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TNCC airway and vent
| Question | Answer |
|---|---|
| list facctors that may cause innefective ventilation in truama pt: | altered mental state, LOC, neurological injury, spinal injury, intracranial injury, blunt trauma eg: rib #, plueritc injury eg: pnuemothorax, hemothorax, previous hx lung conditions, elderly |
| physical inspection of the airway | whilst maintaining C-spine imobalisation as neccessary: vocalisation, level of conciousness, foriegn objects, loose teeth, bleeding vomit or other secretions, heamatomoas, inability to open jaw eg: mandible #, penetrating wound, oedema of sort tissues |
| truma pt, airway patent, what interventions? | maintain C-spine imobalisation as required / make sure collar application does not obstruct airway |
| airway interventions for obstructed airway: | maintain C-spine protection / jaw thrust or chin lift/ suction / NPA (concious or unconcious/ gudel (unconcious only) |
| when would you not use an NPA? | suspected or actual facial trauma, mid facial # ands basal skull # |
| LOAD: meds given to facilitate endotrachal intubation: | Lidocaine, Opioids, Atropine, De-fasiculating agents, |
| RSI: steps | gather equipment/ preoxygenate with 100% 02/ pretreat with drugs to sedate and paralyse/ protection and positioning: sellick manuever/ placement with proof: inflate cuff, confirm with c02 detector, auscultate chest +epigastrium/ |
| post intubation steps: | inflate cuff, confirm with c02 detector, auscultate chest +epigastrium/ secure with ETT tape/ set vent settings, CXR to confirm placement/ recheck vitals and Sp02 |
| for intubation, how many attempts allowed? and time frames? | max three attempts/ each should not exceed 30 seconds/ ventilate pt with 100% 02 for 30-60 seconds between attempts |
| how to confirm tube/ alternate airway placement? | listen to breath sounds over epigastrium and chest wall whilst ventalating pt/ attatch C02 detector/ use esophogeal detection device/ CXR |
| dulllness on percussion of the chest may indicate: | hemothorax |
| hyperresonance on percussion of the chest may indicate: | pnuemothorax |
| breathing interventions: effective breathing: | All TRauma pts should recive 12-15LM regardless of breathing efficacy. |
| Breathing interventions: breathing spontaneous but innefective: | admin 02 NRB/ assist vents with BVM as needed/ put on SP02 monitor/ asssist with definitive airway/ assist with needle thoracentesis / assist with chest tube insertion / assess for and intervene on any life threatening injuries |
| what is the insertion site for needle thoracentesis? | 2nd intercostal spce, midclavicular line (same side as < breathsounds/ injury) |
| breathing interventions: breathing absent | ventilate with Bag and mask attached to 02/ assist with intubation or definitive airway/ asess for life threatening injuries that may require immediate intervention |
| innefective breathing signs and symptoms that may indicate life-threatening condition: | altered mental status (eg: restless/agitated), cyanosis (especially central), asymetric chest wall expansion, paradoxical chest wall movement, acesory muscle use, sucking chest wound, tracheal deviation |
| DOPE for chest tube evaluation and to find the source of ventilator alarms: | D: displaced tube, O: obstructions blocking tube or pateint biting on tube. P:pneumothorax: may be the old inuriy or sustained due to barotrauma from ventilator, E: equipment failure: tubing unnatahced from the machine, kink in tubing |
Created by:
jessharries