Respiratory

Question 1

Difficulty Breathing/Resp. Distress

Answer 1

Albuterol 3-5mg w/ 0.5 Ipratropium.
No improvement- CPAP.
Epi 1mg/ml (1:1), 0.5mg IM. Every 15 minutes.

COPD- Albuterol. Then CPAP.

CHF- CPAP. 12 lead prior to nitro. Nitro 0.4mg if BP> 100. Every 5 minutes.

Question 2

Difficulty Breathing/ Resp Distress

PEDI

Answer 2

Albuterol. Epi 1mg/ml (1:1), 0.01mg/kg up to 0.5mg IM. Repeat every 15 minutes.

CHF- contact OLMCP.

Epiglottis/Croup- Transport in upright position. Epi- 0.1mg/ml (1:10), 0.5mg nebulized. Advanced airway last resort.

Question 3

Difficulty Breathing/Resp Distress

PEARLS

Answer 3

Difficulty secondary to airway burns requires pre-emptive intubation. Consider nebulized saline for pediatrics. Nebulized meds use 6-8LPM O2. 12 LEAD AND IV ACCESS PERFORMED PRIOR TO NTG USE. May give NTG if BP is > 120mmHg

Question 4

Resp Distress Refusal OFFLINE

Answer 4

Taken duoneb. Hx of asthma or COPD (if new, contact OLMCP). SpO2 90% pre and post treatment. Symptoms relieved by single treatment. Pt AOx4 and vitals normal. No other medical complaints. Speak in full sentences.

Question 5

Airway Management Reference Guidelines

Answer 5

Airway Obstruction- if you have tried TWICE then move to surgical cric.

BOUGIE MUST BE USED FOR INTUBATION ATTEMPTS; VIDEO LARYNGOSCOPY MAY BE USED.

AFTER TWO FAILED INTUBATION ATTEMPTS, PROCEED TO SUPRAGLOTTIC AIRWAY.

ETCO2 MUST BE USED TO VERIFY AND MONITOR ALL ADVANCED AIRWAYS.

Question 6

Sniffing Position

Answer 6

Head up or Ear/Sternal Notch position. OPTIMAL POSITION for advanced airways.

Question 7

Preparing for Advanced Airways

Answer 7

Place NRB AND NC on patient at 15 LPM. Leave NC on during intubation attempt.

Question 8

P.A.I.

Answer 8

Rapid/PreIntubation:
Ketamine- 2mg/kg rapid AND Versed 5mg slow (repeat once as needed)
Continuous/PostIntubation:
Ketamine 2mg/kg rapid AND Versed 5mg Slow (repeat once as needed)

Question 9

P.A.I. Pedi

Answer 9

Rapid: (Premedication) Atropine 0.02mg/kg (minimum dose 0.1mg) IV/IO
Induction- ketamine 2mg/kg rapid AND Versed 0.1mg/kg slow (up to 5mg)
Continuous: ketamine 2mg/kg rapid AND Versed 0.1mg/kg (up to 5mg)

Question 10

P.A.I. Pearls

Answer 10

Versed for dissociative or psychotropic effects.
Continuous ETCO2.
Attempt no longer than 30 seconds. MUST use bougie.
Caution using PAI in obese patients.
WITHHOLD VERSED IF BP< 90 or 70+ 2age

Question 11

R.S.I.

Answer 11

Rapid: Ket. 2mg/kg AND Versed 5mg
Neuromuscular Blockade: Rocuronium- 100mg (wait 1 minute before intubation)
Continuous Sedation: Ket. 2mg/kg rapid AND Versed 5mg slow (repeat once as needed). *If not previously given to achieve intubation then Rocuronium 100mg

Question 12

R.S.I. Pedi

Answer 12

Atropine 0.02mg/kg (minimum 0.1mg)
Induction: Ket. 2mg/kg AND Versed 0.1mg/kg (up to 5mg) slow
Neuromuscular Blockade: Rocuronium 1mg/kg (up to 36mg)
Continuous Sedation:
Ketamine- 2mg/kg rapid AND Versed 0.1mg/kg (up to 5mg). Repeat once as needed.
Rocuronium 1mg/kg (same as original dose)

Question 13

R.S.I. Pearls

Answer 13

Continuous ETCO2.
Intubation no longer than 30 seconds and use Bougie.
Withhold Versed with BP less than 90 or 70 + 2age
IF ROCURONIUM NOT AVAILABLE:
*Ket. Dose may be repeated three times. Versed may be repeated up to a cumulative 20mg. If more is required, contact OLMCP.

Question 14

Advanced Airway Confirmation Protocol

Answer 14

1. Visualize ET tube passage through vocal cords.
2. Auscultation of epigastrum and then thorax.
3. Physiologic changes observed (chest rise/fall, condensation)
4. Use ETCO2.
5. Secure airway with holder and pt in c-collar.
6. Recheck if pt moved

Question 15

I-gel Airway Reference

Answer 15

Contraindicated in patients under 25kg/55 pounds. PATIENTS WITH AN IGEL ARE CONSIDERED TO HAVE A STABLE AIRWAY

Question 16

PEEP

Answer 16

Indicated in respiratory failure secondary to pulmonary edema/CHF, drowning, smoke inhalation.
Contraindicated in cardiac arrest.

Question 17

Colorimetric End Tidal

Answer 17

Purple- ETCO2 less than 4mmhg. Still purple after 6 breaths then pull the tube (esophageal intubation).
Yellow- ETCO2 from 15-38

Question 18

CPAP Contraindications

Answer 18

Vomiting
Unable to follow commands
Severe facial trauma
Known pneumothorax 
Resp. Arrest/agonal