Airway and CV assessment Flashcards
1
Q
Steps when approaching unresponsive person?
A
- verify scene is safe
- if victim is unresponsive, shout for help - activate EMS, get AED
- if breathing is normal and there is pulse: watch for respirations and check pulse for up to 10 seconds - if breathing isn’t normal but there is a pulse - then manage airway and breathing - think about opioid overdose
- if there is no breathing and no pulse - then begin CPR and use AED ASAP
2
Q
ACLS guidelines for conscious pt?
A
- healthcare providers should perform ACLS survey: ABC
- Airway: is it open and clear?
- breathing: is ventilation and oxygenation adequate?
circulation: what is needed to support the pulse and blood pressure?
3
Q
Components of airway management?
A
- open airway w/ head tilt/chin lift (if no C spine concerns) - jaw thrust is adequate if C spine issues
- clear airway w/ suction (if available)
- if no resp effort, begin ventilation w/ BVM device
- insert NPA or OPA
4
Q
Airway management in an unconscious pt w/ resp effort?
A
- admin high flow O2
- ensure no obstruction to upper airway
- insert NPA or OPA
- if suspected lower airway obstruction, perform heimlich maneuver
5
Q
What is considered high flow O2?
A
- nasal cannula w/ flow rate of 6L/min provides 40% of FIO2
- dial a concentration or venti-masks can deliver 24-40% FIO2
- NRB masks w/ reservoirs can deliver a little less than 100% FIO2 (liter flow needs to be at least 10)
6
Q
When are NPAs used?
A
- usually better tolerated in conscious pts vs OPAs
- can usually be used even w/ intact gag reflex
- ensure it isn’t too long or too big
- lube w/ lidocaine jelly
- can lead to epistaxis
7
Q
Placement of NPA?
A
- outer diameter of NPA shouldn’t be larger than inner diameter of the nares
- length shouldn’t be longer than tip of pt’s nose to earlobe
8
Q
When are OPAs used?
A
- for unconscious pts
- will often lead to emesis if gag is intact
- needs to be inserted carefully so that tongue isn’t pushed back therefore blocking the airway
- difficult or impossible to insert w/ seizing pt
- not as adequate in edentulous pts
9
Q
Placement of OPA?
A
- proper size stretches from mouth to angle of mandible
10
Q
Use of LMAs?
A
- rescue device after failed intubation
- can be attempted quickly while another person is preparing for cricothyroidotomy
- prehosp setting
- plan for short term intubation
- good alt to continued BVM
- can decrease aspiration risk (for pts who can’t be intubated but can be ventilated)
- allows relative isolation of trachea
- is designed to sit in pt’s hypo pharynx and cover supraglottic structures
- used in many settings: OR, ED, out of hosp care, quick to place, easy to use for inexperienced provider
- success rate for placement is nearly 100% in OR
11
Q
CIs to LMA?
A
- can’t open mouth
- complete upper airway obstruction
12
Q
Insertion of LMA?
A
1) select proper size: size 4 for females, 5 for males
2) inflate then deflate cuff
3) lubricate back of mask
4) pt placed in sniffing positon: may need to use sedation like versed or propofol
5) slide mask down posterior pharyngeal wall until resistance is felt
6) inflate mask w/ recommended amt of air
7) confirm tube position
13
Q
Complications of LMA?
A
- any airway device w/ cuff can cause necrosis if cuff is overinflated
- mask tip can fold and can cause obstruction by pushing down on epiglottis
- mask tip can fold back on itself:
if mask isn’t pushed up against hard palate, if not adequately lubricated, if cuff not adequately deflated
14
Q
What is a combitube - why do this?
A
- fxns when placed in either esophagus or trachea
- insertion doesn’t reqr neck movement
- insert blindly
- check white port for esophageal intubation
- ventilate through blue port
15
Q
Rules for intubation?
A
- oxygenate b/f and after intubation
- intubate early
- intubate as soon as you think about it
- make sure pt isn’t DNI/DNR prior to intubation
