Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
EM Airway Mngmnt
Emergency Medicine Airway Management
| Question | Answer |
|---|---|
| Deoxygenation can result in brain damage in ___ minutes | 4-6 |
| If neck trauma is suspected, use ______ maneuver to establish an initial airway | jaw thrust |
| Indications for an Oropharyngeal Airway | Deeply unconscious patient, absent gag reflex. CI: presence of a gag reflex |
| Disadvantage of oropharyngeal Airways | Does not prevent aspiratioin, unexpected gag may produce vomiting and/or laryngospasm, still may require a head tilt. |
| Complications of oropharyngeal airways | Gagging and retching --may cause vomiting, laryngospasm, and increased ICP. Pharyngeal or dental trauma with poor technique |
| Indications for a Nasopharyngeal Airway | Unconscious/AMS with suppressed gag reflex, Conscious but unable to maintain adequate airway (stroke), post seizure |
| CI's of Nasopharyngeal airway placement | Patient intolerance, nasal fracture, marked septal deviation, coagulopathy |
| Advantages of Nasopharyngeal airway placement | Can be suctioned through, better tolerated by patients with intact gag reflex, can be safely placed without direct visualization |
| Disadvantages of Nasopharyngeal airway | Does not prevent aspiration, poor technique may result in severe epistaxis (may use Afrin beforehand to reduced epistaxis by constricting blood vessels) |
| _____ provides an oval seal around the laryngeal inlet at the esophageal junction and decreases risk of aspiration (does not eliminate it though!) | Laryngeal mask airway |
| If a patient is breathing, assess adequacy by examining | respiratory rate/effort, skin color, mental status (able to protect airway?), Pulse Ox (<85-90%?), ABGs (hyposia, hypercarbia, acidosis) |
| Indications for Endotracheal Intubation | Inability to maintain own airway/prevent aspiration (surgical anesthesia, comatose/GCS<8), Lacking gag reflex/unable to swallow sponataneously, unable to handle secretions. Ventilatory failure: decreased or increased Pa02 despirte supplemental 02 & BiPAP |
| Indications for Endotracheal Intubation (continued) | Respiratory burns, severe facial trauma, epiglottitis, large face/neck abscesses (seen in MRSa, infected dental caries), Need for pulmonary toilet |
| What is Pierre Robin Syndrome? | small jaw, cleft pallet, no gag relfex, downward displacement of tongue |
| What is Klippel-Fiel Syndrome? | Short wide neck, reduced number of cervical vertebrae/fusion |
| In which chronic conditions can a head tilt chin lift is there a risk of fracture or severe injury? | Anklyosing Spondylitis - spine is fused, Rheumatoid Arthritis - |
| Thyro-mental distance | From the upper edge of thyroid cartilage to chin with head fully extended. Short <6cm - more anterior larynx, more acute angle to intubate, less space for everything. Greater than 7cm - sign of an 'easy' intubation |
| LEMON physical assessment | Look externally, Evaluate the 3-3-2 rule, Mallamptati (open and say 'ah' and you can't see anything), Obstruction, Neck mobility |
| 3-3-2 | 3 Fingers fit in mouth, 3 fingers from mentum to hyoid bone (pts fingers), 2 fingers from hyoid to thyroid cartilage |
| Full visibility of tonsils, uvula and soft palate Mallampati Score | Class I |
| Visibility of hard and soft palate, upper portion of tonsils and uvula | Mallampati Class II |
| Only Hard Palate visible | Mallampati Class IV |
| Rapid Sequence Induction | Sedation, Neuromuscluar, intubating (all 3 performed almost simulataneously). Only in "planned" intubations rather than immediate (cardiac arrest) |
| Macintosh is what type of laryngoscope blade? | Curved- lifts valecular (indirectly lifts epiglottis) |
| Miller is what type of laryngoscope blade? | Straight - lifts epiglottis directly. I liked this one better during lab |
| Endotracheal tube sizes | Men: 8-8.5, Women: 7-7.5, Infants and children: estimated by diameter of pinky finger |
| Patient positioning for inserting an endotracheal tube | "sniffing position" |
| Intubation attempts should be within what time frame? | Limit attempts to 15 seconds each |
| What is the Sellick Maneuver? | Cricoid cartilage pressure. Need an assistant, compresses esophagus and prevents regurgitation. Prevents aspiration and assista with visual field |
| BURP maneuver | Backward, Upward, Rightward, Pressure on thyroid cartilage. Studies do not support the benefit of either Sellick or BURP |
| How do you verify tube placement after you are able to hear symmetric breath sounds and see symmetric chest movement? | Check end tidal CO2 via colometry or capnography (<30 for 3-5 breaths), see condensation of water in tube, CXR |
| After you successfully intubate a patient.. | secure tube with tape or device, attach capnography, reassess frequently, suction if needed, sedation may be necessary |
| Thiopental, Propfol, Etomidate, Ketamine and Midazolam are all | Rapid Sequence Induction Agents. Sedation and hypnoses. Common AE's: hypotension, apnea; specific ones have a few others. Onset is about 30 sec and lasts at max 20 minutes |
| Succinylcholine, Vecuronium, Mivacurium, Atracurium, Pancuronium, and Rocuronium are | Neuromuscular (paralytic) agents wtih onset of seconds-minutes lasting minutes to 2.5 hours. Only need to use if they have a head trauma and you want them stationary. Otherwise, sedative is enough |
| Which neuromuscular agent has an AE of hyperkalemia? | Succinylcholine |
| In blind Nasotracheal intubation in a breathing patient, have them sit with their head back and tell them to | take a deep breath (this lifts the epiglottis). Tetracaine is a topical anesthesia that may be used. High incidence of nasal trauma. May use Afrin for vasoconstrictionn |
| In a difficult airway, this technique can be employed: | retrograde Intubation: needle through the cricothyroid membrane, wire through needle, ET tube over wire and advance (other tools: fiberoptic intubation, lighted stylet) |
| Surgical Airway indications | Failed advanced airway, massive face trauma, known cervical fx, upper airway obstruction (foreign body, anaphylaxis, Epiglottitis). Cricothyrotomy faster and safer than tracheostomy |
| Where do you incise skin 2-3cm transversely for a cricothyrotomy? | midline, beneath thyroid cartilage. Leave scalpel in and spread with hemostats. Insert tracheostomy tube/small ET tube and inflate balloon |
Created by:
ltm12