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75 Cards in this Set

  • Front
  • Back
What is the "airway hierarchy"?
1) Supplemental oxygen
2) Noninvasive airway devices
3) Recommended invasive airway devices
How can supplemental oxygen be given
1) Nasal cannula
2) Face masks
What are the non-invasive airway devices?
1) nasopharyngeal airway
2) Oropharyngeal airway
3) bag-Mask ventilator
What are the recommended airway devices
1) Laryngeal mask airway
2) Esophageal-tracheal (combitube) tube
3) Tracheal tube
What's the purpose of ventilation during CPR?
1) maintain adequate oxygenation
2) elimination of CO2
IRT CPR and V-fib sudden cardiac arrest (VF SCA), what is the most important part of CPR? Why?
1) Chest compressions
2) Because O2 delivery to tissues (ie- heart & brain) is limited more by blood flow than arterial O2 content
What ventilation rate is critical during CPR for providers to maintain?
8-10 breaths / min
During CPR & ventilating the patient what should the provider(s) ensure doesn't happen?
Do Not Over Ventilate
What components make up the primary survey?
A= Airway
B= Breathing
C= Circulation
D= Defibrillation
What is the "focus" of basic CPR & defibrillation?
1) check responsiveness
2) activate EMS
3) call for defibrillator
What is the most common cause of airway obstruction when trying to ventilate a patient?
The tongue, or epiglottis
What are the two approved methods to open the airway for ventilations?
1) Jaw thrust
2) Head tilt-chin lift
For what type of patient are oropharyngeal airways reserved for?
1) unconscious (unresponsive)
2) pt's w/no cough/gag-reflex
What can happen if an oropharyngeal airway tube is too short for the patient it is meant to aid in ventilation?
Displace the tongue into the hypopharynx = airway obstruction
In a patient that is not deeply unconscious what type of airway is the best tolerated?
Nasopharyngeal airway
Whichh of the following is better at oxygenating the patient:
- mouth to mask ventilation
- bag mask ventilation
Mouth to mask ventilation
What type of rescuer should use the "mouth to mask ventilation"?
Small-handed rescuers
When using the mouth to mask ventilation method, what is the proper hand placement for the resucuer?
C-clamp shape & jaw-thrust
E-clamp & head tilt-chin lift
When using the bag-mask ventilations, what volume should the patient be ventilated w/on each breath?
"Enough to produce obvious chest rise"
What procedure can be implemented during ventilations to prevent gastric inflation & decrease the risk of regurgitation & aspiration?
Cricoid pressure
What are potential complications with the bag-mask ventilation method?
1) hypoventilation
2) gastric inflation
What [oxygen] does a nasal cannula provide?
24% - 44%
What [oxygen] does a face mask w/oxygen reservoir provide?
60% - 100%
What are the current advanced airways?
1) Esophageal-Tracheal combitube
- King Airway
2) Laryngeal Mask airway
- Cobra Airway
3) Endotracheal intubation
What are the primary/secondary criteria for confirmation of tracheal tube placement?
1) physical exam criteria
2) devices to detect esophageal placement
3) end-tidal CO2 detection
After an advanced airway is in place 2 rescuers must still provide cycles of CPR.
- The compressing rescuer should give continuous compressions @ 100/min.
- The ventilating rescuer provides 8-10 breaths/min.
What are the advantages of the Combitube & endotracheal tube?
1) Isolation of airway
2) Reduced risk of aspiration
3) More reliable ventilation
The "face mask" provides a more secure & reliable means of ventilation than the Laryngeal Mask Airway.
The Laryngeal Mask Airway provides a more secure & reliable means of ventilations than the face mask.
After successful insertion of the Laryngeal Mask Airway all patients can be successfuly ventilated.
There is a small proportion of pt's that can't be ventilated, thus an alternate plan must be in place.
IRT secondary ABCD survey, when should providers defer insertion of an advanced airway?
1) Until the pt, fails to respond to initial CPR
2) Defibrillation attempts, or demonstrates return of spontaneous circulation
What equipment is used for intubation?
1) laryngoscope w/blades
2) tracheal tubes
3) malleable stylet
4) 10ml syringe
5) Magill forceps
6) Water-soluble lubricant
7) suction unit, catheters & tubing
Which hand is the laryngoscope held in when intubating a pt?
Left hand
What are the advantages of tracheal intubation?
1) protects against aspirating foreign material
2) facilitates ventilation/oxygenation
3) facilitates suctioning of trachea & bronchi
4) provides route for drug admin
5) prevents gastric inflation if used w/cuff
6) allows faster chest compressions
What are the indications for tracheal intubation?
1) inability to ventilate an unconscious pt.
2) after insertion of pharyngeal airway
3) inability of pt to protect own airway (ie- coma, areflexia, cardiac arrest)
4) need for prolonged mechanical ventilation
IRT tracheal intubation, what are the recommendations?
1) should be done by most experienced person
2) don't take longer than 30-sec/attempt
3) auscultate thorax/epigastrium after intubation
What are the common areas traumatized during intubation?
1) teeth
2) lips
3) tongue
4) mucosa
5) vocal cords
6) trachea
What are some complications of tracheal intubation?
1) esophageal intubation
2) vomiting & aspiration
3) HTN & arrhythmias
4) hypoxemia from long attempts
5) high risk of tube misplacement, displacement, or obstruction
How is tracheal tube placement confirmed?
1) visualize chest expansion bilaterally
2)listen over epigastrium (breath sounds should NOT be heard)
3) auscultate lung fields bilaterally (breath sounds should be equal & adequate)
IRT an esophageal detector device (EDD), what is a (+) test?
If the tube is in the esophagus, the suction will collapse the lumen of the esophagus, or pull the esophageal tissue against the tip of the tube & the bulb won't re-expand
What can providers do to reduce the risk of unrecognized tube misplacement, or displacement?
Use a CO2 detector
What does it indicate if CO2 is detected on a CO2 detector?
This is a reliable indicator that the tube is correctly positioned in the trachea
What assistive device can be implemented to decrease the chance of accidental tube displacement?
A tracheal tube holder
After the tracheal intubation tube is placed, how is the correct depth determined?
As marked at the front teeth
When should correct placement of advanced airways be verified?
1) after correct placement
2) whenever the pt, is moved
IRT defibrillation, what is the approximate % of survival after 5 minutes?
If no CPR is provided at what rate does survival decrease every minute?
7% - 10% per min.
What are the 4 universal control steps in the operation of AED's?
1. Power on the AED
2. Attach pads
3. Analyze rhythm
4. Shock if advised
What is the ratio of compressions to breaths for BLS CPR?
How many cycles of CPR is given before a rhythm is checked?
5-cycles of CPR
For children 1-8yrs, what should a rescuer use if one is available IRT defibrillation?
A pediatric dose-attenuator system.
If a rescuer is providing CPR to a child and doesn't have an AED w/an pediatric dose attenuator, they can NOT use a standard AED.
They CAN use a standard AED.
What must be done to a victim who is either wet, or lying in water before defibrillation can occur?
1. Remove from water
2. Wipe water off briskly before attaching electrodes and shocking
If a pt., has an implantable pacemaker, where should AED pads be put in relation to the pacemaker?
1-inch (2.5cm) away from the device.
If a pt., has a transdermal med patch, where should AED pads be put in relation to the med patch?
Take the med patch off, wipe off the area and apply AED pads.
What 4 rhythms produce pulseless cardiac arrest?
1) VF
2) VT
3) PEA
4) Asystole
The foundation of ____ care is good ___ care.
If a cardiac arrest is NOT witnessed, what should be the first form of tx?
5-cycles of CPR
IRT defibrillator settings, what does "biphasic" mean?
200J for 1st shock and =, or > than 200J for second /subsequent shocks
Providers should give 1-shock instead of 3-stacked shocks.
Name the 3-types of advanced airways.
1) Endotracheal tube
2) Esophageal-tracheal
3) Laryngeal mask airway
What is the compression rate if an advanced airway is in place?
100 compressions/min
When an advanced airway is in place, what is the ventilation rate?
8-10 breaths/min
What are the primary drugs used for VF/VT?
1) Epinephrine 1mg/3-5min
2) Vasopressin 40 U.IV
3) Amiodarone 300mg IV
4) Lidocaine 1-1.5mg
5) Mag.Sulf. 1-2mg load dose
What rhythm is Mag.Sulf. specifically used for?
When administering drugs for cardiac arrhythmias be administered?
ASAP after rhythm analysis
What are the 6 H's that may cause arrhythmias
1) Hypovolemia
2) Hypoxia
3) Hypo/Hyperkalemia
4) H+ ion acidosis
5) Hypoglycemia
6) Hypothermia
What are the 5 T's IRT arrhythmias?
1) Toxins
2) Tamponade (cardiac)
3) Thrombosis (cor./pulm.)
4) Tension PTX
5) Trauma
When should pulse checks be done?
only if an organized rhythm is observed.
Which meds should be used to maintain BP & HR?
Dopamine & Dobutamine
Which meds should be avoided when maintaining BP & HR?
- Epi
- Norepi
- Isoproterenol
What 3-criteria describe good chest compressions?
1) Adequate rate & depth
2) Allow complete recoil of chest btwn compressions
3) Minimize interruptions in chest compressions
Patients who have either asystole, or PEA will benefit from defibrillation attempts.
insertion of advanced airways & pharmacologic support increase the rate of survival
What drugs are associated w/PEA and Asystole?
1) Epinephrine
2) Vasopressin
3) Atropine
For pt's chest discomfort (ischemia) what are the first meds they should get?
M- Morphine IV
O- Oxygen 4 L/min
N- Nitroglycerin SL/spray/IV
A- ASA 160-325mg