Airway Flashcards by LRN BRWN

what are examples of dynamic airways

bullets -neck trauma
bites - anaphylaxis, angioedema
burns - thermal and caustic airway injuries

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ABC in the decision to intubate

Airway
Breathing
Circulation
Disability
Expected Course
Feral

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Airway signs prompting intubation and causes

mouth and neck infections, tumors, foriegn bodies, bleeds
stridor, phonation, swallowing, secretions, dyspnea

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breathing signs and causes prompting intubation

failure to oxygenate or ventilate
often amenable to medical an non-invasive therapies
think Non-Invasive Ventilation

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Criculation causes and signs to intubate

supporting tissue oxygen delivery by unloading the muscles of respiration
sepsis

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what disabilities would lead you to intubate

CNS catastrophes and CNS depression, ongoing seizures and weakness
*avoid gag - assess the ability to swallow and handle secretions for neuromuscular weakness: FVC < 12mL/kg and NIF < 20 cm H2O
vomiting in the obtunded patient is particular concern

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expected course that will prompt the decision to intubate

anticipated decline, transfer to radiology or another institution

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feral decision to intubate

need for prompt, aggressive sedation to protect patient and others
*especially with potential or undiagnosed medical instability

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RSI intubation considers

peri-arrest
dynamic airway already deteriorating
upper GI bleed
bowel obstruction
vomiting

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Awake intubation consideration

stable GI bleed requiring endoscopy
slowly progressing NM weakness requiring transfer
fixed flexion deformity of the neck
cannot open mouth

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how can you use local anesthesia for an awake intubation

dry
nebulize
atomize
topicalize

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Awake intubation - IV sedation options

ketamine**
versed
fentanyl
dexmedetomidine

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how do you set the table for laryngscopy

ear to sternal notch
equipment is ready: suction under right shoulder
assistant pulls right mouth corner

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how can you optimize the patient’s head

place your right hand under the patient’s head and do sniff and head tilt

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how can you optimize the larynx

using your right hand to maneuver the thyroid cartilage into optimal position

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the black stripe on the bougie tells you what

25 cm - at lips mid trachea in an adult male

considerations for etomidate for RSI

safe choice in most situations
adrenal suppresion
lowers seizure threshold

considerations for ketamine for intubation

reactive airways
IM RSI
hypotension/sepsis
*Avoid if HTN/tachycardia is undesirable
*Contraindicated in high ICP
*hyper sympathetic delirium

problems with succinycholine

rhabdomyolysis
existing hyperkalemiaa
Multiple sclerosis ALS
muscular dystrophies / inheritied myopathies
denervating injuries > 72 hours old (stroke, spinal cord injury)
burns > 72 hours old
tetanus, botulism, and other endotoxin infection
severe infections > 72 hours old (especially intra-abdominal)
immobilization
predisposition to MH
bradycardia
fasciculations - increased ICP

if you want to give Roc for RSI what type of dose range do you need to give

1.6 - 2 mg/kg provided excellent intubating conditions at 40 seconds

duration of action of succinycholine

5-10 minutes

duration of action of rocuronium

30-90 minutes

physiologic killers with intubation

hypotension (SBP =< 90)
hypoxemia
metabolic acidosis

strategies to mitigate hypotension before intubation

2 proximal PIVs or Its
judacious bolus of IVF wide open or pressor support
shoot for BP higher than normal before intubation (SBP>140 mmHg)

What dose of rocuronium has a similar onset of 45 seconds like succinylcholine 2 mg/kg IV

rocuronium 1.6 mg/kg

do shock patients require a decreased dissociative dose of ketamine for RSI

Yes, reduce the dose to 0.5 mg/kg IV may require a subsequent dose of 0.5 mg/kg

Options for push dose pressors

epinephrine phenylephrine vasopressin** (easiest drug to dilute)

how would make your push dose vaso

20 units/1 mL Vaso + 19cc of NS in a 20cc syringe -> 1unit/mL

how to mitigate desaturations during efforts to intubate

NC at 15LPM + NRB at 15LPM keep a PEEP valve close

if youre unable to get a O2 saturation greater than 95% what pathologies are you considering

Lung Shunt Physiology pulmonary edema, PNE

What is a DSI used for and how is it done

delayed sequence intubation is used for uncooperative or combative patient give procedural sedation for the procedure of prexygenation -Ketamine 0.5-1 mg/kg once preoxygenated paralyze -> apneic oxygenation -> intubate

what is BUHE

back up head elevated

pH kills - try to avoid intubation if at all possible. how can you optimize the patient beforehand

consider short trial of NIPPV while you correct the cause of metabolic acidosis

A patient in severe metabolic acidosis who is tachypneic will bicarb help the patient?

no it'll make the patient more acidotic and can lead to cardiac dysrhythmias

high aspiration risk patients and considerations

upper GI bleed, bowel obstruction, pre-induction vomiting consider NGT prior to intubation, intubate in semi-upright position, bag early but slightly less early

difficult airway strategies

initiate rescue maneuvers such as ventilation and cricothyrotomy early so that the patient has enough reserve to allow for calm and effective execution BVM with three airways in, two hands down replace BVM with LMA ventilation make the bougie part of your routine