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Intro to Anesthesia: Part A > Induction & Emergencies > Flashcards

Flashcards in Induction & Emergencies Deck (14)
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1
Q

Induction Part A: Arrival=>LOC (5 steps)

A
  1. Position correctly (sniffing position)
  2. Place on monitors and get pre-induction vitals
  3. Begin Pre-oxygentation
  4. Administer drugs (Versed/ Fentny/Lidocaine)
  5. Induction agent (Propofol/Ketamine/Etomidate)
2
Q

Induction Part B: LOC=>NMB (5 Steps)

A
  1. Confirm LOC (eyelash test)
  2. Test ventilate; use APL; reposition
  3. Apply PNS and check baseline
  4. Make sure Plan B airway available
  5. Administer NMB (Succ/Roc/Vec)
3
Q

Induction Part C: NMB=>Gasses (5 Steps)

A
  1. Ventilate while NBM takes effect
  2. Tape eyes
  3. Confirm loss of twitches
  4. Intubate
  5. Confirm (watch pass cords, auscultate L=> R; 3 ETCo2; chest rise)
4
Q

Sellick’s Maneuver

A

Upward cricoid pressure; increase pressure as patient falls asleep; decreases risk of aspiration in RSI

5
Q

Extubation must take place when patient is…

A

Fully awake or deeply anesthestized; in between called Phase 2 extubation and raises risk of laryngospasm

6
Q

Basic Extubation Criteria (6 items)

A
  1. TV > 6ml/kg
  2. VC > 10ml/kg
  3. RR greater than 5, less than 30 (>30 usually pain)
  4. ETCO2 <50 mmHg
  5. Sustained contraction with PNS
7
Q

Awake Extubation Criteria (3 items)

A
  1. Basic criteria met
  2. Patient responsive, follows commands, can protect
    airway
  3. Can lift head >5 sec (NMB fully reversed)
  • Always suction then remove ETT on positive pressure breath*
  • Always make sure any gasses/drips turned completely off*
8
Q

Deep Extubation Criteria (4 items)

A
  1. Basic criteria met
  2. Muscles relaxant fully reversed (sustained PNS)
  3. Able to maintain airway with mask while patient
    awakens (no secretions, difficult airway)
  4. Ability to remain vigilant while patient awakens
  • Always suction then remove ETT on positive pressure breath*
  • Always make sure any gasses/drips turned completely off*
9
Q

Laryngospasm:

  1. Definition
  2. Signs
  3. Cause
  4. When seen
A
  1. Prolonged intense glottic closure
  2. May be high-pitched squek or absent of sound (ominous); may see rocking horse breahting (flailing of lower ribs and suprasternal in-drawing)
  3. Contraction of lateral cricoarytenoids, thyroarytenoids, and cricothyroid muscle from stimulation of CN X (Vagus)
  4. Induction and more commonly emergence
10
Q

Laryngospasm Triggers (6 items)

A
  1. Secretions
  2. Foreign Body
  3. Pain
  4. Abdominal stimulation
  5. Glottis stimulation on light anesthesia
  6. Reactive airway disease
11
Q

Laryngospasm Prevention (4 items)

A
  1. Deep plane of anesthesia (for induction laryngospasm)
  2. No Phase 2 extubation (either awake or deep)
  3. Suction prior to extubation
  4. Remove ETT with positive pressure breath
12
Q

Laryngospasm Treatment (6 steps)

A
  1. Recognize event
  2. Remove offending stimulus
  3. Larson Maneuver
  4. 100% FiO2 w/ PPV
  5. Deepen anesthetic (Prop push)
  6. Small dose of NMB (Succ 20-40mg)
13
Q

Larson Maneuver

A

Retromandibular notch; apply painful pressure for 3-5 seconds

14
Q

Rapid Sequence Intubation:

  1. Indications
  2. Differences between standard induction
A
  1. Used in situations when aspiration risk high and emergent airway needed
  2. Cricoid pressure, keep on till AFTER confirmation of placement; watch the clock after NMB (60 seconds); removes test ventilations