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Flashcards in Airway Management & CV Collapse Deck (55):
1

What does ABC mean in an emergent setting?

Airway
Breathing
Circulation

2

Airway Management in General

Head tilt-chin lift
Jaw thrust
Suction if needed
BVM if no respiratory effort
Insert NPA/OPA

3

Airway Management in Unconscious Patient with Respiratory Effort

Administer high-flow oxygen
Ensure no upper airway obstruction
Insert NPA/OPA
Suspected lower airway obstruction: Heimlich maneuver

4

Types of "High-Flow" Oxygen

Nasal cannula: 6 L/min
Venti-masks
Non-rebreather mask

5

In what type of patient is a NPA better tolerated compared to the OPA?

Conscious patients

6

When can a NPA be used?

Conscious
Unconscious
Patients with intact gag reflex

7

Complication of a NPA

Epistaxis

8

How to Measure a NPA

Tip of nose to earlobe

9

When are oropharyngeal airways generally used?

Unconscious patients

10

Why does an OPA need to be inserted carefully?

So the tongue is not pushed back into the pharynx blocking the airway

11

How to Measure an OPA

Mouth to angle of the mandible

12

Indications for a Laryngeal Mask Airway (LMA)

Rescue device after failed intubation
Attempted quickly while another person preparing for cricothyroidotomy
Prehospital setting
Plan for short term intubation
Good alternative to BVM ventilation: decrease intubation risk

13

Where does an LMA sit?

Patient's hypo pharynx and covers the supraglottic structures
Isolates the trachea

14

Where is an LMA used?

OR
ED
EMS

15

Contraindications to an LMA

Cannot open mouth
Complete upper airway obstruction

16

How to Insert an LMA

Select proper size
Inflate/deflate cuff
Lubricate back of mask
Patient placed in sniffing position
Slide mask down posterior pharyngeal wall until resistance felt
Inflate mask
Confirm tube position

17

LMA Complications

Necrosis: if cuff overinflated
Mask tip can fold and cause obstruction by pushing on epiglottis
Mask tip can fold back on itself

18

Intubation "Rules"

Oxygenate before and after intubations
Intubate early
Intubate as soon as you think of it
Make sure patient isn't a DNI/DNR

19

Why are rapidly acting sedatives and a neuromuscular blocking agent used in intubation?

Minimize risk of aspiration of stomach contents

20

Indications for Rapid Sequence Intubation (RSI)

Standard of care for intubations not anticipated to be difficult

21

Contraindications of RSI

Anticipating difficult airway placement
Inability to ventilate patient (paralytic may be contraindicated)

22

7 P's of RSI

Preparation
Pre-oxygenation
Pre-treatment
Paralysis
Protection and positioning
Placement with proof
Post-intubation management

23

Pneumonic for Preparation in RSI

STOP MAID

24

What does STOP MAID stand for?

S: suction
T: tools for intubation
O: oxygen source
P: positioning
M: monitors
A: assistant, Ambu bag with face mask, airway devices, airway assessment
I: IV access
D: drugs

25

Tools Used in Intubation

Laryngoscope blades
Handle
Video laryngoscope

26

Types of Monitors Necessary for Intubation

ECG
Pulse oximetry
Blood pressure
ETCO2
Esophageal detectors

27

Preoxygenation in RSI

Administration of high-flow oxygen
Take 8 VC breaths
Manual ventilation if necessary
Maintain potency of upper airway
5L of O2 via NC

28

Pretreatment in RSI

Atropine for pediatric patients
Lidocaine
Opioids

29

Medications that can be Used for Paralysis with Induction

Etomidate
Ketamine
Midazolam (versed)
Propofol
Thiopental sodium
Methohexital

30

Benefits of Etomidate

Excellent sedation with little hypotension

31

Contraindications of Etomidate

Known to suppress adrenal cortisol production

32

Benefits of Ketamine

Stimulates catecholamine release
Bronchodilation

33

Contraindications of Ketamine

Elevated ICP
Elevated BP

34

When may Ketamine be an excellent induction agent?

Bronchospasm
Septic shock
Hemodynamic compromise

35

Benefits of Midazolam (Versed)

Potent dose-related amnesic properties

36

Contraindications of Midazolam (Versed)

Dose-related myocardial depression can result in hypotension

37

Benefits of Propofol

Bronchodilation

38

Relative Contraindication of Propofol

Dose-related hypotension

39

Benefits of Thiopental Sodium

Cerebroprotective and anti-convulsive properties

40

Contraindications of Thiopental Sodium

Potent venodilator and myocardial depressant
Relative: reactive airway disease due to histamine release
Acute intermittent and variegate porphyrias

41

Benefits of Methohexital

Cerebroprotective

42

Contraindication of Methohexital

Acute intermittent and variegate porphyrias

43

Neuromuscular Blocking Agents (Paralytics)

Succinylcholine
Vecuronium or rocuronium

44

Contraindications of Succinylcholine

Hyperkalemia
Neuromuscular disease
Ocular trauma
Malignant hyperthermia
Rhabdomyolysis
Stroke or burn >72 hours old

45

Reasons for Cricoid Pressure

Collapse the esophagus to prevent regurgitation of gastric contents
Facilitate visualization of vocal cords

46

Confirmation of Placement of ET Tube

ETCO2 monitor
Auscultation of breath sounds
Esophageal intubation detection device
CXR: can just tell how far tube is in

47

What color is the ETCO2 monitor on inhalation and exhalation?

I: purple
E: yellow

48

Postintubation Management

Secure ET tube
CXR to evaluate depth of tube and assess for barotrauma
Support BP
Mechanical ventilation

49

Indications for a Cricothyroidotomy

When patient has failed to be oxygenated adequately by all other possible methods and intubation has failed

50

Relative Contraindication of a Cricothyroidotomy

Young children due to shape of airway- may lead to subglottic stenosis

51

Step 1 of a Cricothyroidotomy

Identify the cricothyroid membrane by palpation

52

Step 2 of a Cricothyroidotomy

Horizontal stab incision through skin and cricothyroid membrane

53

Step 3 of a Cricothyroidotomy

Hook placed prior to removal of scalpel
Caudal traction used to stabilize larynx

54

Step 4 of a Cricothyroidotomy

Insert tracheostomy tube into the trachea

55

How does cardiovascular collapse occur?

Hypotension causes an increase in systemic vascular resistance and decreased tissue perfusion
Repeat until complete collapse