Lee County Common Treatment Guidelines - Airway/Ventilation/Oxygenation Management

Question 1

What is the goal of Airway, Ventilation and Oxygenation Management?

Answer 1

To provide evidence-based and reasoned logic core principles for Progressive Airway, Ventilation and Oxygenation Management

Question 2

Is airway management a ONE treatment modality?

Answer 2

No, it is a progression of interventions ranging from least invasive (BLS) to the most invasive (ALS) as necessary.

Question 3

What is the primary goal of progressive airway management?

Answer 3

To start simple, work through the various levels and stop when the airway is patent.

Question 4

When placing an advanced airway, be careful to avoid what?

Answer 4

Iatrogenic hyper/hypocapnea, hypotension, bradycardia and Spo2 desaturation events.

Question 5

Indications for prehospital endotracheal intubation can be narrowed to the following:

Answer 5

-inability to ventilate and/or oxygenation with non-invasive techniques
-inability to manage secretions with conventional methods
-high index of suspicion for laryngeal edema

Question 6

Prehospital endotracheal intubation is worse among who?

Answer 6

-Pediatrics
-Closed head/traumatic brain injuries
-Poly-trauma patients

Question 7

What philosophy is to be used when performing endotracheal intubation?

Answer 7

2 and out.
2 laryngoscopic attempts per case

Question 8

What position substantially increases the likelihood of obtaining a better laryngeal view?

Answer 8

The heads-up sniffing position

Question 9

What is the preferred method of Laryngoscopy?

Answer 9

Video over Direct

Question 10

How is an endotracheal intubation attempt defined?

Answer 10

As passing the laryngoscope blade and/or endotracheal tube beyond the teeth with the intent to intubate the trachea.

Question 11

What is the desired pathway for Progressive Airway Management?

Answer 11

-Natural Airway
-Head Positioning - Airway Axis Alignment
-Basic Mechanical Airways - Nasopharyngeal and/or Oropharyngeal
-Advanced Airways (Extraglottic or Endotracheal)
*SGAD for CardioPulmonary Arrests
-Cricothyroidotomy - (Needle, Percutaneous, Surgical)

Question 12

What is the mechanical aspect of breathing in which air moves into the lungs and CO2 moves out of the lungs?

Answer 12

Ventilation

Question 13

Proper ventilation requires which two things?

Answer 13

Adequate tidal volume and respiratory rate.

Question 14

Oxygenation is defined as what?

Answer 14

The addition of oxygen to any system, including the human body. Also the process of treating a patient with oxygen, or of combining a medication or other substance with oxygen.

Question 15

Primary treatment goals for patients suffering from inadequate oxygenation include:

Answer 15

-Preventing or correcting hypoxia
-Optimizing etCO2 and SpO2
-Minimizing the effects of secondary and/or iatrogenic injury
-Decreasing airway resistance

Question 16

Inadequate oxygenation is recognized at what level?

Answer 16

SpO2 < 94%

Question 17

What does PEEP stand for?

Answer 17

Positive End-Expiratory Pressure
It is an effective way to improve oxygenation in patients that are non-invasively or invasively ventilated.

Question 18

What do PEEP stents do?

Answer 18

Open closed alveoli and recruits lung thus increasing surface area for gas exchange. Also increases functional residual capacity (FRC) which improves pulmonary reserves between breaths.

Question 19

What is the range of PEEP in prehospital care?

Answer 19

5 - 15cmH2O (classic settings: 5, 7.5, 10, 12.5, and 15)

Question 20

Tight-lung patients typically do better at what PEEP setting?

Answer 20

5cmH2O

Question 21

Wet-lung patients typically do better at what PEEP setting?

Answer 21

7.5 - 15 cmH2O

Question 22

What is meant by tight-lung?

Answer 22

Reactive airway disease

Question 23

What is meant by wet-lumg?

Answer 23

Congestive heart failure/Pulmonary edema

Question 24

What is the desired pathway for Progressive Ventilation/Oxygenation Management?

Answer 24

-Eupneic - Normocapnic, Normosaturated
-Truncal Positioning - Airway Axis Alignment
-Passive Oxygenation
-Non-Invasive Ventilation/Oxygenation
-Invasive Ventilation/Oxygenation

Question 25

During the Eupneic phase of Progressive Ventilation, what intervention is used?

Answer 25

None, monitor for changes

Question 26

What is Airway Axis Alignment?

Answer 26

Head Tilt - chin lift, jaw thrust, sniffing position, head of bed up, ramping

Question 27

What is used in Passive Oxygenation?

Answer 27

Nasal Cannula, high-flow nasal cannula, non-rebreather mask, nebulizer, controlled mechanical ventilation, bag mask ventilation

Question 28

What are non-invasive ventilation methods?

Answer 28

CPAP, controlled mechanical ventilation, bag mask ventilation

Question 29

What are Invasive Ventilation methods?

Answer 29

Controlled mechanical ventilation - PEEP, Bag make ventilation - PEEP

Question 30

What has been shown to improve oxygen saturation in apneic patients during advanced airway management placement?

Answer 30

Apneic Nasal Oxygenation (nasal cannula at 15lpm)

Question 31

What is a common pitfall in ventilation?

Answer 31

To over-ventilate patients by providing too much tidal volume (Vt) or too fast a minute rate (Vf).

Question 32

What position should Airway/Pulmonary patients be transported?

Answer 32

semi-Fowler’s - supine positioning can result in a marked reduction in functional residual capacity

Question 33

What is preferred over Bag mask Ventilation (BMV)?

Answer 33

Controlled Mechanical Ventilation (CMV) or the use of an Automated Transport Ventilator (ATV)