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ATLS > Airway + Ventilation > Flashcards

Airway + Ventilation Flashcards

(55 cards)

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1
Q

Definitive airway

A

A tube placed in trachea below vocal cords and a cuff inflated

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2
Q

How to deal with vomiting and risk of aspiration

A

Immediate suction and rotate patient to the lateral position whilst restricting cervical motion

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3
Q

Airway management in laryngeal fracture

A

Try ET intubation

If not, try emergency tracheostomy

If difficult, do cricothyroidectomy

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4
Q

Noisy breathing sign of

A

Partial airway obstruction

(eg snoring, stridor, gurgling)

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5
Q

Absence of breath sound sign of

A

complete airway obstruction

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6
Q

Helmet removal technique

A
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7
Q

Factors that indicate the potential for difficulties with airway manoeuvres

A

C spine injury

Severe arthritis of c spine

Sig Maxillofacial or mandibular trauma

Limited mouth opening

Obesity

Anatomical variation (eg receding chin, iverbite, short muscular neck)

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8
Q

LEMON assessment of difficult ventilation

A

Look externally; small mouth or jaw, facial trauma

Evaluate 3-3-2 rule

Mallampati

Obstruction

Neck mobility

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9
Q

E in LEMON assessment

A

Assessment of difficulty of intubation by 3-3-2 rule

If the following criteria are met it is less likely to be difficult intubation

The distance in finger breadths:

  • between incisors: at least 3
  • between hyoid and chin: at least 3
  • between thyroid notch and floor of the mouth: at least 2
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10
Q

M in LEMON assessment

A
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11
Q

Algorithm for assessing the need for intubation in trauma pt with suspected c spine injury

A
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12
Q

How is airway obstructed in pt with reduced consciousness

A

tongue could fall backwards blocking airway

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13
Q

How to deal with airway obstruction if tongue is the cause

A

Chin-lift or jaw-thrust

(Nasopharyngeal or oropharyngeal airways maintain the airway)

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14
Q

Chin lift in presence of c spine stabilisation

A
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15
Q

Jaw thrust in presence of c spine stabilisation

A
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16
Q

Contra-indication to NP airway

A

Cribriform plate fracture

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17
Q

How to insert OP airway in adults

A

upside down and rotate 180 degrees as entering

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18
Q

How to insert OP airway in children

A

Right way down, do not rotate 180 degrees as can damage mouth and pharynx

Could use a tongue blade to depress the tongue

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19
Q

Supraglottic airways

A

LMA

i-gel

Laryngeal tube airway (LTA)

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20
Q

LMA

A

With balloon

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21
Q

ILMA

A

Intubation through laryngeal mask airway

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22
Q

i-gel

A

Does not require inflation

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23
Q

Extraglottic airway

Study These Flashcards
A

LTA or ILTA (note arent definitive airways)

intubating LTA (ILTA) allows intubation through LTA

24
Q

Examples of definitive airway

Study These Flashcards
A

Orotracheal tube

Nasotracheal tube

Surgical airway (cricothyroidotomy and tracheostomy)

25
Indications for definitive airway
1. Inability to maintain an airway by other means eg in inhalation injury, facial fractures, or retropharyngeal haematoma 2. inability to maintain adequate oxygenation by face mask or presence of apnoea 3. combativeness or obtundation due to reduced GCS
26
Which one comes first c spine or airway
Airway: If the definitive airway is needed eg GCS \<8, intubate before obtaining imaging for c spine
27
Which of orotracheal and endotracheal is better for a spontaneously breathing patient
nasotracheal
28
Which one of oro/nasotracheal intubation methods are more commonly used
Orotracheal
29
Complications of nasotracheal airways
Sinusitis Pressure necrosis
30
Which one of oro/nasotracheal airways used for apnoea
orotracheal
31
Relative contraindication for nasotracheal airway
Facial, frontal, basilar skull, and cribriform plate fractures
32
Raccoon eyes
periorbital bilateral ecchymosis temporal bone fracture
33
Battle sign
Post auricular ecchymosis
34
Role of cricoid pressure during intubation
Can reduce risk of aspiration (although may limit the view of the larynx)
35
Eschmann Tracheal Tube Introducer (ETTI) aka
Gum Elastic Bougie (GEB)
36
Intubation using ETTI
37
Borborygmi
Epigastric rumbling/gurgling sound after intubation Indicates oesophageal intubation
38
How to confirm correct intubation
Auscultation (suggests correct placement but does not confirm) carbon dioxide detector (capnograph) (not able to exclude single bronchial intubation) CXR (confirms correct placement)
39
Rapid sequence induction (RSI) drugs in trauma setting
Suxamethonium as muscle relaxant Etomidate as anaesthetic agent with mild sedation
40
Problems with etomidate
suppresses adrenal gland
41
Positives of etomidate
Doesn't affect blood pressure or intracranial pressure
42
Why not use thiopental in rapid sequence induction
It causes myocardial instability In trauma pt likely to have hypovolaemia
43
Problems with suxamethonium
Hyperkalaemia (careful use in crush injuries, major burns or electrical burns) (Extremely careful in CKD, chronic paralysis, chronic neuromuscular disease)
44
Indications for surgical airway
Glottis oedema Larynx # Severe oropharyngeal haemorrhage Inability to place ET tube
45
Which surgical airway is more commonly used, cricothyroidotomy or tracheostomy
Cricothyroidotomy: - less bleeding than tracheostomy - faster
46
Needle cricothyroidotomy procedure
Large bore cannula through the cricothyroid membrane Side hole on the cannula or a Y connector to attach to 15L/m oxygen
47
What size needle should be used for the needle cricothyroidotomy
12-14 gauge in adults 16-18 gauge in children
48
The ratio of ventilation to pause in needle cricothyroidotomy
1 second on, 4 seconds off (by placing the thumb on the other side of the y tube, or the other side of the hole) This allows passive exhalation
49
How long can needle cricothyroidotomy last
30-45 mins (due to inadequate exhalation and CO2 accumulation)
50
The risk with percutaneous trans-tracheal intubation
barotrauma including pulmonary rupture, pneumothorax
51
When would you use needle cricothyroidotomy over surgical cricothyroidotomy?
The needle is more urgent than surgical
52
Surgical cricothyroidotomy procedure
53
Contra-indication to surgical cricothyroidotomy
Children under 12 Easy to damage cricoid cartilage (the only circumferential structure that provides support to the upper airway)
54
PaO2 levels associated with different SpO2 sats
55
Use of pulse oximetry is limited in which scenarios
Severe vasoconstriction Carbon monoxide poisoning

ATLS (14 decks)

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