Approach To The Emergency Patient

Front 1

history essentials

Back 1

PQRST
pain, quality, region radiation, Severity, timing temporal relationship

AMPLE

allergies, meds, PMH, Last meal, tetatnus, other, events leading up to

Front 2

at C6

Back 2

is the cricoid cartilage

Front 3

stridor may represent

Back 3

partial airway obstruction at the level of the larynx (inspiratory) and trachea (expiratory)

Front 4

when to use an OPA what is the substitute in a semiconcous patient

Back 4

unconcious patients without a gag reflex that are spontaneosly breathing measure OPA and make sure it goes from the corner of the mout to angle of the jaw...NPA should measure from the tip of the nose to tragus of ear

Front 5

oxygen deliver technique for patients with COPD

Back 5

venturi mask since it can accurately controls proportion of inspired 02

can use flow rates of 2-12 at 24 - 60% concentration

Front 6

type of o2 delivery technique that may promote C02 retention s

Back 6

imple face mask

Front 7

what drugs can be delivered via an ETT

Back 7

NAVEL
narcan
atropine
veersed (midazolam)
epi
lidocaine

all given at aboud 2-4 times normal dose

Front 8

what are the 9 Ps of RSI

Back 8

1-possiblitiy of success
2- prep
3.preoxygenation
4.pretreatment
5-paralysis
6-protection and position
7-placement
8-proof
9-post-intubation

Front 9

ppossibility of success factors

Back 9

LEMON
1. look externally (BONES - beard obese, no teeth, elderly, sleep apnea snoring)

2. evalluate 332 rule ( three fingers in the mouth, three from tip of the chin to hyoid, two fingers from floor of mouth to thyroid)

3. mallampati (I - uvuala, soft palate pillars, II- uvula masked, III-base of tongue)

4. airway obstruction
5. neck mobility

Front 10

number two oif the 9 Ps is what?

what is involved (mneumonic)

Back 10

prep

SOAP ME (SUction, O2, Airway equip, Pharmacy, monitor equip)

Front 11

SOAP ME of the prep (9 ps)

Back 11

suction, oxygen, Airway equipment, pharmacy monitor equipment

Front 12

A typical adult male will take what size ET tube

Back 12

7.5-8.0

Front 13

a typical femal adult will take what size ETT

Back 13

7.0 - 7.5

Front 14

estimate size of ett in a child

Back 14

4 plus age in years/4

Front 15

estimate size of ett in a child

Back 15

4 plus age in years/4

Front 16

third P in the 9 Ps is what

Back 16

preoxygenation x 5 minutes

Front 17

in situations where time is limited in the preoxygenation setting of RSI what can one do

Back 17

eight vital capacity breaths in rapid succesion from a 100% O2 source

Front 18

LOAD stands for what

Back 18

Lido - (for increased ICP, RAD) 1.5mg/jg

Opiod (fentanyl) 3-6mcg/kg, 1-3mcg/kg

Atropine - for kids less than 10 or adults with second dose of sux, 2mg, .02mg/kg

defasciculation (panc, vec) .01mg/kg ",

Front 19

LOAD stands for what

Back 19

Lido - (for increased ICP, RAD) 1.5mg/jg

Opiod (fentanyl) 3-6mcg/kg, 1-3mcg/kg

Atropine - for kids less than 10 or adults with second dose of sux, 2mg, .02mg/kg

defasciculation (panc, vec) .01mg/kg ",

Front 20

after pretreatment (LOAD) what is next

Back 20

paralysis with induction -

Front 21

name the common induction agents

Back 21

barbs (thiopental), methhexital

BZDs (versed) - does not have analgesia, is also an aticonvulsant

etomidate - decreases ICP like barbs

propofol

Front 22

most hemodynamically stable induction agent is

Back 22

etomidate but dose must be reduced in in unstabel patients

DOC for patients with increased ICP because it decreases cerebral O2 demand

Front 23

induction agent that stimulate catecholamine release therefore induction agent of choice in hypotensive, hypovolemic or bronchospastic patients

Back 23

ketamine - hoever it increases ICP

Front 24

increases laryngeal secretions and atropine must be given beforehand in this induction agent

Back 24

ketamine induction DOC for hypotensive patient

Front 25

major disadvantage of thipental and other barbs

Back 25

the ability to cause hypotension

Front 26

depolarizing NMBA

Back 26

sux - intially causes fasciculations followed by paralysis within 10 - 15 secs

Front 27

1.5/mg/kg rivp

Back 27

sux dose in adults 2mg/kg in kids

Front 28

preteatment with sux

Back 28

.02mg/kg of atropine in kids because it causes brady

Front 29

.05m/Eq rise in K

Back 29

sux causes

Front 30

cricoid pressure is useful whenw

Back 30

hen the patient becomes apneic because it prevents regurge of gastric contents,

Front 31

slid into the valeecula (blade), below eppiglottis

Back 31

into valeculla (mac)

below epiglottis (miller)

Front 32

if glottic cartilage is not readily visible what is next

Back 32

BURP (backward, upward, rightward, pressure) with placement of thyroid (not cricoid pressure)

Front 33

once you get a view of the glottis when intubating what is next

Back 33

insert until the cuff is 2-3cm past the vocal cords

Front 34

proper ETT placement is supposed to be

Back 34

2-3cm above the carina

Front 35

clinical indication for BNTI (blind nasotracheal intubation) are rare but when would one do one, when would one not

Back 35

may be used in a spontaneously breathing patient with a difficult airway

not performed on one who is apneic, or one who has face or neck trauma

Front 36

how far is the BNTI ett placed

Back 36

32cm at the nares in males and 27-28cm in females, always insert on the righ to avoid so the bevel will face the septum once the tube as passed the glottis listen for airflow

Front 37

always select an ETT tube size about 0.5 - 1.0mm less than normal in what

Back 37

BNTI

Front 38

primary CI to crycothyrodotomy

Back 38

being younger than 12

Front 39

if there is a [patient who needs a cricothyrotomy but is too young what is preffered

Back 39

needle cric with transtracheal jet ventilation

Front 40

he estimation of ett for peds is done how

Back 40

age + 4/4, little finger dm,

Front 41

the depth of ETT placement in peds is estimated how

Back 41

(age/2) + 12

Front 42

the depth of ETT placement in peds is estimated how

Back 42

(age/2) + 12

Front 43

type of blade preferred in peds

Back 43

curved because the tracheal opening is higher in kids (c1 in infants C3-4 at age 7) this helps visualize the more anterior glottis and push distensible anatomy out of the way

Front 44

most narrow portion of the adult airway

Back 44

vocal cords

while cricoid is most narrow in peds this is the reason cuffs are not employed

Front 45

most important intervention for a patient with status asthmaticus

Back 45

RSI along with prep for cricoth, all patients pretreated with lido 1.5mg/kg to reduce couging and bronchospasm and inudction with ketamine is ideal at 1.5mg/kg as it stimulates catecholamine release

Front 46

reflex sympathetic response to laryngoscopy results in

Back 46

systemic release of catecholamines and increased ICP. this response can be blunted throught the adm of fentanyl 3mcg/kg over 30-60s sux causes increased ICP but coadmin of a small amount of competitive antagonism like ved blunts this effect

Front 47

if a trauma patient is suspected to have spine injury and may need an airway

Back 47

no time should be wasted in getting lateral cspine films

Front 48

RSI with in-line mobilization is ideal for

Back 48

intubating suspected cervical spine injury