Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Acute Care > Advanced airway management > Flashcards

Advanced airway management Flashcards

1
Q

what are the indications for intubation

A
  1. failure to maintain or protect airway
  2. failure of ventilation or oxygenation
  3. expected decline/ decompensation in clinical status
  4. cardiac arrest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

failure to maintain or protect airway

A
  • comatose (GSC <8/15) (prevents aspiration)
    *airway trauma (e.g. facial fracture)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

failure of ventilation or oxygenation

A
  • SaO2 < 90% on high flow oxygen
  • or PaO2 <7.9 kPa on FiO2> 40%
  • ventilation failure (rising CO2)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

categories of a potentially difficult airway

A
  1. anatomically difficult intubation
  2. physiologically difficult intubations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

anatomically difficult airway management predictors

A
  1. moans
  2. lemon
  3. rods
  4. short
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

MOANS

A

diffucult bag valve mask ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

LEMON

A

difficult laryngoscopy and intubation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

RODS

A

difficult extra-glottic device placement (LMA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

SHORT

A

difficult cricothyroidotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

difficult BVM

A

M- mask seal problems (beards)
O- obstruction/ obesity
A- age>55 (poor muscle and tissue tone)
N- no teeth (face caves in)
S- stiff lungs (high pressure to BVM)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

difficult surgical airway

A

L- look externally
E- evaluate the 3-3-2 rule
M- mallampati
O- obstruction/ obesity
N- neck mobility- limited

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

look externally

A

body habitus, head and neck anatomy (short neck), mouth (small opening, loose teeth or prominent teeth), jaw abnormalities (significant malocclusion and beards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

3-3-2 rule

A
  • can you fit 3 fingers between the incisors
  • is the mandible length 3 fingers from the mentum to the hyoid bone
  • is the distance between the hyoid to the thyroid 2 fingers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

mallampati

A

class I and class II- adequate oral access
class III- moderate difficulty
class IV- high degree of difficulty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

obstruction or obesity

A

conditions such as epiglottis, head and neck cancer. Ludwig’s angina, neck hematoma, foreign body or thermal injury can compromise laryngoscopy, the passage of the endotracheal tube (ETT), BVM, or all three

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

neck mobility

A

neck mobility can be significantly reduced in patient with trauma (cervical collar) or the elderly and those with arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

difficulty surgical airway

A

S- surgery or disrupted airway
H- hematoma (infection/ abscess)
O- obesity
R- radiation therapy- previous
T- tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

difficult extra glottic device

A

R- restricted mouth opening
O- obstruction
D- disrupted or distorted airway
S- stiff neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what do you do if an anatomically difficult airway is predicted

A
  • you have back- up devices that will suit the condition
    *you have a plan for intervention should there be a problem
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

physiologically difficult airways

A
  • hypoxic patients
    *metabolically deranged (severely acidotic patients)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

rapid sequence intubation (IRS)

A
  • RSI is the administration, after pre- oxygenation, of a potent induction agent followed immediately by a rapidly acting neuromuscular blocking agent to induce unconsciousness and motor paralysis for tracheal intubation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

where is RSI used

A

in emergency care

23
Q

which patients do not need RSI

A

patients who are intubated during cardiac arrest

24
Q

why RSI

A
  1. emergency patient have full stomachs
  2. preoxygenation allows for safe apnea period without bag valve mask ventilation and the associated risk of gastric distention and aspiration
  3. sedation and paralysis together allow for optimal intubating conditions (get the tube in first time)
  4. use of short acting drugs allows for rapid return of spontaneous ventilation
25
Q

stages of RSI

A

10 min- preparation
5 min- preoxygenation
2 min- pretreatment
0 min- paralysis with induction
+30s- placement of tube
+45s- proof of tube position
+90s- post intubation monitoring

26
Q

preparation (SOAP ME)

A

S- suction
O- oxygen : preoxygenation nd delivery device
A- airway devices (laryngoscope/ETT/ OPA) and alternative airways
P- position patient correctly
M- monitors to use during procedure (BP/ 3 lead/ Sats) and medication for intubation
E- equipment to confirm (stethoscope, ETCO2, EDD)

27
Q

Steps for Rapid Sequence Intubation

A
  1. preparation of equipment
  2. preparation of the patient
  3. preparation of the team
  4. positioning
  5. pre- oxygenation
  6. pretreatment/ preload
  7. placement of tube
  8. proof of tube positioning
  9. post intubation monitoring
28
Q

what is the aim of preoxygenation

A

aims to increase oxygenation and remove nitrogen from lungs

29
Q

how do we pre-oxygenate

A

give 100% oxygen for 3-5 min or 8 vital capacity

30
Q

what do we use for pretreatment

A
  • crystalloid fluid bolus 10mll/kg
    *fentanyl 1-3 mcg/kg or
  • lignocaine 1.5 mg/kg
31
Q

name induction agents

A

ketamine
etomidate
fentanyl
midazolam
propofol
thopental

32
Q

name preferred agents for paralysis with induction

A

suxamethonium 102 mg/ kg TBW
rocuronium 0.6-1.2 mg/ kg IBW
vecuronium 0.15- 0.25 mg/kg IBW

33
Q

placement of the tube: which side do you stand

A

right side

34
Q

placement of the tube: how do we use the laryngoscope

A

insert it between down and epiglottis and swipe tongue towards the mandible/ jaw

35
Q

placement of the tube: insertion of the tube

A
  1. tip of ett (endotracheal tube) advanced through the cords
  2. depth: black line at cords/ cuff through cords
    3.confirm with edd
  3. then inflate balloon
  4. check placement
    secure ett
36
Q

proof of tube position

A
  1. capnography (end tidal CO2)= gold standard
  2. direct visualization of ETT through cords
  3. esophageal detector device (EDD)
  4. misting of ETT
  5. equal rise and fall of chest
  6. 5 point auscultation
    - epigastrium= absent sounds
    - axilla and bases both sides have good air entry
37
Q

Esophageal detector device (EDD) if in oesophageus

A

if in esophagus will not re-expand as esophagus will collapse round edd

38
Q

falses of EDD

A
  1. falsely re-expands if in stomach due to air
  2. falsely doesn’t re-expand if small child (,20kg) or obesity
39
Q

end tidal CO2 monitoring function

A

to look at end tidal CO2 to assess if in trachea

40
Q

end tidal CO2 monitoring: qualitative

A

yellow= yes
*ph sensitive filter paper
*turns yellow if >2-5kPa pCO2
*only qualitative

41
Q
A
42
Q

quantitative= capnography

A

*infrared detection
*waveform analysis

43
Q
A
44
Q

problems with qualitative: false positives

A

gas cooldrinks
gastric distention from BVM

45
Q

problems with qualitative: false negatives

A

cardiac arrest
massive PE
massive obesity

46
Q

saturation monitor

A

pulse oximeter detects Hb oxygen saturation peripherally. it is a delayed response

47
Q

when to be careful when using pulse oximeter

A

*nailpolish
*high ambient light
*carbon monoxide poisoning
*no pulse in patient
*hypotensive
*hypothermic

48
Q

post intubation monitoring

A

*3 lead ECG monitoring for rhythms
*sat monitoring
*ABGs (PaO2 and PaCO2)
*BP (non- invasive or invasive)
*Capnography if available
*CXR for ETT placement

49
Q

what happens if SATS DROPS

A

D- displacement of ETT (bronchi/ RMB/ oesophagus)
O- obstruction of ETT/ circuit
P- pneumothorax
E- equipment failure
S- stomach full of air (especially children)

50
Q

complications of intubations

A

*trauma
*infection- pneumonia
*laryngospasm/ bronchospasm
*esophageal intubation
*right main bronchus intubation
*tension pneumothorax

51
Q

if you cannot intubate

A

ventilate

52
Q

rescue devices for intubation

A

LMA(laryngeal mask airway)
Combitube

53
Q

if you cannot intubate, cannot ventilate

A

surgical airway- cricothyroidotomy

Acute Care (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions