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Flashcards in Advanced Airway Principles Deck (21):
1

Respiratory Failure ABG Values

pH < 7.2

CO2 > 55

PaO2 < 60

2

Indications for Intubation

  • Inability to Swallow
  • Can't Ventilate/Oxygenate
  • GCS < 8
  • Expected Clinical Course
  • Apnea
  • Obstruction
  • Respiratory Failure

3

LEMON Mnemonic

  • Look
  • Evaluate 3-3-2
  • Mallampati (I-IV)
  • Obstructions
  • Neck Mobility

4

3-3-2 Rule

3 Fingers in Mouth

3 Fingers Between Jaw and Hyoid

2 Fingers Between Hyoid and Thyroid

5

Mallampati Scale

I - soft palate, uvula, anterio/posterior tonsillar pillars visible

II - Tonsilar pillars hidden by tongue

III - Only the base of the uvula can be seen

IV - Uvula cannot be seen

6

Sellick's Manuever

Direct downward pressure on the thyroid cartilage, occludes esophagus and prevents aspiration during intubation.

7

BURP Manuever

Backward, Upwards, Rightwards Pressure

8

CXR Intubation Confirmation

Distal tip of ETT 2-3cm superior to the carina or level of the T2-T3 vertebrae

9

7P's for Intubation

Preparation

Preoxygenation

Pretreatment

Paralysis with Induction

Protect and Position

Placement with proof

Post Intubation Management

10

LOAD Mnemonic

(RSI Pretreatment)

Lidocaine - blunts the cough reflex preventing ICP increase

Opiates - blunts the pain response

Atropine - for invants, prevents reflex bradycardia

Defasiculating Dose - use succinylcholine, rocuronium, or vecuronium

11

Succinylcholine

  • Depolarizing NMB
  • Dose 1-2mg/kg
  • 1-2min onset, 4-6min duratino
  • Can cause hyperkalemia
  • Can cause malignant hyperthermia

12

Malignant Hyperthermia S/Sx

  • Masseter spasm/trismus
  • Sustained tetanic muscle contractions
  • Rapid increase in temperature
  • Increased ETCO2
  • Tachycardia/HTN
  • Mixed Acidosis

13

Malignant Hyperthermia Tx

Dantrolene Sodium (Dantrene)

3.0mg/kg

DO NOT GIVE calcium channel blockers - malignant hyperthermia caused by problem with Ca removal from cells

14

Vecuronium (Norcuron)

  • Non-Depolarizing NMB
  • Slow onset, long acting
  • Defasiculating doses reduces increased ICP during intubation
  • Onset 4-6min, duration 30-45min
  • 0.04-0.06mg/kg if after Sux
  • Maintenance 0.01-0.015mg/kg IVP 2-45min PRN

15

Rocuronium (Zemeron)

  • Non-Depolarizing NMB
  • Defasiculating dose can reduce increased ICP during intubatin
  • Onset 4-6min, duration 30-45min
  • Dosing 0.1-0.2mg/kg IV q20-30min

16

Etomidate (Amidate)

  • Induction agent
  • 0.3mg/kg
  • 30sec onset, 3-12min duration
  • Causes almost no change in BP or CO
  • NO analgesic properties
  • CI - adrenal suppression (sepsis or Addison's)

17

Midazolam (Versed)

  • Sedation/anxiolysis with retrograde amnesia
  • BDZ
  • 2.5-5mg IV
  • Onset 60-90sec, 15-30min duration
  • Do not use with other BDZs

18

Propofol (Diprivan)

  • Hypnotic with no analgesic properties
  • Dose varies but typically 1.5mg/kg IV
  • Onset 15-45sec, 5-10min duration
  • Decreases CPP and MAP

19

Ketamine (Ketalar)

  • Hypnotic, Analgesic, Amnesic
  • 1mg/kg IV, 2mg/kg IM
  • Onset 45-60sec, Duration 11-17min
  • Used to stop pain impulses
  • Potent bronchodilator
  • May increase airway secretions
  • Caan have hallucinations upon awakening

20

Morphine

  • Opioid analgesic
  • 2-5mg IV/IM/IO
  • Onset within minutes, duration 2-3 hours
  • Avoid in head injury and respiratory depression
  • Causes hypotension, nausea, flushing

21

Fentanyl

  • Opioid Analgesic
  • 50-100mcg IV q2h PRN
  • Onset 1-2min, 45-60min duration
  • Avoid with increased ICP, hypoventilation, hypotension, and bradycardia