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Interventions 1 (RESP 266) > Mod 4: Intubation > Flashcards

Mod 4: Intubation Flashcards

1
Q

Why do you intubate (need airway management)?

A

Protect airways
partially obstructed airways
complete airway obstruction
Apnea
Respiratory distress
Hypoxemia, hypercarbia, acidemia

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2
Q

What is the RR before someone fatigues and fails to breathe on their own?

A

35

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3
Q

Drooling and strider are indicators of what?

A

intubation, usually they’re a sign of some sort of inflammation that is partially blocking the airway

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4
Q

Clinical signs for intubation? (7)

A

Decreased LOC (GCS < 8)

Ventilation irregular or ineffective

Color: cyanosis

Adventitious sounds

excessive secretions/inability to clear secretions

increased WOB (such as retractions)

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5
Q

What is a good indicator that intubation was placed correctly or in?

A

End tidal CO2

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6
Q

Crash vs Rapid sequence intubation (RSI) intubation

Edit

A
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7
Q

What does the acronym “Lemon” indicate?

A

Predictors of possible difficult laryngoscope

  1. Look at the patient
  2. Evaluate the 3-3-2
  3. Mallampati to classification
  4. Obstruction
  5. Neck mobility
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8
Q

What is the Mallampati classification?

A
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9
Q

What are 3 points of the 3-3-2 rule?

Edit

A
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10
Q

Burp vs Sellick maneuver? what do they both ultimately do?

Edit

A

Improve the grade of view for the mouth by 1

Method
Gently applied pressure to cricoid.

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11
Q

Assisting a laryngoscopy or intubation is always done on which side?

A

on the right side

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12
Q

Colorimeter is normally purple, what does it indicate when it turns yellow?

A

CO2

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13
Q

What are the indications of intubation

hint A-E?

A

Inability to manage airway through other means

A: Airway: Airway obstruction
B: breathing
C: Circulation
D: Disability
E: Expected course

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14
Q

Airway indications for intubation

A

Airway obstruction present or potential aspiration occurred/potential

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15
Q

Breathing indications for intubation

A

Oxygenation failure
Ventilation failure

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16
Q

Circulation indications for intubation

A

Shock

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17
Q

Disability indications for intubation

A

Alter LOC (GCS > 8)

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18
Q

Expected course indications for intubation

A

Expected decoration of A,B, C, or D

Intubation needed for intervention (surgery, cath lab)
Long transports

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19
Q

Indicators for airway management

A

Protect airways

partially obstructed airway (or complete)

Apnea

Respiratory distress

hypoxemia, hypercarbia, acidemia

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20
Q

Need for airway management;

Signs that demonstrate a lack of response to protect airways?

A

Coma

lack of gag

inability to cough

respiratory distress

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21
Q

Examples of respiratory distress?

A

increased RR

High/low Vt

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22
Q

signs of a partially obstructed airways?

A

strider, paradoxical respiration, accessory muscle use

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23
Q

Emergency indications for Intubation?

A

hypoxemic respiratory failure

hypercapnic respiratory failure

upper airway obstruction/injury

shock/hemodynamics instability

clinal conditions associated with risk for airway compromises

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24
Q

Clinical signs for intubation?

A

Decreased LOC

ventilation irregular or ineffective

cyanosis (colour)

Adventitious sounds O/A: strider, diminished or absent

excessive secretions or can’t clear

increased WOB: i.e nasal flaring, retractions etc.

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25
Q

How do you confirm EDT placement?

A

Auscultation
-both sides
-epigastric
-chest expansion

Monitors:
-SpO2
-HR
-EtCO2

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26
Q

Normal capnogram or Normal EtCO2 value/range?

A

35-45mmHg

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27
Q

Esophageal detection device (blue bulb) what does it indicate?

A

attach with bulb compressed:

If it does not inflate = esophagus

if inflates = trachea (intubated)

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28
Q

how do you secure the ETT?

A

twill ties

tapes

device

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29
Q

Post intubation magement

A

confirm placement at the teeth, gums, or lips
record on patient chart

monitor patient prior to leaving bedside

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30
Q

RSI Notes:

A
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31
Q

complications with intubation?

A

-failure to establish patient airway
-vocal chord paralysis
-upper airwa trauma, laryngeal, esophageal damage
-Aspiration
-cervical spine trauma
-laryngo/bronchospasm
-bleeding or dental incidents

Problems w/endotracheal tube
-cuff perforation
-cuff her inaction
-pilot tube valve incompetence

-nosocomial infection

32
Q

Nasal complications (nasal intubation specific)

A

-Nasal damage including epistaxis
-Tube kinking in pharynx

33
Q

Nasal complications not local to nasal

A

-sinusitis and otisis media
-tracheal damage including tracheoesophageal fistula, tracheal i nominate fistula, tracheal stenosis and tracheomalacia

-pneumonia

-laryngeal damage with consequent laryngeal stenosis, laryngeal ulcer, granuloma, polyps

34
Q

What equipment do you want to Prep for intubation

A

suction and BVM
laryngoscope handle and blades (mac/miller 3 or 4)
stylet
ETT appropriate size and 1 down.
Magill forceps
xlocaine spray
10cc syringe
OPA
ETT tape or holder
spare batteries

35
Q

What things should you consider when assisting w/intubation?

A

suction
safety check equipment
manual ventilation
monitor patient
air pause (2 attempts, 30s)

36
Q

ETT size?

A

women: 7 or 7.5

men: 8 or 8,5

37
Q

what should be done before deciding to intubate?

A

maneuver position to create a patient airway and to ventilate with O2

38
Q

factors that could make intubation difficult?

A

short neck
protruding maxillary incisors
receding mandible
reduced mobility of neck

39
Q

how do you measure Ç-spine mobility?

A

measuring distance from lower border of mandible to beyond to thyroid notch at full neck extension (sniffing position)

should be greater than 4 finger breaths

40
Q

7 P’s for RSI

A

preparation
preoxygenation
pre-treatment
paralysis and induction
placement and confirmation
post-intubation management

41
Q

preparation for RSI

A

assess degree of difficulty (airway, IV access, monitoring)

gather equipment

ensure adequate team is present

identify back up plan

42
Q

pre-oxygenate patient for RSI

A

100% O2, usually done with a manual resuscitator or NRB (3-5 mins, obtain highest SpO2 possible)

Allows several minutes before desaturation to 90%

provides patients w/reserve during intubation

43
Q

Time frame for desaturation during intubation?

A

8 mins for a healthy 70kg adult

Desaturation from 90 to 0 occurs in less than 120 seconds

varies for pregnant and obese patients

44
Q

pre-treatment for RSI

A

anxiolytics, benzodiazepines, or opiodes could be given prior to intubation drugs

Sedatives -> paralytic

45
Q

RSI: paralysis with induction

A

combo of a sedative with a neuromuscular blocking agent

renders patient unconscious and induces paralysis
-sedatives also have a amnesia affect

46
Q

What are common intubation drugs

A

Propfol, ketamine, etomidate

-commonly have a short onset of action and half life.

47
Q

What are induction agents and why are they given with intubation drugs?

A

sedatives to provide amnesia, blunt sympathetic responses, and improve intubation conditions

48
Q

what are paralytic drugs? why are they given during intubation?

A

Neuromuscular blocking agents (NMBA)

cause skeletal muscle paralysis
-must be used with an induction agent.

49
Q

Examples of paralytic drugs?

A

succinylcholine

rocuronium

50
Q

what is the Sellick Maneuver?

A

Considered to help with aspiration.

look this one up.

51
Q

what is a biannual laryngoscopy?

A

pressure applied on the neck opposite of the lift of the laryngoscope

52
Q

laryngeal grades?

A
53
Q

what is the purpose of B.U.R.P?

A

Burp improves laryngeal position
-brings glottis down into view by 1 full grade

Backwards
upwards
rightwards
pressure

54
Q

Depth of insertion

A

visually, when the black line on the ETT goes through vocal chords

Women: (average) 19-21
Men: 21-23

55
Q

when Inflating ETT Cuff, what pressure do you want?

A

25-30 cmH2O

56
Q

Confirmation of ETT placement

A

Detection of CO2 exhaled gas - EtCO2

Chest x-ray (depth inserted by carina)

Endoscopic visual

Auscultation can suggest, but is not full proof.
-i.e bilateral symmetrical breath sounds.

condensation suggests but not full proof.

57
Q

colorimeter changes color to what?

A

CO2, purpose -> yellow

58
Q

What is the Sellick maneuver?

A

helps with aspiration (anterior cricoid pressure)

-doesn’t do much tho apparently

59
Q

When would you use “BURP”? (backward pressure)

A

Grade 3 or 4 view.

Helps bring the glottis down and improve view by 1 full grade

60
Q

What could cause aspiration when giving oxygenation w/BVM?

A

full stomach or pregnancy (things could come back up)

61
Q

Why do you want to avoid BVM once RSI drugs are given?

A

avoid gastric insufflation and regurgitation

62
Q

What are indicators that patient can’t protect their airway

A

Lack of gag

Inability to gag

resp. distress

63
Q

signs of a partially obstructed airway

A

Stridor

Paradoxical resp

accessory muscle use

64
Q

Signs of resp. distress

A

Increased RR

High/Low Vt

65
Q

Signs of increased WOB?

A

Accessory muscle use:
-Retractions
-Nasal flaring
-High RR

66
Q

Indications for intubation:

A

ABCDE

-Inability to manage airway through other means

-prolonged need for vent. assistance

67
Q

What is ABCDE protocol?

A

Identifies intubation via

[A]irway: obstruction or potential aspiration

[B]reathing: oxygenation/ventilation failure

[C]irculation: shock

[D]elirum: altered LOC aka GCS < 8

[E]xpected course: impending failure of above

68
Q

4 cardinal signs of airway obstruction

A

Muffled (hot potato voice)

Can’t clear secretions

stridor

sensation of dyspnea

69
Q

Before intubation, what steps should you take to clear/create the pt’s airway for optimal oxygenation and ventilation?

A

Correct pt position (sniffing position)

Preoxygenate to 100% (if possible)

Ready necessary equipment

sometimes drugs

70
Q

How long should you preoxygenate a patient

A

3-5 mins to obtain highest possible SpO2 (oxygen reservoir)

71
Q

How long does it generally take for a patient to desaturate from 100% to 90%

A

8 minutes

but can easily be 120 seconds if depending on the pt size

72
Q

What is the typical drug order given to a patient for intubation?

A

An induction agent is given first, followed by a paralytic.

1.[Protocol or ketamine] —>
2. [succinylcholine or rocuronium]

73
Q

Why do you avoid BVM after preoxygenating and RSI drugs are given to a patient?

A

Avoid regurgitation and aspirations

74
Q

Indications for intubation: specific cases

A

Hypoxemic resp. failure

Hypercapnic resp. failure

upper airway obstruction or injury

shock/hemodynamic instability

clinical conditions associated w/risk of airway compromise

75
Q

What are some examples of clinical conditions associated w/risk of airway compromise?

A

Stroke

Drug overdose

Coma

76
Q

Why would Hypoxemic resp. failure lead to intubation?

A

Despite 100% FiO2 or non-invasive PPV support, the patient condition may not be improving.

77
Q

What Indicators are usually associated w/hypercapnic resp. failure and why are they important to pay attention to?

A

Resp. acidosis and increased WOB

They’re indicative of impending resp. failure.

Interventions 1 (RESP 266) (16 decks)

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