Exam 2 - Airway Flashcards
(42 cards)
Describe the relationship between Respiration, Ventilation, and Oxygenation.
The respiratory and cardiovascular systems work together to ensure that a constant supply of oxygen and nutrients is delivered to every cell in the body and that carbon dioxide and other waste products are removed from every cell.
What should always be performed prior to PARALYSIS?
Sedation
*first line sedative: Ketamine
*first line paralytic: Rocuronium (Zemuron)
Why should an NG or OG be placed during RSI?
In an MTF setting, to allow for decompression of the stomach, suctioning as well as administration of oral nutrition.
What is FIO2?
Fraction of inspired oxygen : percentage of O2 in inhaled air
*room air contains 21% FIO2 - documented as 0.21
How does the body maintain an Acid-Base Balance through the respiratory system?
Hypoventilation and Hyperventilation, along with Hypoxia disrupt acid-base balance.
Respiratory & Renal systems help maintain homeostasis.
What is the fastest way to eliminate excess acid?
Through the respiratory system in the form of CO2 through the lungs.
Name the 3 cricothyroidotomy techniques.
Standard Open Surgical - uses a flanged and cuffed airway cannula. *least desirable option.
Bougie-Aided - similar to Standard Open just with bougie-aid.
CricKey - curvilinear, overall length 19cm, combines the functions of a tracheal hook, stylet, dilator, and bougie. Incorporated with Melker.
What are the contraindications for intermediate Airways like the iGel?
may not be suitable for maxillofacial trauma & inhalation burns.
Describe the ADVANTAGES of Endotracheal Intubation.
- isolates the trachea and permits control of airway.
- impedes gastric distensions by channeling air directly into trachea.
- eliminates the need for a mask seal.
- offers a direct passage for suctioning airway passages.
- permits the administration of medication.
Describe the DISADVANTAGES of Endotracheal Intubation.
- techniques requires considerable training and experience.
- requires specialized equipment.
- requires direct visualization of the vocal cords.
- bypasses the upper airway’s functions of warming, filtering, and humidification of inhaled air.
- inappropriate in nearly all tactical situations.
MACHINE
Check Ventilation to ensure proper functioning.
Minimum: have BVM with PEEP valve ready to assist with ventilation if needed.
Better: Add Oxygen (O2 tank or O2 Concentrator)
Best: Ventilator (SAV II, Hamilton T1, or Impact 731)
SUCTION
How you plan to deal with a vomiting patient? Should include flexible tube for ET tube suctioning.
Minimum: Improvised Suction w Syringe (20cc or larger) and NPA
Better: Disposable Device (Suction Easy System)
Best: Powered Suction
MONITOR
Monitoring required before and after intubation, should include four basic vital signs: BP, Pulse, Pulse Ox, ETCO2
Minimum: Manually monitor pulse, BP, and respirations.
Better: Finger Pulse OX, ETCO2
Best: Mechanical monitoring Pro-paq, ETCO2, BP, Pulse OX, EKG etc.
AIRWAY
What are the airway adjuncts listed from Minimum, Better, Best.
Minimum: NPA, OPA, Crich kit
Better: I-Gel or LMA*preferred
Best: Full Airway Kit with Laryngoscope and full range ET tubes & Bougie stylet
IV
Considerations
No Min, Better, Best
Consider adding 20Ga IVs for difficult stick.
Describe the process of performing an Awake Cricothyroidotomy.
- preoxygenate
- pretreat with 8mg Zofran
- give 1-2mg IV of Versed to cause amnesia
- have an assistant hold patient upright
- sedation dose of Ketamine 1-2mg IV slow
- clean area with povidone iodine
- inject wheal of 2% Lidocaine over cric membrane
- advance needle
- if you see bubbles, you’re in the trachea
- squirt 3mLs into trachea
- lean patient back and hyperextend neck
- make vertical incision normal
What are the 6 steps of RSI?
Preoxygenation
Continuous Monitoring
Premedication
Sedation
Paralysis
Insertion of intermediate Airway or Intubation
The main goal of preoxygenation is to extend the “safe apnea time”. The amount of time following cessation of breathing/ventilation until critical oxygen desaturation occurs SPO2 _____ in clinical setting and ______ in prehospital setting.
clinical setting: 88-90%
prehospital setting: 85-90%
Describe all of the components of continuous monitoring.
Pulse oximetry
Pulse rate
Blood pressure
Respirations
ETCO2
Wave Form Capnography
Normal ETCO2 is _____mmHg and consists of what four phases?
38mmHg
inspiratory baseline
expiratory upstroke
alveolar plateau
inspiratory downstroke
What is the normal end-tital CO2?
And what is the normal range of ETCO2?
a. 38mmHg
b. 35 - 45mmHg
The ETCO2 can be analyzed for what 5 characteristics?
i. HEIGHT
ii. FREQUENCY
iii. RHYTHM
iv. BASELINE
v. SHAPE
A normal capnogram occurs in four phases, name and describe each phase.
Phase 1: Inspiratory baseline - reflects inspired gas, normally devoid of CO2.
Phase 2: Expiratory upstroke - transition of CO2 from alveoli to anatomical dead space of airway.
Phase 3: Alveolar Plateau - CO2 rich gas reaches it peak in the sensor and is fairly steady.
Phase 0: Inspiratory Down Stroke - the patient inhales again, bringing clear air past sensor, dropping graph back to zero to start over again at phase 1.
If the patient has systolic BP greater than ____, administer a sedative.
90mmHg
