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Interventions 1 (RESP 266) > Mod 4: Intubation > Flashcards

Mod 4: Intubation Flashcards

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1
Q

Why do you intubate (need airway management)?

A

Protect airways
partially obstructed airways
complete airway obstruction
Apnea
Respiratory distress
Hypoxemia, hypercarbia, acidemia

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2
Q

What is the RR before someone fatigues and fails to breathe on their own?

A

35

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3
Q

Drooling and strider are indicators of what?

A

intubation, usually they’re a sign of some sort of inflammation that is partially blocking the airway

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4
Q

Clinical signs for intubation? (7)

A

Decreased LOC (GCS < 8)

Ventilation irregular or ineffective

Color: cyanosis

Adventitious sounds

excessive secretions/inability to clear secretions

increased WOB (such as retractions)

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5
Q

What is a good indicator that intubation was placed correctly or in?

A

End tidal CO2

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6
Q

Crash vs Rapid sequence intubation (RSI) intubation

Edit

A
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7
Q

What does the acronym “Lemon” indicate?

A

Predictors of possible difficult laryngoscope

  1. Look at the patient
  2. Evaluate the 3-3-2
  3. Mallampati to classification
  4. Obstruction
  5. Neck mobility
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8
Q

What is the Mallampati classification?

A
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9
Q

What are 3 points of the 3-3-2 rule?

Edit

A
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10
Q

Burp vs Sellick maneuver? what do they both ultimately do?

Edit

A

Improve the grade of view for the mouth by 1

Method
Gently applied pressure to cricoid.

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11
Q

Assisting a laryngoscopy or intubation is always done on which side?

A

on the right side

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12
Q

Colorimeter is normally purple, what does it indicate when it turns yellow?

A

CO2

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13
Q

What are the indications of intubation

hint A-E?

A

Inability to manage airway through other means

A: Airway: Airway obstruction
B: breathing
C: Circulation
D: Disability
E: Expected course

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14
Q

Airway indications for intubation

A

Airway obstruction present or potential aspiration occurred/potential

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15
Q

Breathing indications for intubation

A

Oxygenation failure
Ventilation failure

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16
Q

Circulation indications for intubation

A

Shock

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17
Q

Disability indications for intubation

A

Alter LOC (GCS > 8)

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18
Q

Expected course indications for intubation

A

Expected decoration of A,B, C, or D

Intubation needed for intervention (surgery, cath lab)
Long transports

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19
Q

Indicators for airway management

A

Protect airways

partially obstructed airway (or complete)

Apnea

Respiratory distress

hypoxemia, hypercarbia, acidemia

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20
Q

Need for airway management;

Signs that demonstrate a lack of response to protect airways?

A

Coma

lack of gag

inability to cough

respiratory distress

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21
Q

Examples of respiratory distress?

A

increased RR

High/low Vt

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22
Q

signs of a partially obstructed airways?

A

strider, paradoxical respiration, accessory muscle use

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23
Q

Emergency indications for Intubation?

A

hypoxemic respiratory failure

hypercapnic respiratory failure

upper airway obstruction/injury

shock/hemodynamics instability

clinal conditions associated with risk for airway compromises

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24
Q

Clinical signs for intubation?

A

Decreased LOC

ventilation irregular or ineffective

cyanosis (colour)

Adventitious sounds O/A: strider, diminished or absent

excessive secretions or can’t clear

increased WOB: i.e nasal flaring, retractions etc.

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25
How do you confirm EDT placement?
Auscultation -both sides -epigastric -chest expansion Monitors: -SpO2 -HR -EtCO2
26
Normal capnogram or Normal EtCO2 value/range?
35-45mmHg
27
Esophageal detection device (blue bulb) what does it indicate?
attach with bulb compressed: If it does not inflate = esophagus if inflates = trachea (intubated)
28
how do you secure the ETT?
twill ties tapes device
29
Post intubation magement
confirm placement at the teeth, gums, or lips record on patient chart monitor patient prior to leaving bedside
30
RSI Notes:
31
complications with intubation?
-failure to establish patient airway -vocal chord paralysis -upper airwa trauma, laryngeal, esophageal damage -Aspiration -cervical spine trauma -laryngo/bronchospasm -bleeding or dental incidents Problems w/endotracheal tube -cuff perforation -cuff her inaction -pilot tube valve incompetence -nosocomial infection
32
Nasal complications (nasal intubation specific)
-Nasal damage including epistaxis -Tube kinking in pharynx
33
Nasal complications not local to nasal
-sinusitis and otisis media -tracheal damage including tracheoesophageal fistula, tracheal i nominate fistula, tracheal stenosis and tracheomalacia -pneumonia -laryngeal damage with consequent laryngeal stenosis, laryngeal ulcer, granuloma, polyps
34
What equipment do you want to Prep for intubation
suction and BVM laryngoscope handle and blades (mac/miller 3 or 4) stylet ETT appropriate size and 1 down. Magill forceps xlocaine spray 10cc syringe OPA ETT tape or holder spare batteries
35
What things should you consider when assisting w/intubation?
suction safety check equipment manual ventilation monitor patient air pause (2 attempts, 30s)
36
ETT size?
women: 7 or 7.5 men: 8 or 8,5
37
what should be done before deciding to intubate?
maneuver position to create a patient airway and to ventilate with O2
38
factors that could make intubation difficult?
short neck protruding maxillary incisors receding mandible reduced mobility of neck
39
how do you measure Ç-spine mobility?
measuring distance from lower border of mandible to beyond to thyroid notch at full neck extension (sniffing position) should be greater than 4 finger breaths
40
7 P’s for RSI
preparation preoxygenation pre-treatment paralysis and induction placement and confirmation post-intubation management
41
preparation for RSI
assess degree of difficulty (airway, IV access, monitoring) gather equipment ensure adequate team is present identify back up plan
42
pre-oxygenate patient for RSI
100% O2, usually done with a manual resuscitator or NRB (3-5 mins, obtain highest SpO2 possible) Allows several minutes before desaturation to 90% provides patients w/reserve during intubation
43
Time frame for desaturation during intubation?
8 mins for a healthy 70kg adult Desaturation from 90 to 0 occurs in less than 120 seconds varies for pregnant and obese patients
44
pre-treatment for RSI
anxiolytics, benzodiazepines, or opiodes could be given prior to intubation drugs Sedatives -> paralytic
45
RSI: paralysis with induction
combo of a sedative with a neuromuscular blocking agent renders patient unconscious and induces paralysis -sedatives also have a amnesia affect
46
What are common intubation drugs
Propfol, ketamine, etomidate -commonly have a short onset of action and half life.
47
What are induction agents and why are they given with intubation drugs?
sedatives to provide amnesia, blunt sympathetic responses, and improve intubation conditions
48
what are paralytic drugs? why are they given during intubation?
Neuromuscular blocking agents (NMBA) cause skeletal muscle paralysis -must be used with an induction agent.
49
Examples of paralytic drugs?
succinylcholine rocuronium
50
what is the Sellick Maneuver?
Considered to help with aspiration. look this one up.
51
what is a biannual laryngoscopy?
pressure applied on the neck opposite of the lift of the laryngoscope
52
laryngeal grades?
53
what is the purpose of B.U.R.P?
Burp improves laryngeal position -brings glottis down into view by 1 full grade Backwards upwards rightwards pressure
54
Depth of insertion
visually, when the black line on the ETT goes through vocal chords Women: (average) 19-21 Men: 21-23
55
when Inflating ETT Cuff, what pressure do you want?
25-30 cmH2O
56
Confirmation of ETT placement
Detection of CO2 exhaled gas - EtCO2 Chest x-ray (depth inserted by carina) Endoscopic visual Auscultation can suggest, but is not full proof. -i.e bilateral symmetrical breath sounds. condensation suggests but not full proof.
57
colorimeter changes color to what?
CO2, purpose -> yellow
58
What is the Sellick maneuver?
helps with aspiration (anterior cricoid pressure) -doesn't do much tho apparently
59
When would you use "BURP"? (backward pressure)
Grade 3 or 4 view. Helps bring the glottis down and improve view by 1 full grade
60
What could cause aspiration when giving oxygenation w/BVM?
full stomach or pregnancy (things could come back up)
61
Why do you want to avoid BVM once RSI drugs are given?
avoid gastric insufflation and regurgitation
62
What are indicators that patient can’t protect their airway
Lack of gag Inability to gag resp. distress
63
signs of a partially obstructed airway
Stridor Paradoxical resp accessory muscle use
64
Signs of resp. distress
Increased RR High/Low Vt
65
Signs of increased WOB?
Accessory muscle use: -Retractions -Nasal flaring -High RR
66
Indications for intubation:
ABCDE -Inability to manage airway through other means -prolonged need for vent. assistance
67
What is ABCDE protocol?
Identifies intubation via [A]irway: obstruction or potential aspiration [B]reathing: oxygenation/ventilation failure [C]irculation: shock [D]elirum: altered LOC aka GCS < 8 [E]xpected course: impending failure of above
68
4 cardinal signs of airway obstruction
Muffled (hot potato voice) Can’t clear secretions stridor sensation of dyspnea
69
Before intubation, what steps should you take to clear/create the pt’s airway for optimal oxygenation and ventilation?
Correct pt position (sniffing position) Preoxygenate to 100% (if possible) Ready necessary equipment sometimes drugs
70
How long should you preoxygenate a patient
3-5 mins to obtain highest possible SpO2 (oxygen reservoir)
71
How long does it generally take for a patient to desaturate from 100% to 90%
*8 minutes* but can easily be 120 seconds if depending on the pt size
72
What is the typical drug order given to a patient for intubation?
An induction agent is given first, followed by a paralytic. 1.[Protocol or ketamine] —> 2. [succinylcholine or rocuronium]
73
Why do you avoid BVM after preoxygenating and RSI drugs are given to a patient?
Avoid regurgitation and aspirations
74
Indications for intubation: specific cases
Hypoxemic resp. failure Hypercapnic resp. failure upper airway obstruction or injury shock/hemodynamic instability clinical conditions associated w/risk of airway compromise
75
What are some examples of clinical conditions associated w/risk of airway compromise?
Stroke Drug overdose Coma
76
Why would Hypoxemic resp. failure lead to intubation?
Despite 100% FiO2 or non-invasive PPV support, the patient condition may not be improving.
77
What Indicators are usually associated w/hypercapnic resp. failure and why are they important to pay attention to?
Resp. acidosis and increased WOB They're indicative of impending resp. failure.

Interventions 1 (RESP 266) (16 decks)

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