Airway and Ventilatory management Flashcards

(35 cards)

1
Q

Which patients should receive supplemental Oxygen?

A

All trauma patients

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2
Q

What can a combative / agitated patient be a sign of

A

Altered mental state secondary to:
- HI
- Intoxication
- Hypoxia
- Hypercapnia

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3
Q

Definitive airway definition

A

Tube inserted into trachea with cuff inflated below level on vocal cords, and connected to oxygen enriched assisted ventilation

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4
Q

Signs of airway compromise include

A

Head / neck injury
Tachypnoea
Agitation
Low SpO2
Stridor / snoring
Absent breath sounds in fields
Subcutaneous emphysema at head, neck or chest
Deviated trachea

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5
Q

Patients at risk of compromised ventilation

A

Unconscious with HI
Obtunded pt (intoxication or hypercapnia)
Thoracic injuries
Facial burns
Inhalation injuries

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6
Q

Purpose of a definitive airway in patients at risk of compromised ventilation

A

Provide an airway
Deliver supplemental O2
Support ventilation
Prevent aspiration

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7
Q

Signs of potential airway obstruction in maxillofacial trauma

A

Fractures of Nasopharynx / Oropharynx
Oropharyngeal haemorrhage
Dislodged teeth

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8
Q

Triad of laryngeal fracture signs

A

Hoarse voice
Subcutaneous emphysema
Palpable fracture

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9
Q

Sign of ventilation problems caused by C spine injury

A

Diaphragmatic breathing
Compromised ability to meet rising oxygen demands

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10
Q

Sign of ventilation problem caused by complete cervical cord transection

A

Abnormal breathing
Paralysis of intercostal muscles

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11
Q

Causes of asymmetrical chest wall movements

A

Splinting rib cage
Pneumothorax
Flail chest

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12
Q

Causes of reduced breath sounds to hemithorax

A

Thoracic injury - haemo / pneumothorax

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13
Q

Indications of definitive airway placement

A

A - impending or potential airway compromise
B - apnoea or inability to maintain adequate oxygenation by facemask
C - agitation due to cerebral hypoperfusion
D - GCS 8 or lower, sustained seizure activity, protect against aspiration

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14
Q

Helmet removal process

A

2 people
Person 1 provides manual inline motion restriction from below
Person 2 expands the sides of helmet and removes from above
Re-establish inline restiction from above and secure the head and nec during airway management

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15
Q

Factors indicating difficult airway

A

Obese
Beard
Elderly / Paediatric
Spinal trauma / arthritis / immobilisation
Edentate

Maxillofacial / mandibular trauma

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16
Q

Mnemonic for assessing an airway

A

LEMON

Look externally
Evaluate 3-3-2 rule
Mallampati
Obstruction / Obesity
Neck mobility

17
Q

3-3-2 rule for airway assessment

A

Mouth opening distance between incisors 3 fingers
Mandible to hyoid distance 3 fingers
Floor of mouth (?or hyoid bone) to thyroid cartilage distance 2 fingers

18
Q

Mallampati class 1

A

Soft palate
Uvula
Fauces
Pillars

19
Q

Mallampati 2

A

Soft palate
Uvula
Fauces

20
Q

Mallampati 3

A

Soft palate
Base of uvula

21
Q

Mallampati 4

A

Hard palate only visible

22
Q

Contraindications to nasopharyngeal or oropharyngeal airways

A

Basal skull fracture
Midface fractures

23
Q

Methods of intibation

A

Orotracheal intubation
Nasotracheal intubation

24
Q

Technique preferred for intubation of trauma patient

A

3 person technique:

Person 1 inserts tube (always test inflation of cuff)

Person 2 provides adjuncts (eg. suction, bougie, cricoid pressure) and connects tube to ventilator support

Person 3 provides C spine stabilisation

25
Options when unable to intubate
Use recue airway devices Needle cricothyroidotomy followed by surgical airway Establish surgical airway
26
Rapid sequence induction indications
Pt needs intubation but intact gag reflexes Pt sustained head injury
27
RSI drug options
Ketamine / Thiopentone / Propofol Suxamethonium / Rocuronium Fentanyl / Opioid
28
Benefit of using Ketamine in RSI
Raises BP rather than causing hypotension which most other agents do
29
Needle cricothyroidotomy
Provides oxygen until definitive airway can be placed Preferred for children < 12 yrs of age Percutaneous transtracheal oxygenation technique (PTO)
30
Surgical cricothyroidotomy
Usually preferable to emergency tracheostomy Not recommended for children < 12 yrs of age
31
Cricoid pressure technique
BURP Backwards, Upwards and Rightward pressure
32
Complications of positive pressure ventilation following intubation
Converting simple pneumothorax to tension pneumothorax Causing pneumothorax secondary to barotrauma
33
Method to improve mask seal in edentate patients
Pack space between cheeks and gum with gauze
34
Methods to assess sufficient ventilation
ABG Continual end tidal carbon dioxide analysis
35
Indications for a surgical airway (cricothyroidotomy or tracheostomy)
Oedema of the glottis Larynx fracture Severe oropharyngeal haemorrhage that obstructs airway Inability to place endotracheal tube through vocal cords