Chapter 11: Airway Management Flashcards
(121 cards)
1
Q
2 ways oxygen reaches body tissues and cells
A
breathing & circulation
2
Q
what is responsible for the regular rise and fall of the chest
A
diaphrgram and intercostal
3
Q
nasopharynx
A
air passes through, and is lined with a ciliated mucous membrane that keeps the contaminants such as dust and other small particles
4
Q
what do mucus membranes do
A
warm and humidify air as it enters the body
5
Q
oropharynx
A
posterior position of oral cavity bordered superiorly by hard and soft palates, laterally by the cheeks and inferiorly by the tounge
6
Q
larynx
A
elevated and the epiglottis folds over glottis to prevent aspiration of contents into trachea
7
Q
thyroid cartilage
A
shield shaped structure formed by 2 plates joined in a v shape anteriorly to form what is called the adams apple
8
Q
cricoid cartilage
A
inferiorly to the thyroid cartilage, forms lowest portion of the larynx
9
Q
glottis
A
space between vocal cords and the narrowest portion of the adults airway
10
Q
what are the external boundaries of the lower airway
A
4th cervical vertebra, xiphoid process, the narrow, cartilaginous, lower tip of the sternum
11
Q
what does the lower airway span
A
the glottis to the pulmonary capillary membrane
12
Q
carina
A
point at which the trachea bifurcates into the lift and right mainstream bronchi
13
Q
visceral pleura
A
thin tissue, slippery outer membrane that covers the lung
14
Q
parietial pleura
A
inside thoraic cavity
15
Q
mediastinum
A
between the lungs, surrounded by tough connective tissue and containing the heart, great vessels, esophagus, trachea, major bronchi, and nerves
16
Q
phrenic nerve
A
two nerves that innervate the diaphragm, needed for adequate breathing
17
Q
patients with COPD
A
have difficulty eliminating carbon dioxide through exhalation, alters dirve for breathing
the body uses a backup system to control breathing (hypoxic drive)
found in end stage COPD
18
Q
dyspnea
A
shortness of breath
19
Q
external repsiration
A
process of breathing fresh air into the respiratory system and exchanging oxygen and co2 between alveoli and the blood in pulmonary capillaries
20
Q
internal respiration
A
exchange of oxygen and carbon dioxide between systemic circulatory system and the cells of the body
21
Q
what is needed for aerobic internal respiration to take place
A
adequate levels of perfusion and external ventilation
22
Q
chemoreceptors
A
monitor levels of oxygen, co2, hhydrogen ions, pH of CSF
23
Q
What happens then serum CO2 or H+ increase
A
When serum carbon dioxide or hydrogen ion levels increase, chemoreceptors stimulate the medulla to increase the respiratory rate, removing more carbon dioxide or acid from the body.
24
Q
intrinsic factors effecting pulmonary ventilation
A
its conditions include infections reacitons, airway obstruction, associated with hypercarbia, swelling, trauma, and muscular dystrophy
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extrinsic factors effecting pulmonary ventilation
Foreign body airway obstruction
Trauma
Trauma to the airway or chest requires immediate evaluation and intervention.
Patients with a fracture to the mandible, especially unconscious patients, may not be able to maintain an open airway on their own and may require the insertion of an airway adjunct.
Blunt or penetrating trauma and burns can disrupt airflow through the trachea and into the lungs, resulting in oxygenation deficiencies.
Trauma to the chest wall can result in structural damage to the thorax, leading to inadequate pulmonary ventilation.
Swelling, punctures, and bruising have an effect on the ability to deliver oxygen to the alveoli and into
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external factors affecting respiration
atmospheric pressure and partial pressure of oxygen (for example, at high altitudes)
or closed enviroments like mines
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internal factors affecting respiration
conditions that reduce surface area of gas exchange decreasing body's oxygen supply
nonfunction alveoli inhibit the diffusion of O and CO2
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intrapulmonary shunting
blood entering the lungs from the right side of the heart bypasses the alveoli and returns to the left side of the heart in an unoxygenated state
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hemothorax
collection of blood in pleural cavity
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pneumothorax
accumilation of air/gas in cavity
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how to treat a patient in shock
aggressively to prevent further interruptions
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aerosol-generating procedure (AGP)
an airway manipulation that induces the production of aerosols that may present a risk for airborne transmission of pathogens such as CPR
33
signs of normal breathing for adult patients
A normal rate (between 12 and 20 breaths/min)
A regular pattern of inhalation and exhalation
Clear and equal lung sounds on both sides of the chest (bilateral)
Regular and equal chest rise and fall (chest expansion)
Adequate depth (tidal volume)
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normal respiratory rate for adults
12-20 breaths/min
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normal respiratory rate for children
12-40 breaths/min
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normal respiratory rate for infants
30-60 breaths/min
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retractions
skin pulling in around the ribs or above the clavicles during inspiration
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agonal gasps
gasping breaths after a patient heart stops
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labored breathing
require effort from accessory muscles
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cheyne-stokes respiraitons
seen in patients with stroke and patients with serious head injuries, it is having an irregular respiratory breathing pattern
patient has increasing rate and depth of respiration that followed by a period of apnea
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ataxic repsirations
serious head injuries may also cause changes in the normal respiratory rate and pattern of breathing, ineffective respirations and not an identifiable pattern
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kussmaul respitations
patients experiencing a metabolic or toxic disorder may display other abnormal patterns, it is characterized as deep, rapid respirations seen commonly for patients with metabolic acidosis
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assessment of respirations
consider high altitudes and poisonous gases
if ems unit carries a handheld carbon monoxide detector, assess ambient air before entering location
if a space is not safe (air) remove yourself and the patient if possivle from the scene and contact appropiate source
44
what does pale skin indicate, and what happens as the condition worsens
poor perfusion caused by illness or shock
As this condition worsens, cyanosis
becomes noticeable first peripherally, in the fingertips, and then centrally, in the mucous membranes and around the lips.
Eventually, anaerobic metabolism takes place, causing the skin to mottle.
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pulse oximetry
provides an accurate indication of a patients oxygen status
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under normal conditons what should the SpO2 be
94% or greater
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what does an SpO2 lower than 94% indicate
requirestreatment unless patient has chronic condition
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when is oxygen applied during a stroke or heart attack
when SpO2 dorps below 94%
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steps of performing a pulse oximetry
1) clean patients finger, place the index or middle into the pulse oximeter probe. turn it on and note the led reading of the SpO2
2) palpate the radial pulse to ensure that it corrolates with the led display on the pulse oximeter
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what to do when performin a pulse oximetry in patients with signifigant vasoconstriction or low perfusion states (including cardiac arrest)
move the sensor to a more central location like the bridge of the nose or earlobe
51
end-tidal CO2
partial pressure or maximal concentration of CO2 at end of exhaled breath
hence the tidal (which is total breath), end tidal is the exhaled breath
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capnometry
device that provides digital numerical reading of the end tidal CO2 level
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capnography
provides numeric reading and a graph
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normal range displayed in capnography
35-45 mm Hg
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Phase I (A-B) of capnographic wave form
respiratory baseline, initial stage of exhalation, the gas sample is dead space gas, free of CO2
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Phase II (B-C) of capnographic wave form
expiratory upslope, @ B, alveolar gas (contains high level of CO2) mixes w/ dead space gas, rsulting in abrupt rise in exhaled CO2
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Phase III (C-D) of capnographic wave form
alveolar plateau, all gas sampled is alveolar
point D is the maximal end tidal CO2 level, the best reflection of the alveolar CO2 level
height of waveform at point D correlates with the numeric value of exhaled carbon displayed on the cardiac monitor
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Phase IV
inspiratory downstroke occurs then the patient inhales fresh gas and is breathed into the lungs
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duration of each waveform
duration of ventilation
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space between waveforms
patients respiratory rate
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waveform abnormalities in in CO2 levels
you can recognize abnormalities in carbon dioxide levels by noting the height of the capnographic waveform.
If the patient is hypoventilating, he or she is retaining too much carbon dioxide, so you would expect a tall capnographic waveform.
If the patient is hyperventilating and eliminating too much carbon dioxide, or if carbon dioxide return to the lungs is decreased, the waveform is smaller.
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steps to position an unconscious patient
1) support head while partner straightens legs
2) have partner place his/her hand on patients far shoulder and hip
3) roll the patient as a unit with the emt at the patients head calling the count to begin the move
4) open and assess patients airway and breathing status
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what is a common airway obstruction
tounge
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head tilt-chin left maneuver
opening the airway to relive an obstruction can be done fast by tilting the patients head back and lifting the chin
patient in supine position, and position yourself besides patients head
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jaw-thrust manuver
place the fingers behind the angle of the jaw and lift the jaw upward, this way you can get a mask to seal and allows breathing through mouth and nose
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opening the mouth
place the tips of your index giner and thumb on patients teeth
open the mouth by pushing the thumb on the lower teeth and index finer on the upper teeth (cross finer technique)
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suctioning
when you hear gurgling the patient needs suctioning
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suction catheter
hollow cylindrical device used to remove fluids
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tonsil top catheter
for infants and children,
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nonrigid plastic catheters
suction nose and liquid secretions in back of mouth or for patients with stoma, which is an opening through skin into an organ or other structure
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how to inspect a suction
clamp the tubing and make sure hteu nit generates a vacuum of more than 300 mm Hg
check that a battery charged unit has charged batteries
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how to suction a patients airway
1) make sure the suctioning unit is properly assembled and turned on. clamp the tubing and ensure it vaccums more than 300 mm Hs
2)measure catheter from corner of mouth to the earlobe or angle of jaw
3) turn the patients head to the side (unless c spine injury) and open the mouth using the cross finger technique or tongue jaw lift, and insert catheter to predetermined depth without suction
4) apply suction in a circular motion as you withdraw catheter
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if patient cannot be suctioned quickly and easily
remove catheter, log roll to patients side, clear the mouth with gloved finger, and only try to remove object if it is visible with open mouth examination
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continuous vnetilation
not appropriate if vomit or other particles are present in the airway
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oropharyngeal airways
keeps upper tounge from blocking upper airway, make it easier ti suction oropharynx if needed
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do not do oropharyngeal airways on patients who are...
has intact gag reflex, concious patients, and if hte patient gags remove it and prepare toe log roll patient
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inserting an oral airway 180 rotation
1) size the airway by measuring from the patients earlobe to the corner of the mouth
2) open patients mouth with cross finger technique, hold airway upside down with other hand, insert airway with the tip facing the roof of the mouth
3) rotate the airway 180 degrees, insert the airway until the flange rests on parients lips and teeth, this way the airwau will still hold the tounge foward
78
inserting oral airway with 90 rotation
1) depress tongue so it remains forward
2) insert oral airway sideways from corner of mouth until flange reaches teeth
3) rotate oral airway at 90 degree angle and remove the bite stick as you exert a gentle backward pressure on oral airway until it rests securely in place against the lips and teeth
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nasopharyngeal airways
used on unresponsive patient or a patient with altered level of consciousness who has intact gag reflect and is not able to maintain airway
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when to not use nasopharyngeal airways
severe head injury with blood draining fro nose, history of fractured nasal bone
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steps for inserting a nasopharyngeal airways
1) size the airway by measuring from the tip of the nose to the patients earlobe. cost the tip with a water soluble lubricant
2) insert lubricated airway into larger nostril with the curvature following the floor of the nost. if using the right nare, the bevel should face the septum. if using left nare, insert the airwau with tip of airweay pointing upward allowing bevel to face septum
3) gently advance the airway. if using the left nare, insert the nacopharyngeal airway until resistance is met. then rotate it 180 degrees into position, this rotaiton is not neede dif using right nostril
4) continue until the flange rests against the nostril. if you feel ant resistance of obstruction, temove the airway and insert it into the other nostril
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recovering position
for a clear airway and for those who are nore injured and breathing on their own
not appopiate if they have any spinal pelvic and hip injuries
how to do it: roll patient to their side, so it all moves at the same time, extend the patients lower arm and place the upper hand uner his/her cheek
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hypixic patients
always give oxygen
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where are flowmeters attatcher to
pressure regulators
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pressure of gas in full Osygen cylinder
2000 psi
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steps to placing oxygen cylinder
1) using o wrench, turn valve counterclockwise to crack cylinder
2) attatch regulator or flowmeter to valve stem using the two min indexing holes and make sure that the washer is in place over the larger hole
3) align the regulator so the pins fit snugly into the correct holes on the valve stem and hand tighten the regulator
4) atatch the oxygen connective tubing into flowmeter
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supplemental oxygen hazards: combustion
keep fire away, ensure area is ventilated, never leave cylinder unattended
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oxygen toxicity
damage to cellular tissue due to excessive oxygen levels in the blood
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when should oxygen be delivered to patients
when they have signs of heart failure, shortness of breath, saturation of less than 94%, signs of shock
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administer minimum amt of oxygen to maintain saturation at or above 94%, exceptions to these minimums include,
Patients who have been exposed to carbon monoxide
Patients with potential anemia
Patients with shock
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nonrebreathing masks
preferred way of giving oxygen in prehospital settings to thsoe who are breathing normally but showing signs of hypoxia
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nasal cannulas
small tubelike prongs that fit into patients nostrils, provide 22-44% oxygen when flowmeter is 1-6L/min
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partial rebreathing masks
patients who suffer from hyperventilation syndrome, there is no one way valve between the mask and reservoir
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venturi masks
medium flow device delivers 24-40% oxygen, advantage is its use of fine adjustment capabilities in long term management of psychologically stable patients
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tracheostomy masks
patients cannot breathe through their mouths, designed for those to cover the tracheostomy hole, if this mask isnt available place a face mask over the stoma
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humidification
only for long term oxygen therapy. dry oxygen isnt harmful for short term use.
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what happens during normal ventilation
disphragm contracts and negative pressure is generated in chest cavity
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how is positive pressure ventilation initiated
a device forces air into the chest cavity from the external enviroment
When positive pressure ventilation is initiated, more air is needed to achieve the same oxygenation and ventilatory effects of normal breathing.
This increase in pressure causes the walls of the chest cavity to push out of their normal anatomic shape.
There is an increase in the overall intrathoracic pressure within the chest cavity.
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barrier devices
provides protection but not from diesases transmitted by airborne pathogens or aerosolized droplets
100
bag mask device
less tidal volume than mouth to mask ventilation but delivers a higher concentration of oxygen
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volume in the bag of adult bag mask device, and pediatric bag
1200-1600 mL, 500-700 mL
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steps to perform one rescuer bag mask ventilations
1) assemble equipment and position yourself above patients head, open airway using head tilt-chin lift or jaw thrust maneuver
2) open patietns moutn and suction as needed to clear secretions and insert an oral or nasal airway
3) select appropiate mask and position it properly on patients face. using ec clamp method make a seal by holding index finger over lower part of the bask and thumb on upper part of the mask. use remaining fingers to pull the lower jaw into the mask, bring lower jaw up to the mask with the last three fingers
4) Squeeze the bag with your other hand until you see adequate chest rise. For adults, squeeze once every 6 seconds. For infants and children, squeeze once every 2-3 seconds. In patients with ongoing CPR and an advanced airway in place, use a rate of 1 breath every 6 seconds.
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gastric distention
condition where air fills the stomach and as a result of high volume and pressure during artificial ventilation
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passive ventilation
the act of air moving into and out of the lungs during chess compressions
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how can passive ventilation be enhanced
inserting an oropharyngeal airway and providing supplemental oxygen.
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automatic transport ventilator (ATV)
manually triggered ventilation device attatched to a control box that allows the variables of ventilation to be set
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Continuous positive airway pressure (CPAP)
noninvasive means of providing ventilatory support for patients experiencing respiratory distress
increases pressure in chest/lungs
opens collapsed alveoli
pushes more oxygen across alveolar membrane
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indications of CPAP
for patients experiencing respiratory distress in compensatory mechanisms
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steps to using CPAP
1) with standard precautions, assess patient for indications and contraindications of CPAP. confirm patients blood pressure and explain the procedure to the patient. check equipment, then connect circut to CPAP generator
2) connect face mask to circut tubing
3) connect tubing to oxygen tank
4) place the patient in a high fowler position to faciliatate breathing and coach the patient through the initial application of the mask. instruct the patient to place the mask over the mouth and nose, creating the most airtight seal possible
5) after the mask is placed on the face and the patient adjusts to it, use the strapping mechanism to secure it to the patients head. ensure that the seal between the mask and the face remains intact.
6) adjust the PEEP valve and the FLO2 according to the manufacturers recommendations to maintain adequate oxygenation and ventilation. With CPAP in place, the patients oxygenation saturation level should improve. Constantly reassess the patient for signs of clinical deterioration and or complications
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tracheostomy
opening at the center front and base of the neck
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If the patient has a tracheostomy tube
ventilate through the tube with a bag-mask device (the standard 15/22-mm adapter on the bag-mask device will fit onto the tube in the tracheal stoma) and 100% oxygen attached directly to the bag-mask device.
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what can wheezing indicate
mild lower airway obstruction
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severe airway obstruction
cannot breathe, talk, or cough
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The more oxygen available in the alveoli,
the longer the patient can maintain adequate gas exchange in the lungs while the intubation procedure is being performed. This critical phase of the intubation procedure is called preoxygenation.
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preoxygenation
providing oxygen in combination with ventilation prior to intubation in order to raise oxygen levels of body tissues
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apneic oxygenation
technique where oxygen administered via a high flow nasal cannula is left in place during intubation attempt allowing continuous oxygen delivery into airways during all phases
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direct laryngoscopy
visualization of the airway with a laryngoscope
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video laryngoscopy
visualization of the vocal cords, thereby placement of the endoteacheal tube facilitated by used of video camera and monitor
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B :Perform Bag-mask preoxygenation.
E :Evaluate for airway difficulties.
M :Manipulate the patient.
A :Attempt first-pass intubation.
GI :Use a supraGlottic airway if unable to intubate.
C :Confirm successful intubation/Correct any issues.
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esophageal intubation
improper placement of advanced airway device into the esophagus rather than into the trachea
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