Case Files (2) Flashcards
Which initial interventions should be set in a semiconscious or unconscious patient?
Oxygen by nasal cannula or face mask
Airway positioning
Airway adjuncts
Which airway adjuncts can be distinguished and when should each be used?
Oropharyngeal Airway Adjuncts (OPA) and Nasopharyngeal Airway Adjuncts (NPA)
OPA: Unconscious or semiconscious patient WITHOUT gag reflex, who is going positiv pressure ventilation
NPA: Unconscious or semiconscious patient WITH gag reflex, contraindicated in patients with severe facial trauma
Which airway positiong maneuvers are can be distinguished?
Chin lift
Jaw thrust
Name 4 indications for Intubation!
Respiratory failure
Poor airway protection
Facilitation of medical evaluation
Anticipated deterioration in patient’s clinical condition
Name signs for a poorly protected airway that indicate the need for urgent intubation (3)!
Pooling secretions
Absent or weak cough reflex
Depressed mental status (GCS ≤ 8)
In general: A patient who tolerates insertion of an oropharyngeal airway is not protecting his/her airway and requires intubation!
What alternative to invasive ventilation are there for patients who show signs of respiratory failure but are still awake and alert?
A trial of noninvasive methods of positive pressure ventilation (e.g. BiPap) can be performed
Define rapid sequence intubation!
Rapid sequence intubation (RSI) is a method that attempts to simultaneously sedate and paralyze a patient for endotracheal intubation. The major goal is to leave the airway unprotected for as brief a period of time as possible.
Name the materials for endotracheal incubation!
SOAP ME, IV!
Suction
Oxygen
Airway adjuncts
Pharmacology
Monitoring
Equipment
IV needle
What is the purpose of preoxygenation before intubation?
To allow for a greater reservoir of oxygen in the lungs via nitrogen washout.
What is the purpose of pretreatment before intubation and what substances are used?
Manipulation of the airway causes a transient increase in intracranial pressure. In patients who have increased ICP this may be devastating. Several medications may be used in attempt to diminish the effect of airway manipulation on intracranial pressure: Fentanyl, Lidocaine, Paralytic Agent.
However, there are conflicting data regarding the potential benefit!
What is induction?
The step of administering a medication that will quickly and reliably sedate the patient prior to paralysis. Mostly etomidate is used, as it is rapidly sedating and hemodynamically neutral. However, it causes transient adrenal suppression (some avoid it, when intubating septic patients).
Ketamine may also be used (especially in status asthmatics, anaphylactic or septic shock). Ketamine leaves airway reflexes protected and does not induces apnea!
What is the correct positioning of a patient for RSI?
Sniffing position
What are “The 7 Ps for RSI”?
Preparation Preoxygenation Pretreatment Paralysis and induction Positioning Placement with Proof Postintubation Management
How can you confirm a endotracheal tube is placed in the trachea?
Gold standard: Watching the ETT pas through the vocal cords
Others:
Fogging
Breath sounds
End-tidal CO2
How can you classify paralytic agents? Name a few examples?
Depolarizing vs. Non-Depolarizing
Depolarizing:
Succinylcholin: increases Potassium-levels and neuromuscular junction; therefore contraindicated in subacute burns, renal failure, subacute strokes, multiple sclerosis etc.
Non-Depolarzing:
Rocuronium
Vecuronium
Contraindicated if anticipated difficult airway!
