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What should be administered to all severely injured trauma patients?
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List three things that are detrimental to patients with intracranial injury
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ATLS - Ch 2
Airway & Ventilatory Management
| Question | Answer |
|---|---|
| What should be administered to all severely injured trauma patients? | Supplemental Oxygen |
| List three things that are detrimental to patients with intracranial injury | 1-Hypoxia 2-Hypercarbia 3-Upper Airway Stimulation |
| What three things suggest laryngeal fracture? | 1-Hoarseness 2-Subcutaneous emphysema 3-Palpable fracture |
| What level of C-spine injury spares phrenic nerve? | below C3-C4 |
| If phrenic nerve is spared, what is the result? (2) | 1-abdominal breathing 2-paralysis of intercostal muscles |
| How many people should be involved in removing a motorcycle helmet? | Two |
| What GCS score requires prompt intubation? | GCS < 8 |
| Give three complications of basilar skull fracture | 1-CSF Rhinorrhea 2-Ecchymosis of eyes bilaterally (Raccoon Eyes) and behind ears (Battle Sign) 3-CSF Otorrhea |
| Which is easier to perform: cricothyroidotomy or tracheostomy? | Cricothyroidotomy |
| What size needle for jet insufflation? | Adult 12-14 g Child 16-18 |
| What is the amount of oxygen for jet insufflation? | 15 L/min (40-50 psi) |
| What is the cycle of jet insufflation? | 1 sec on, 4 sec off, using thumb over open end of Y-connector |
| Where does the needle go in jet insufflation? | Through the cricothyroid membrane |
| Give three relative contraindications to jet insufflation | 1-Chest trauma 2-COPD 3-Complete glottic obstruction |
| What tube size used for cricothyroidotomy? | 5 to 7 mm ET tube |
| What is a relative contraindication to cricothyroidotomy? | Age less than 12 |
| What are two indication for cricothyroidotomy? | 1-Complete upper airway obstruction 2-Fractured mandible body |
| Give three causes of left shift of hemoglobin saturation curve | 1-Alkalemia (elevated pH) 2-Lower temperature 3-Lower PaCO2 |
| List complications of cricothyroidotomy (9) | 1-Laryngeal injury 2-Tracheal injury 3-Esophageal injury 4-Subglottic edema/stenosis 6-Laryngeal stenosis 7-Aspiration 8-Hemorrhage or hematoma 9-Creation of false passage in ST neck |
| The first priorities in ATLS are | Airway and Ventilation |
| Three considerations regarding airway compromise. Can be | 1-sudden and complete 2-insidious and partial 3-progressive and recurrent |
| Early sign of of airway or ventilatory compromise? | tachypnea, though may be related to pain or anxiety or both |
| Facial fractures can be associated with (3) | 1-hemorrhage 2-increased secretions 3-dislodged teeth |
| Fractures of mandible can cause | loss of normal airway support |
| Patient refusing to lie down may be experiencing | difficulty maintaining airway or handling secretions |
| If airway compromise is suspected | a definitive airway is required |
| Noisy breathing indicates | partial airway obstruction that suddenly can become complete |
| Most important early measure to assess airway | talk to patient and elicit a verbal response |
| Agitation suggests | hypoxia |
| Obtundation suggests | hypercarbia |
| Cyanosis indicates | hypoxemia due to inadequate oxygenation |
| Cyanosis is identified by inspection of (2) | 1-nail beds 2-circumoral skin |
| Additional evidence of airway compromise (2) | 1-retractions 2-use of accessory muscles of ventilation |
| Three objective findings of airway compromise | 1-observe the patient 2-listen for abnormal sounds 3-feel location of trachea for deviation or fracture |
| Three signs of adequate ventilation | 1-symmetrical rise and fall of chest 2-auscultation of air movement on both sides 3-pulse oximetry and end-tidal CO2 |
| Three measures to improve ventilation | 1-airway maintenance techniques 2-definitive airway measures 3-methods of providing supplemental ventilation |
| Optional method of removing a motorcycle helmet | cast cutter |
| OPA in conscious or unconscious patient? | unconscious |
| Two ways to insert OPA | 1-tongue blade 2-upside down and rotate |
| Upside down OPA insertion should not be used in | children, because rotation can damage mouth and pharnyx |
| NPA in conscious or unconscious patient? | either |
| OPA | oropharyngeal airway |
| NPA | nasopharyngeal airway |
| LMA | laryngeal mask airway |
| When patient arrives in ER with LMA | prepare for definitive airway |
| Is LMA a definitive airway? | No |
| MEA | multilumen esophageal airway |
| Is MEA a definitive airway? | No |
| When patient arrives in ER with MEA | prepare for definitive airway |
| LTA | laryngeal tube airway |
| When patient arrives in ER wit LTA | prepare for definitive airway |
| Is LTA a definitive airway? | No |
| GEB | gum elastic bougie |
| Description of GEB | 60-cm long, 15-Fr resinstylette with Coude tip angled 40 degrees 3.5 cm from tip with 10-cm graduations |
| GEB is used when | vocal cords cannot be visualized on direct laryngoscopy |
| Tracheal positioning of GEB is confirmed (3) | 1-feeling for clicks as tip rubs cartilaginous tracheal rings 2-tube rotates right or left when entering bronchus 3-when tube is held up at bronchial tree |
| Three types of definitive airway | 1-orotracheal tube 2-nasotracheal tube 3-surgical airway (cricothyroidotomy or tracheostomy) |
| Criteria for definitive airway (6) | 1-apnea 2-inability to maintain patent airway 3-protection from aspiration (blood or vomitus) 4-impending or potential compromise of airway 5-closed head injury (GCS <8) 6-inadequate oxygenation by facemask |
| ETTI, also known as | Eschmann Tracheal Tube Introducer, gum elastic bougie |
| Normal lateral C-spine film ____ exlude possibility of C-spine injury | does not |
| BURP | backward, upward, and rightward pressure aids in visualizing the vocal cords |
| How do you confirm ET tube placement? (5) | 1-Auscultation bilateral breath sounds 2-Watching chest rise & fall 3-End-tidal CO2 detector 4-Visualizing ETT through cords 5-CXR |
| Borborygmi | rumbling or gurling noises in epigastrium |
| Presence of borborygmi suggest | esophageal intubation |
| Presence of CO2 in exhaled air indicates ____ but does not ensure ____ | 1-airway has been successfully intubated 2-the correct position of the ET tube |
| If CO2 is not detected | esophageal intubation has occurred |
| Preparation for intubation(12) | 1-suction 2-oxygen 3-bag-mask 4-laryngoscope 5-GEB 6-LMA 7-LTA 8-crico kit 9-ET tube 10-pulse ox 11-CO2 detector 12-drugs |
| When proper position of ET tube is determine | secure in place |
| When patient is moved with ET tube in | reasses tube placement by auscultation and CO2 detection |
| Blind NT intubation requires____ and is contraindicated in patient with ____. | spontaneous breathing apnea |
| Relative contraindications for NT intubation (4) | 1-facial fractures 2-frontal sinus fractures 3-basilar skull fractures 4-cribriform plate fractures |
| Factors predicting difficult intubation | 1-cervical spine injury 2-severe cervical spine arthritis 3-significant maxillofacial or mandibular trauma 4-limited mouth opening 5-receding chin 6-overbite 7-short muscular neck |
| L E M O N | Look externally Evaluate the 3-3-2 Rule Mallampati Obstruction Neck Mobility |
| 3-3-2 Rule | 3 fingers between incisor teeth 3 fingers between hyoid and chin 2 fingers between thryoid notch and floor of mouth |
| Mallampati Classification | Class I: pillars, soft palate, uvula, fauces Class II: soft palate, uvula, fauces Class III: soft palate, base of uvula Class IV: hard palate only |
| Dose of etomidate | 0.3 mg/kg (usually 20 mg) |
| Dose of succinylcholine | 1 to 2 mg/kg (usually 100 mg) |
| Etomidate effect on BP | not significant |
| Onset and duration of succinylcholine | <1 min 5 min or less |
| Succinylcholine not used in patients with _____ because of ____. | severe crush injuries, major burns, electrical injuries, preexisting chronic renal failure, chronic paralysis, chronic neuromuscular disease potential for severe hyperkalemia |
| Thiopental and sedatives | lower blood pressure, potentially dangerous in patients with hypovolemia |
| To reverse sedative effects of BZD, use | flumazenil |
| Surgical cricothyroidotomy preferable over tracheostomy for three reasons | 1-easier to perform 2-associated with less bleeding 3-requires less time |
| How long can jet insufflation be used? | 30 to 45 minutes |
| Cricothyroidotomy can damage ____ in children | cricoid cartilage, the only circumferential support for upper trachea in children |
| Regarding percutaneous tracheostomy in trauma | it is not safe and not recommended |
| Prolonged periods of inadequate or absent ventilation and oxygenation | should be avoided |
| Tight fitting mask with reservoir flow rate is | at least 11 L/min |
| Pulse oximetry measures ____, not ____. | oxygen saturation of blood O2 sat partial pressure of oxygen PaO2 |
| O2 sat > ____ suggests adequate ____, greater than ____. | 95% adequate PaO2 70% |
| Pulse oximetry cannot distinguish | oxyhemoglobin from carboxyhemoglobin or methemoglobin |
| Pulse oximetry is limited in patients with | 1-severe vasoconstriction 2-carbon monoxide poisoning |
| Reliability of pulse oximetry is decreased with (2) | 1-anemia Hg <5 g/dL 2-hypothermia <30 C or <86 F |
| Bag-mask ventilation should be performed by ____ persons | two when possible |
| Two complications of bag-mask ventilation causeing gastric distension | 1-vomiting and aspiration 2-pressure on vena cava, causing hypotension and bradycardia |
| How does doctor know when to abort intubation? | hold breath and abort when YOU must breathe |
Created by:
tcrouch2000
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