Chapter 14 Airway Management Flashcards
(274 cards)
0
Q
Brian injury or death can happen in little as this time frame
A
4 to 6 minutes
1
Q
When managing a Pts airway,your primary objective is optimal ____________.
A
Ventilation
2
Q
The functional level of the respiration system is the
A
Alveoli.
3
Q
Primary function of the respiratory system is
A
O2 in and CO2 out. A proper exchange of both gases
4
Q
The nasal cavity and the mouth meet at the
A
Pharynx (throat)
5
Q
The pharynx has three parts. Name
A
The nasopharynx, the oropharynx, and the laryngopharynx.
6
Q
These cavities are prone to infection due to the fact that they trap particles as they enter the airway
A
Sinuses
7
Q
Tubes from the inner ear that help drain and equalize it.
Are called
A
Eustachian tubes (Auditory tubes)
8
Q
The oropharynx extends down to the
A
Epiglottis
9
Q
For a unresponsive PT. What is the leading cause of airway obstruction
A
The tongue
10
Q
The anchor of the tongue is the
A
Hyoid bone. It is a free floating bone not connected to any hard structure
11
Q
At what structure does the nasopharynx end and the oropharynx start.
A
The uvula
12
Q
The gag reflex comes for nerves stimulated where
A
The posterior of the pharynx
13
Q
Name the two sets of tonsils and where there located
A
The Palestine tonsils are more prominent not he side of the throat
The Adenoids tonsils are located on the upper rear wall of the oral cavity.
14
Q
Which tonsils can cause a ear infection when infected
A
The Adenoids
15
Q
The laryngopharynx is also called. Where is located
A
Hypopharynx. Between the epiglottis and glottis
16
Q
Two important landmarks for tracheal intubation.
A
The epiglottis and vallecula
17
Q
The depression or “little valley between the bas of the tongue and the epiglottis is called
A
The valecula
18
Q
When intubating With the strait laryngoscope what is a important landmark
A
Epiglottis
19
Q
When intubating With the curved laryngoscope what is a important landmark
A
The vallecula
20
Q
AKA. Voice box. It houses the vocal cords and keeps air to the trachea and food to the esophagus.
A
The larynx
21
Q
The space between the true vocal cords is
A
The glottis
22
Q
Patency of the glottis largely depends on what
A
Muscle tone
23
Q
The _________ cartridge is the narrowest diameter of the airway for children younger then ten years old.
A
Cricoid
24
The fibrous membrane between the thyroid and cricoid cartridge is called. Why is it important.
The cricothyroid membrane. The place where we perform a cric at. (Cricthyroidotomy).
25
Stimulation of the Vagus nerves that run the length if the trachea can cause what physiological affects when stimulated, let's say with a intubation blade or endotracheal tube. (HR, BP, RR)
Decreased HR, BP, and RR
26
Superior margin of T4 and the inferior margin if the xiphoid process mark the anatomical margins of what structure
The lower airway
27
Average length of a adult trachea is
10 to 12 cm
28
Foreign bodies tend to go into which lung most of the time. Why
The right. It's main bronch mainstay is larger and makes less of a curve when it branches off the carina
29
The point of entry for the bronchioles.
The Hilum
30
Beta 2 receptor stimulation results in what response from the bronchioles.
Smooth muscle from the bronchioles relax
31
The stse of alveolar collapse due to no surfactant being present
Atelectasis
32
The cartilaginous rings of a human do not fully mature until what age
8 years
33
The adult larynx is located approx at what cervical vertebrae??
The Peds??
Adult C4-C5
| Peds C1-C4
34
For a neonate at what age do oral respirations begin
5-6 months
35
The diaphragm of a neonate is ________ in shape
Horizontal
36
The diaphragm of a adult is ________ in shape
Oblique
37
Chest rise may be happening but try respirations may not be happening due to underlying injuries and less protection from the undeveloped rib cage. This type of movement is called
Paradoxic movement.
38
Major respiration stimulus comes from this part of the brain.
Medulla oblongata.
39
During inspiration a nervous impulse is transmitted to the diaphragm via what major nerve
The phrenic nerve
40
The Hering-Breuer reflex is designed to keep us from doing what.
Over inflation of the lungs in a conscious spontaneously breathing perso
41
Average tidal volumes for a adult and Ped is
Adult 500 ml
| Ped 8ml/kg
42
The Hering-Bauer reflex is only active in adults for two reasons. Wen is it active for Peds
Adults 1. Exercise (increased tidal volume is needed)
2. The apneustic center of the brain is damaged or non functional.
Peds. It is always active
43
The pressure exerted by each individual gas in a mixture
Partial pressure.
44
1 mm Hg is equal to __ Torr
| How many Torrs at sea level
1 mmHg =1 Torr
| At sea level. 760 Torr
45
Four main gases in the Earths atmosphere
Oxygen O2, Nitrogen Na, Water vapor H20, Carbon Dioxide CO2
46
Normal levels of PaO2 are
| Normal levels of PaCO2 are
80-100 torr
| 35-45torr
47
______ refers to a decreased amount of O2 saturated Hemoglobin in the blood stream.
Hypoxemia
48
Refers to a low level of O2 in the tissues.
Hypoxia
49
Most common cause of hypoxemia is
Hypoxia
50
What structure is directly behind the thyroid cartridge and is the narrowest portion of the adult airway.
The glottis opening
51
The point of attachment for the vocal cords
Arty enosis cartridges
52
Stimulation of the vagus nerves that run along the pharynx can result in what 3 major physiological responses.
Bradycardia
Hypotension
Decreased RR
53
When you right stem intubate someone how far should you back the tube out before reassessing.
A few centimeters
54
Stimulation of the Beta 2 receptor sites in the bronchioles results in what
Relaxation of bronchial smooth muscle
55
The medical term used to describe the actual functioning parts of a human lung
Parenchyma
56
To intubate a pediatric Pt., Where should padding be placed to help align the airway
Under the torso
57
For neonates. The connection of the epiglottis and soft palate can stay intact except for what two instances.
Crying and disease
58
Cuffed endo tubes are not needed for Peds younger then. Why
8 years old. Their cricoid ring is small enough to make a good seal.
59
In neonates and children what is the primary muscle of inspiration
The diaphragm.
60
Gas exchange from the alveoli and RBCs is called __________ respiration.
External respiration.
61
Gas exchange between the blood cells and the tissues is called __________ respiration.
Internal
62
At sea level what is O2s partial pressure in relation to the other 3 main gases in the atmosphere
160 torr
63
What percentage of venous hemoglobin is bound with CO2. Where is the rest located.
33%. The rest is located in the HCO3. (Bicarbonate ions)
64
What is the condition polycythemia Vera.
Too large amount of RBCs
65
Earliest physical signs of hypoxia is
Restlessness and anxiety
66
The bluing of a persons skin due to hypoxia is called
Cyanosis
67
Normal concentrations of O2 bound hemoglobin are __mg/dL. Cyanosis can occur at what concentration
15 mg/dL.
| 5mg/dL
68
Decreased elimination of CO2 secondary to airway disease is also called what and is normally present with patients with Emphasema
Air trapping
69
How is a patients lips going to present when having trouble breathing due to Emphysema .
Pursed in order to "trap" air into the lungs in order to keep the alveoli inflated
70
A Pulmonary embolus or a tension pneumothorax can cause which one. Hypocarbia or Hypercarbia
Hypocarbia. Decrease function and perfusion of the lung tissue.
71
The amount if air left over and not used in the gas exchange. How many ml's does it consist of.
Dead air space. Approx 150 ml
72
The volume of gas inhaled or exhaled during a normal single respiratory cycle. It consists of how many ml's.
Tidal volume. Approx 500 ml
73
The amount of air that dies reach the alveoli for gas exchange. It consists of how many ml's.
Alveolar air volume. Approx 350 ml
74
What is the true measurement of a Pts Ventilatory status and is vital in assessing pulmonary function.
Minute volume
75
A minute volume ascertains what.
The Ventilatory rate and depth of each inhalation.
76
The volume of air remaining in the lungs after a NORMAL expiration.
Functional reserve capacity
77
After maximal forced exhalation, this is the amount of air in the lungs not able to be expelled
Residual volume
78
The amount of gas that can be forcefully inspired in addition to a normal breaths tidal volume.
Inspiratory reserve volume
79
The amount if gas that can be forcefully expired at the end of a normal expiration.
Expiratory reserve volume
80
The percentage of O2 in inspired air commonly documented as a decimal.
FiO2 = the 0.85
81
The greatest rate of air flow that can be achieved during forced expiration beginning with the lungs fully inflated.
Peak expiratory flow
82
Can hypothermia cause Hypocarbia.
Yes. It decreases metabolism and decreases CO2
83
The most effective care for hyperventilating Pts is to treat the ___________ cause.
Underlying
84
Total lung volume for a adult man is approx
6 liters
85
Primary control of respiration lies in what portion of the brain
The brain stem
86
What portion of the brain stem is responsible for involuntary respirations.
Medulla
87
If the phrenic nerve, which is a involuntary pathway is continually stimulated what happen physiologically.
RR increase
88
The phrenic nerves are directly connected to the
Diaphragm
89
If the medulla should fail what center in the secondary respiration portion of the brain stem can take over.
The apneustic center in the Pons
90
The apneustic center does what.
Prolongs inspiration and inhibiting expiration.
91
What other center in the Pons controls expiration.
Pneumotaxic center
92
The primary function of the pneumotaxic center is to do what
Inhibit inspiration
93
The impulses of what center in the Pons overrides the other
The pneumotaxic impulses override the apneustic center impulses normally.
94
Apneustic respirations consist of what.
Prolonged inhalation with brief exhalation
95
Where are chemoreceptors located and what do they do
The medulla, carotid arteries, and the Arch of the Aorta. They monitor the O2, CO2, and pH of the respiratory system.
96
What is principally responsible for respiratory center stimulation.
The pH of the CSF circulating in the brain
97
A pt with a decreased partial pressure of O2 in the BLOOD is in a state of
Hypoxemia
98
If the chemoreceptors of a COPD Pt becomes desensitized to the higher levels of pH what happens
O2 levels will now take over as the primary stimulus regulating respiration.
99
Excess O2 administration to a pt breathing as a result of hypoxia drive could cause what theoretically. How
Respiratory arrest. It slows the respiratory drive so much it could put the body in arrest. Since the respiratory drive is ran by O2 levels instead of CO2 as in a normal human.
100
A person compensating for a lower airway obstruction will be in what position.
Tripod position
101
Patients with an upper airway obstruction will be found in what position to compensate.
Sniffing position.
102
Infant (1-12months) RR
30-60 breaths/min
103
Toddler (1-3years) RR
24-40 breaths/min
104
Preschooler (4-5years) RR
22-34 breaths/min
105
School age (6-12 years) RR
18-30 breaths/min
106
Adolescent (13-18) RR
12-16 breaths/min
107
Adult (18 years or older) RR
12-20 breaths/min
108
What position unless contraindicated should we place people in respiratory distress.
45 degree or 90 degree semi fowlers
109
An uncomfortable awareness of one's own breathing.
Dyspnea.
110
A TOTAL lack of oxygen available to tissues is called
Anoxia
111
Angulation of the sternum that indicates the point where the second rib joins with the sternum.
Angle of Louis
112
What anatomical landmark is used as a starting point from which the ribs and intercostal spaces can be counted.
Angle of Louis
113
The number of each intercostal space corresponds to that of the rib immediately above or below it.
Above it
114
The angle formed by the MARGINS of the ribs at the sternum
Costal angle
115
The presence of cyanosis is indicative of what serious physiological problem.
Serious gas exchange problem requiring immediate corrective action.
116
Dyspnea relieved by a change in position (either sitting upright or standing) is called
Orthopnea
117
Orthopnea indicates what major possible physiological problems.
Left ventricular failure or serious pulmonary complications (due to hypoxia and hypo ventilation)
118
Chest movement that can occur when multiple adjacent ribs are broken is called
Paradoxic movement
119
A barrel chest is common with what type of patient
Emphysema.
120
This condition produces a snap crackle and pop sensation that feels like crisped rice cereal under the skin.
Subcutaneous emphysema
121
A life threatening condition that produces poor bag compliance
Tension pneumothorax
122
Snoring is indicative of what type of respiratory problem.
Physical obstruction
123
If a person is unconscious what is the most probable obstruction to the airway if they are snoring
The tongue
124
Gurgling is indicative of what respiratory blockage.
A large amount of secretions or vomitus
125
Define stridor, what is it caused by
A high pitched shrill noise that is usually heard on inhalation caused by an upper airway compromise and possible impending airway obstruction.
126
A cough that produces sputum is said to be a ___________ cough
Productive
127
The primary goal of auscultation is to determine if lung sounds are
Present and equal bilaterally
128
What lung sound is associated with asthma
Wheezes on inspiration and expiration
129
When fluid accumulates in the smaller airway passages and is normally associated with pulmonary edema.
Crackles (rales)
130
This act is thought to open atelactic (collapsed) alveoli and happens about once per minute
Sighing
131
Secondary to inflammation and mucous or fluid in the LARGER airway passages, it is congestion heard on inspiration. It is associated with bronchitis or pneumonia.
Rattles (rhonchi)
132
If a person has been intubated in the past what does that mean to a paramedic.
They will have a higher likelihood of needing another in the future.
133
What is the main purpose of a primary survey.
Seek out and find all life threats.
134
If their is any doubt over the adequacy of ventilation in addition to oxygenation of the patient we should do what
Use supplemental oxygen and positive pressure ventilation.
135
Oxygen is available in two forms.
Liquid and gas
136
What size cylinders are usually used by paramedic crews.
D and E.
137
What are the capacities of D, Jumbo D, E, L, and M tanks
D 400L, Jumbo D 640L, E 680L, M 3450L.
138
Which size tank is usually stored in the rescue itself and not portable.
Size M which holds 3450L
139
What is the equation to figure the amount of Minutes left in a air cylinder.
Minutes remaining = Tank pressure (psi) X 0.28/ Flow (L/min)
140
This device creates a anatomical reservoir in the naso pharynx for O2 administration
Nasal Cannula
141
What O2 concentration does a nasal cannula create.
25-45% at 1-6L/min flow
142
Which device is useful for people that are predisposed to CO2 retention.
Nasal cannula
143
When using a simple face mask. What minimal flow rate must you have in order to not allow buildup of the Pts exhaled CO2 in the mask.
5L/min or higher
144
What is the O2 concentration that a simple mask can deliver at what flow rate.
40-60% at 6-10 L/min
145
What is the recommended flow rate for a simple face mask.
8-10 L/min
146
Which mask has a reservoir bag that collects the Pts own dead space to mix with oxygen and allows it to be reused.
Partial rebreather mask
147
If a person has poor respiratory effort and is apneic, do not use a mask or cannula, instead do what.
Bag with positive pressure ventilation
148
What is the O2 concentration of a Partial Rebreather Mask.
35-60% at 6-10L/min
149
Which mask is used when high flow O2 is called for
Nonrebreather Mask
150
What is the O2 concentration of a Non Rebreather and it's needed flow rate.
100% at 10-15L/min
151
When using a nonrebreather or partial rebreather the reservoir bag must be how full
At least two thirds full.
152
Which mask is precise in its delivery.
The Venturi mask
153
Which mask is recommended for a person with a hypoxia respiratory drive such as with COPD
The Venturi mask system.
154
What med can help with laryngospasms after extubation.
Bronchodilators
155
What are the two manual maneuvers meant to do for an unconscious victim.
They both help get the tongue off the back of the Pharynx.
157
Two type of suction catheters.
Hard (tonsil tip, Yankauer)
| Soft (whistle tip, flexible, or French)
158
How long should you oxygenate a pt after suctioning and before you suction again.
30 seconds to 1 minute before repeating suction.
159
Suction should not be applied for more then how long in adults, Children, and Neonates.
Adults: no more then 10-15 seconds
Children: no longer then 10 seconds
Neonates: no more then 3-5 seconds.
160
What type of suction catheter an be used blindly
Soft (French) catheter
161
Which catheter is best used for secretions
The soft (French)
162
When suctioning, if the Pt starts to cough or gag, what physiological effects can happen.
Increased HR and BP
163
Devices that assist in either maintaining an open passageway, protect the airway from aspiration, or both are called
Airway adjuncts
164
An oropharyngeal airway extends from where to where
The lips to the pharynx
165
To suction the lower airway with a French catheter. How should you measure it.
Measure the distance from the nose to the ear and the nose to the sternal notch.
167
What manual maneuver is needed when cervical spine injuries are suspected and the head tilt chin lift is contraindicated.
The modified jaw thrust.
168
Suctioning times for
Adult
Child/Infant
Neonate
Adult. 10-15 secs
Child/Infant. 10 secs
Neonate. 3-5 secs
169
An OPA is measured how.
From corner of mouth to the earlobe or the angle of the jaw
170
The NPA should not be used in anyone that may be on anticoagulants. Why
They may suffer from epistaxis (bloody noses) and create more of a problem with securing the integrity if the airway.
171
How should a NPA be measured
The tip of the nose to the angle of the jaw or tip of the ear
172
The Bevel of a NPA should be pointed where.
The septum.
173
Expired air contains how much O2
16%
174
Which device, a bag mask device or mouth mask device, can deliver a better tidal volume for the patient. Why
The mouth-mask device due the fact you can make a better seal with two hands while supporting. Better head position.
175
What % of O2 delivered via
A bag mask device without supplemental O2.
A bag mask device with supplemental O2.
A bag mask device with supplemental O2 and reservoir
21%
40-60%
90-100%
All set at a flow rate of 15 L/min
176
Cricoid pressure is done for what reason.
To pinch off the esophagus with the cricoid cartridge (full rigid ring) against the 5th or 6th vertebrae.
177
Cricoid pressure in neonates should be done how
And in children
Neonates. Finger tip
Children thumb and index finger
178
Three indications the the Pt is being well ventilated is
Improved color
Pulse oximetry
Responsiveness
179
The most frequent problem with bag-mask ventilation is
Inability to deliver adequate Ventilatory volumes
180
When using a ATV we should set the Tidal volume to what.
Also what Rate
What if Pt is in cardiac arrest. What rate
6-7 ml/kg (500-600ml)
10-12 breaths/min
Cardiac arrest. 8-10 breaths/min
181
Some ATV should not be used on Pts younger then
5 yo
182
Are Flow restricted, Oxygen-powered Vent devices indicated for children.
No. May create Barotrauma.
183
A metal tracheostomy tube will require what to connect to a bag-mask device.
A adaptor.
184
What type of tracheostomy tube helps the patient to learn to breath through the upper airway, expel secretions, and talk.
Fenestrated tracheostomy tubes
185
The 3 most common complication with tracheostomy tubes is
Dislodgment. Obstruction. Infection
186
If a tracheostomy tube is displaced and their is not a new one available what can we do.
We can drop a tracheal tube
187
Extreme caution should be taken when placing a naso gastric tube when what is present
Major facial or head trauma.
188
If esophageal trauma, verices, cancer, or any other issues are suspected where should a gastric tube be placed.
In the controlled environment of a hospital.
189
What size bag-mask for Peds and neonates. What size should not be used for neonates
Peds and neonates. 450-500ml bag
Neonates should not be give the 250 ml bag because it does not provide the proper volume needed.
190
Padding of the shoulders to align the airway should be used in patients younger then ___ yo.
3
191
The cartilaginous rings of a human do not fully mature until what age.
8yo
192
What are the 2 sizes of a Combi-tube.
37 Fr for Pts between 4 and 5 feet tall.
| 41 Fr for Pts taller then 5'feet tall.
193
How much air is put into the Distal and Proximal cuffs of the 37 Fr and 41 Fr Combitubes
37. 80ml distal and 15ml proximal
| 41. 100ml distal and 15ml proximal.
194
What is the minimum height that we can use a Combitube.
They are not to be used an anyone less then 4 feet tall.
195
For a PTL airway how tall do you have to be for it to be used. And how old.
5-7 feet tall.
| At least 14 years old.
196
The black line of the LmA should be aligned with what to ensure that it has been placed correctly.
The upper lip.
197
An LMA cannot be used if the mouth cannot be opened at least how far.
0.6 inches
198
Major disadvantage of an LMA.
Can't protect from aspiration
199
The King is designed to placed in the _______ ONLY.
Esophagus ONLY.
200
What are the three sizes of the King device. How much air to inflate each sizes cuffs.
Size 3 for Pts 4-5 feet tall. 45-60 ml.
Size 4 for Pts 5-6 feet tall. 60-80 ml.
Size 5 for Pts 6 feet or taller. 70-90 ml.
201
How far should you advance a King device.
Till the bag mask device connector is even with the lips or gums.
202
If a person is less then 4 feet tall can you place a King device.
No
203
What are two important conditions exist for placing an ET tube.
Pts who have inadequate oxygenation
| Pts who cannot maintain their own airway.
204
Easiest of all indications for the use of an ET tube is
Cardiac or respiratory arrest
205
A person with a fast and reversible condition like hypoglycemia or a drug overdose should or should not be intubated.
Not. They can come out of their condition quickly as long as we make sure they do not aspirate.
206
The greatest challenge when securing an airway is knowing ------
When to intervene
207
What condition if present des not allow us to intubate unless imminent respiratory arrest is likely.
Epiglottis.
208
When intubating. It is good practice to have what available especially if you suspect an airway that may be shutting due to inflammation.
An ET tube one half size smaller and one a half size larger.
209
A proper blade should be sized how.
Between the Pts lips and larynx.
210
The straight blend is called
| The curved is called the
The miller, Wisconsin, or Flagg blade.
| The Macintosh blade.
211
What size blade is for infants and large adults.
Size 0 for infants and size 4 for large adults.
212
What shape blade is preferred for infants.
The miller, Wisconsin, or Flagg
213
What type of lubricant should be used on a ET tube. Which kind should never be used.
Water based is the only one used.
| Petroleum can cause cuff damage and cause inflammation.
214
A cuffed ET tube is not indicated in what age patients, why.
Pts younger then 8 yo. They have smaller cricoid cartilages that provide a good seal by themselves.
215
ET tubes are available in what lengths.
12-32 cm
216
Internal ET tube sizes range from what sizes.
2.5 -5.5mm uncuffed and 5.0-10.0mm cuffed
217
Common ET tube sizes for an adult is
7.0-8.5 mm
218
For an immediate placement on an an adult what sizeET tube is used.
7.5mm
219
When an ET tube is placed properly the distal # markings should be recorded. They usually range between what cm markings.
19-23 cm to the front teeth.
220
A stylet is usually how big in diameter.
4mm
221
A stylet should be how far from the end if the ET tube.
One half inch
222
To get a Proper and accurate reading from either a color device or capnography we should get at least how many full breaths from a patient.
6 full breaths are needed for accurate placement.
223
When using a EDD. When should we inflate the cuff in an ET tube.
We should inflate after the EDD device has confirmed placement.
224
Increased Vagal tone and gagging can result in what
Bradycardia and increased ICP.
225
What else can we do, on top of using a securing device, to ensure the ET tube does not become displaced.
Secure a Neck Collar
226
How long should we stop bagging for a ET tube placement attempt.
No longer then 30 seconds.
227
How far should the cuff be advanced past the vocal cords.
1/2 - 1 inch past the cords (glottis)
228
How long should we preoxygenate a person before placing a ET tube.
30 seconds - 1minute
229
What position aligns the three axes (mouth, pharynx, and trachea) the best for intubation.
The sniffing if no C spine trauma is suspected.
230
Describe the Acronym BURP and what isn't used for.
Backward Upward Rightward Pressure technique
| To aid in manipulating the Larynx in order to view the vocal cords
231
In folate the distal cuff of a ET tube at least how much.
Between 6-10 ml of air depending on the size selected.
232
A good rule of thumb for cuff inflation is
Inflate till it is full but easily compressed between your thumb and index finger
233
A weakness in the lung parenchyma called a ______ can make the patient more susceptible to a pneumothorax secondary to positive-pressure ventilation.
Bleb
234
You must use at least how many devices to confirm ET tube placement in the trachea.
At least 2 devices.
235
How many CMs past the vocal cords should the cuff of the ET tube be placed.
1 or 2 cm's past
236
When possible what should be used for Peds that weigh less then 35 kg's in order to size them for an ET tube.
A braslow tape.
237
What are some formulas for tube sizing for Peds less then 10 years old. Uncuffed and cuffed.
Age / 4 + 4 = uncuffed
| Age / 4 + 3 = cuffed
238
For proper depth of ET tube placement for Peds older then 2 yo, what is the formula
Age / 2 + 12 = ET tube depth
239
For EDD on a Ped how much should they weigh at least.
20 kg
240
For a Nasotracheal placement what should their Glasgow Coma score be.
Less then 8 on the Glasgow Coma scale
241
What is the age cut off door a Nasotracheal tube.
At least 10 yo
242
A smaller tube for Nasotracheal placement is needed. How much smaller?
1/2 to 1 size smaller
243
What type of jelly if approved can be placed on the distal end of the Nasotracheal tube to help with pain and bleeding.
Lidocaine
244
What important step that is different from the rest is needed for digital placement of a ET tube.
A bite block must be placed in the Pts mouth
245
For transillumination technique, what indication tells us that we are in the trachea
The light passing through the Adam's apple (thyroid cartridge)
246
What are the 7 P's of RSI
```
Preparation 0-10 min
Preoxygenate 0-5 min
Premedicate 0-3 min
Paralysis with sedation 0
Protect the airway 0-15 seconds
Pass the tube and proof of placement 0-45 seconds
Post intubation management 0-60 seconds
```
247
What Mallampati Airway Classification should RSI be used on
Class 1 and 2
248
To wash out nitrogen from the lungs of a patient for RSI. What mask is best
The non rebreather.
249
To minimize bradycardia and limit secretions for RSI. What medication should be given and how long before the intubation procedure.
Atropine. Given at least 1-2 minutes before
250
What is a great alternative to Atropine if MCEP approves
Glycopyrrolate (Robinul)
251
If the Pt has ICP or a suspected head injury. What is a great medication for RSI. Why
Lidocaine. It diminishes cough and gag reflexes and does not increase and may diminish ICP
252
The first medications for RSI are referred to as ________ agents.
Adjunctive meds or agents
253
Which should be given first. The paralytic or sedative. Why
The sedative should be given first. Nothing worse then being paralyzed and being conscious. Put them out before you paralyze them.
254
Sedation is also called ________ in RSI
Induction
255
The cricoid thyroid membrane lies how far below the vocal cords.
1 cm
256
How big of a needle is needed for a Cric in a Adult and a Ped
Adult 14 gauge
| Ped 18 gauge
257
What special piece of equipment is needed for a needle cric to ensure proper oxygenation.
A jet ventilator at 50 psi
258
How long should you limit a needle cric to until better means are available.
30 to 45 minutes.
259
What is the size range for a cric endotracheal tube
6 to 7 mm
260
Never perform a surgical cric on a child younger then ____ yo.
5.
261
O2 saturation of hemoglobin can be measured with what device.
Pulse ox
262
SpO2 means
Saturation of peripheral oxygen
263
Older Pts over 75 yo may have this range of SpO2
86 to 90%
264
What is it called when you have a low amount of hemoglobin.
Hemocrit
265
How big is you first incision with a scalpel when performing a surgical cric and what direction does it go.
1-2 cm. vertical to the neck
266
Colorimetric capon meters have only been know to function how long.
15 minutes
267
According to the book what is the normal level do exhaled CO2.
33 to 43 mm Hg
268
Which phase according to the book represents inhalation on a capnography wave graph.
Phase 0
269
Alveolar plateau is represented by what phase on a capnography wave graph.
Phase 3.
270
End Tidal CO2 is a number acquired at what point during ventilation.
The point at which exhalation ends and inhalation begins
271
PEEP stands for
Positive end-expiatory pressure
272
CPAP and PEEP should not exceed ___ cm H2O.
10
273
What is BiPAP
Two levels of positive pressure effect the patient. One on inhalation like CPAP but has another on exhalation also.
274
When is BiPAP used.
On patients with chronic respiratory failure.
275
CPAP should not be used on a patient younger then
14 yo
