Chapter 4 - Airway and Ventilation Flashcards
(28 cards)
Upper airway parts
- nose, mouth, pharynx, larynx, epiglottis and trachea
These help to humidity filter and transport inhaled air from the atmosphere to the alveoli
Lower airway
bronchi, lungs and alveoli
These help for circulatory gas exchange
Diffusion
gases move from higher to lower concentration
- oxygen enters the alveoli and Carbon dioxide escapes
Perfusion
the movement of blood through the circulatory system through the heart and lungs
What can cause airway obstruction in the trauma patient
Altered LOC
Secretions
Maxillofacial trauma
Neck or larynx trauma
Oxygen - Sa02 meaning
Percentage of red blood cells with hemoglobin bound to oxygen
ABG > 94%
Oxygen Sp02 meaning
perf. oxygen sat. >94%
Oxygen Pa02 - meaning
amount of oxygen dissolved in plasma
Normal ABG - 80-100 mmHG
Ventilation - Pac02
the partial pressure of carbon dioxide in the blood (c02) in arterial blood 35-45 mmHg
ETC02 - meaning
max concentration of C02 at the end of each breath.
Normal > Capno 35-55 mmhg
colorimetric 2-5 % ETCO2 (15-38 mmHG)
Hypoxemia
insufficient level of oxygen in the blood - pa02
Normal 80-100 mmHg
Hypoxia
Inadequate oxygen supply to the tissue - pa02
Normal 80-100 mmHG
Hyperoxia
excess of supplemental oxygen in the blood
Normal Pa02100 mmHg
Hyperoxia Pa02 > 120 mmHg
Breathing - rates
10-12 per min
= one every 5-6 seconds
NPO
tip of nose to tip of ear lobe - common R) nare
circ. complications
- hemorrhage
- pneumomediastinum
- lac to cricoid ring
- tracheal trauma
-subglottic stenosis - vocal cord damage
LEMON - difficult airways
(L) - look; assess for patient trauma to fae.
(E) evaluate - 3-3-2 (3 fingers in mouth, 3 between chin and neck and 2 between neck and mandable)
(M) mallampti score ; mouth opening to size of tongue
(O) obstruction / obseity
(N) neck mobility
How do you know if an ETT is in?
a. rise and fakk of chest
b. listen to any presence of gurgling over the epigastusm, which may indicate the tube in the esophagus.
c. bilateral breathe sounds
d. CO2 (POSITIVE IF WE SEE C02 EXHALED after 6 breathe)
*Breath sounds are heard only on the R) side indicates that the ETT could be in the right stream bronchus and has been inserted too far
LABS - BASE AND LAC
Base deficit serves as an endpoint measurement of the adequacy of cellular perfusion.
A lactate that normalises with 24 hours of injury due to regulation and supportive care is connected to improved outcomes
Intubation technique - BURP
Backward
Upward
RIght ward
pressure
Seven P’s of rapid sequence intubation
Preparation
Pre-oxygenate
Pre intubation optimization
Paralysis with induction
Protection (airway from aspiration)
Placement with proof
Post intubation management
Intubation - pre-treatment drugs (2)
Lignocaine
- may reduce the risk of ICP during intubation
ONSET = 45-90 seconds
Duration = 20 minutes
Fent.
- mitigates sympathetic response (increased BP and HR)
ONSET 2-3 minutes
Duration = 30-60 minutes
Induction drugs (4)
Etomidate
- acts of gaba receptors to block neuroexciration and produce anesthesia.
ONSET - 15-45 seconds
Duration 3-12 minutes
Ketamine
- acts on GABA receptors, causing neuro inhibition and anesthesia, antagonises opioid receptors causing analgesia
ONSET - 45-60 seconds
Duration 10-20 minutes
Midaz
- acts on gaba receptor complex to produce sedation and amenia
ONSET - 30-60 seconds
DURATION- 15-30 minutes
Prop
- sedative amnestic agent, suppresses brain activity and inhibits long term memory creation
ONSET - 15-45 second
Duration 5-10 minutes
Paralysis drugs (3)
Sux
- depositing agent that stimulates all chlorogenic receptors (synthetic and parasynmathic casing paralysis)
ONSET - 45-60 seconds
DURATION 6-10 minutes
ROC
- a nondepolarising agent that inhibits neuromuscular receptors, causing muscular paralysis
ONSET - 45-60 seconds
DURATION - 45 minutes
Verc.
- nondepolarizing agent that inhibits neuromylar receptors causing muscle paralysis
ONSET - 75-90 seconds
DURATION - 25-40 minutes
