Emergency Medicine Airway Management
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| Deoxygenation can result in brain damage in ___ minutes | 4-6
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| If neck trauma is suspected, use ______ maneuver to establish an initial airway | jaw thrust
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| Indications for an Oropharyngeal Airway | Deeply unconscious patient, absent gag reflex. CI: presence of a gag reflex
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| Disadvantage of oropharyngeal Airways | Does not prevent aspiratioin, unexpected gag may produce vomiting and/or laryngospasm, still may require a head tilt.
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| Complications of oropharyngeal airways | Gagging and retching --may cause vomiting, laryngospasm, and increased ICP. Pharyngeal or dental trauma with poor technique
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| Indications for a Nasopharyngeal Airway | Unconscious/AMS with suppressed gag reflex, Conscious but unable to maintain adequate airway (stroke), post seizure
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| CI's of Nasopharyngeal airway placement | Patient intolerance, nasal fracture, marked septal deviation, coagulopathy
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| Advantages of Nasopharyngeal airway placement | Can be suctioned through, better tolerated by patients with intact gag reflex, can be safely placed without direct visualization
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| 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)
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| _____ 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
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| 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)
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| 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
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| 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
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| What is Pierre Robin Syndrome? | small jaw, cleft pallet, no gag relfex, downward displacement of tongue
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| What is Klippel-Fiel Syndrome? | Short wide neck, reduced number of cervical vertebrae/fusion
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| 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 -
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| 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
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| 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
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| 3-3-2 | 3 Fingers fit in mouth, 3 fingers from mentum to hyoid bone (pts fingers), 2 fingers from hyoid to thyroid cartilage
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| Full visibility of tonsils, uvula and soft palate Mallampati Score | Class I
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| Visibility of hard and soft palate, upper portion of tonsils and uvula | Mallampati Class II
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| Only Hard Palate visible | Mallampati Class IV
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| Rapid Sequence Induction | Sedation, Neuromuscluar, intubating (all 3 performed almost simulataneously). Only in "planned" intubations rather than immediate (cardiac arrest)
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| Macintosh is what type of laryngoscope blade? | Curved- lifts valecular (indirectly lifts epiglottis)
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| Miller is what type of laryngoscope blade? | Straight - lifts epiglottis directly. I liked this one better during lab
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| Endotracheal tube sizes | Men: 8-8.5, Women: 7-7.5, Infants and children: estimated by diameter of pinky finger
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| Patient positioning for inserting an endotracheal tube | "sniffing position"
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| Intubation attempts should be within what time frame? | Limit attempts to 15 seconds each
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| What is the Sellick Maneuver? | Cricoid cartilage pressure. Need an assistant, compresses esophagus and prevents regurgitation. Prevents aspiration and assista with visual field
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| BURP maneuver | Backward, Upward, Rightward, Pressure on thyroid cartilage. Studies do not support the benefit of either Sellick or BURP
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| 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
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| After you successfully intubate a patient.. | secure tube with tape or device, attach capnography, reassess frequently, suction if needed, sedation may be necessary
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| 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
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| 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
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| Which neuromuscular agent has an AE of hyperkalemia? | Succinylcholine
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| 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
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| 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)
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| 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
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| 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
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