Advanced Airway Management Flashcards
8 P’s of intubation
•Preparation
•Positioning
•Pre-oxygenation
•Pretreatment
•Paralysis and induction
•Protection and positioning
•Placement
•Post management
HEAVEN criteria
•Hypoxemia- DL
•Extremes of size- VL
•Anatomic disruption/obstruction- VL
•Vomit/blood/fluid- DL/VL
•Exsanguination- DL
•Neck mobility- VL
How much lung volume is lost when a patient is lying flat?
50%. Elevate the head 30-35 degrees for optimum lung recruitment
Components of passive oxygenation
•Hyperoxygenate for 3-5 min
•NC 15lpm
•We need to try for Nitrogen washout
•Use BVM if sats are <93%
*Use PEEP & ETCO2
Premedications for intubation
•Atropine- for children (< 1yo)
•Fentanyl- for ^ ICP or cardiovascular disease patients **>5mcg/kg can cause respiratory depression
•Push dose pressors:
—Epi- 5-20mcg q 1-5 min
—Vasopressin- 10mL q 2 min in 100mL or 1mL q 2 min out of a 9mL flush(like push dose epi)
—Neo-synephrine- 50-200mcg q 1-5 min(1mg/100mL)
How to find shock index(SI)
on exam
(HR/SBP)
Anything > 0.9 means high SI and higher mortality potential
Be careful in a high shock/ low perfusion state
How to determine NG, OG, suction cath, and chest tube size
ETTx2 = NG, OG, and suction cath size
ETTx4 = chest tube size
Larson Maneuver
Applying pressure behind the ears while doing a jaw thrust if Ketamine was pushed too fast and the vocal cords are closed up
Etomidate
Don’t give to patients with adrenal insufficiency or sepsis
ETT tube sizes
Women: 7.0-8.0 & depth 3x the tube size
Men: 8.0-9.0 & depth 3x the tube size
Peds >1yo: (age + 16)/4
ETCO2 confirmation
No trace WRONG PLACE
Post intubation management
•Vent
•Secure ETT
•Continue pain management
•Continue Sedation
•Consider continued paralysis if above measures are not working
Surgical Airway
•Landmark identification
•ALWAYS: Vertical incision
•Trach hook
•Horizontal cut in cricoid membrane
•ETT (6.0-6.5) with bougie
•Secure
