 10 second
Infant: 5 seconds

*Apply intermittent suction while withdrawing and rotating catheter

45
Q

What should be put down the ETT tube prior to suctioning?

A

3 - 5 ml of sterile water

46
Q

What does LEMON stand for?

Predictors for difficult Laryngoscopy

A 
Look - beard, anatomy, obesity, etc.
Evaluate the 332 rule
Mallampati - scored 1 to 4
Obstruction - foreign body, trauma, etc.
Neck Mobility - normal ROM? C-collar?
47
Q

What does BONES stand for?

Predictors of difficult BVM

A 
B - Beards
O - Obesity, Old patient, Obstruction
N - Neck stiffness, mass & trauma or No Teeth
E - Expecting (late pregnancy)
S - Snores, stridor, stiff lungs
48
Q

What does RODS stand for?

Predictors for difficult Supraglottic Device Placement or Function

A

R - Restricted mouth opening
O - Obstruction
D - Distorted / displaced airway
S - Stiff Lungs, chest, neck or Severe bronchospasm

49
Q

What does SHORT stand for?

Predictors of possible difficult Surgical Airway

A 
S - Surgery to the neck
H - Hematoma
O - Obesity
R - Radiation
T - Trauma
50
Q

What does DOPEGS stand for?

Patient deteriorating once advanced airway is in place

A

D Dislodged tube - airway is in the esophagus, oropharynx or Drugs (pt not adequately sedated)
O Obstruction - airway is obstructed or Oxygen (patient not receiving enough O2)
P Pneumothorax
E Equipment - malfunction
G Gastric inflation
S Stacking of breaths (air trapping)

51
Q

What is the Tidal Volume (tV) setting on a ventilator?

A

The amount to be delivered with each breath and calculated using ideal body weight.

Standard Range: 6 - 8 ml/kg
Lung protective: 4 to 6 ml/kg

52
Q

Ventilation rate with chest compressions and an advance airway in place?

A

10 bpm

*According to the “Commonly used Airway management Mnemonics, Calculations and Figures” handout.

53
Q

Ventilation rate with a pulse for rescue breathing

A

12 bpm

*According to the “Commonly used Airway management Mnemonics, Calculations and Figures” handout.

ACP Skills and Review (15 decks)

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