Airway Part 2 Flashcards
(24 cards)
Preoxygenation
100% O2
normal Vt 3-5 minutes or 8 vital capacity breaths within 60 sec
minimum 5L FGF
Adequate preoxygenation
movement of bag
well defined ETCO2
Fraction of expired O2 90% or greater
Apneic oxygenation
15LPM with nasal cannula
transnasal humidified rapid insufflation ventilatory exchange
60LPM for 3 min
Cricoid pressure
10-20 N when awake
30-40 N after loss of consciousness
remove if vomiting occurs- rupture esophagus
common cause of unanticipated difficult airway
lingual tonsil hyperplasia
indications of difficulty with SAD
placement requires multiple attempts or providers
leak pressure less than 10-15 cmH2O and poor expired Vt
CICO is more common in what population
pregnant patients
11 extubation criteria
- acceptable hemodynamics
- normothermia
- ability to maintain patent airway
- adequate muscle strength
- acceptable metabolic indicators (lytes and ABG)
- acceptable hgb
- adequate analgesia for optimal resp. effort
- adequate respiratory mechanics
- ability to maintain adequate oxygenation with FiO2 <50
- ability to maintain alveolar ventilation
- acceptable spontaneous RR
how to assess if the patient has the ability to maintain patent airway
return of laryngeal/cough reflexes and appropriate LOC
adequate resp mechanics
vital capacity >15ml/kg
max neg insp force >-20cmH2O
adequate Vt (4-5ml/kg)
adequate oxygenation for extubation
spO2>90
PaO2>60
adequate ability to maintain alveolar ventilation
PaCO2 <50
laryngospasm can affect which muscles
tensing of the cords by the cricothyroid muscles
adduction of the cords by the thyroarytenoid and lateral cricoarytenoid muscles
cricothyroid muscles are innervated by what
SLN
thyroarytenoid and lateral cricoarytenoid muscles are innervated by what
RLN
4 complications of laryngospasm
pulm edema
bradycardia
aspiration
hypoxemia
laryngotracheobronchitis
inflammation and edema of the airway below the cords. Stridor or barking cough
treatment of laryngotracheobronchitis
humidified O2
racemic epi
decadron
helium O2 mixture
how much racemic epi to give for laryngotracheobronchitis
0.5 ml of 2.25%
how much decadron to give for laryngotracheobronchitis
0.1-0.5 mg/kg
risk minimization for aspiration
antacids (30cc sodium citrate)
histamine- blockers (famotidine 20, cimetidine 300, or ranitidine 50)
PPIs (omeprazole)
reglan 10mg
risk factors for aspiration
scleroderma
hypotension
trauma/stress
DOPE
displacement
obstruction
pneumo
equipment failure
