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49 Cards in this Set
- Front
- Back
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adequate airway:
Adequate flow of air into lungs -Non-obstructed -Adequate tone in ... muscles to prevent collapse of lumen Adequate ... drive by patient -Adequate oxygenation and ventilation Protection of airway from ... -Patient must be conscious and alert -Able to swallow secretions, airway protected from gastric aspiration |
pharyngeal
respiratory aspiration |
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Indications for establishing emergent airway:
Alteration in ... with the inability to protect the airway Protection of the respiratory tract from ... of gastric contents Respiratory compromise with the need to deliver positive pressure ... Severe pulmonary or multisystem injury associated with respiratory failure, such as sepsis, airway obstruction, hypoxemia, and hypercarbia |
consciousness
aspiration ventilation |
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basic airway anatomy:
What is the upward airway? what is the downward airway? |
mouth, pharynx, to thyroid cartilage and thyroid gland
past thyroid gland to trachea and into lungs |
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Pediatric considerations:
... larger relative to mandible Glottis higher and more ... Vocal cords angled more ... and ... Larger floppy epiglottis which may lay into posterior wall of pharynx |
Tongue
anterior anteriorly and inferiorly |
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evaluation of airway:
Extend neck (if no trauma) and place in ... position Observe size and alignment of neck and ... distance |
sniffing
thyromental |
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Evaluation of airway:
Assess nasal ... Obtain pt history if possible (AMPLE) -... Listen to airway sounds-hoarseness, stridor, gurgling Have ... readily available and turned on |
patency
Allergies, Meds, PMHx, last meal, event suction |
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airway obstruction:
Infection: tonsillar enlargement, abscess, epiglottitis ... (enlargement of tongue), relaxation of pharyngeal muscles causing collapse Angioedema Laryngospasm Foreign body |
Macroglossia
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Possible presentations:
Sore throat with inability to control secretions -Epiglottitis; severe tonsillar edema Lip and tongue ... after new medication or food -angioedema Intoxication with somnolence and snoring |
edema
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Airway obstruction:
You may need XR evaluation of airway Only in ..., breathing patient ...: “thumb print sign” on XR |
stable
Epiglottitis |
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Noninvasive airway management:
Purpose: to secure open airway and allow adequate air flow -Patient must have adequate ... May be temporizing until definitive airway obtained |
respiratory drive
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Proper positioning to open airway:
Chin lift -Ideal alignment of airway with head elevated, and OA ... (chin lift) ... thrust adds to linear arrangement of airway |
extended
Jaw |
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look at slide 17
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ok
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Oropharyngeal airway:
Prevents base of tongue from occluding hypopharynx Use only when no ... present Insert over tongue with tip upward or to side, then rotate into position Measure from ... to ... |
gag reflex
corner of mouth angle of mandible |
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Nasopharyngeal Airway (Nasal Trumpet):
-Prevents soft palate and tongue obstruction of airway -May use even when patient has ... intact -Insert into most patent nostril -Lubricate tip with ... -Enter horizontal to palate -Advance until maximal airflow heard -Measure from ... to ... |
gag reflex
lidocaine tip of nose mastoid process |
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BVM (Bag-valve Mask) ventilation:
Self inflating bag Non-rebreather valve attached Attach to face mask for ... ventilation Clamp mask to face to form ... May be done with 1 or 2 person method; more effective with ... person method |
noninvasive
seal 2 |
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BVM (Bag-valve Mask) Ventilation:
Uses: -... manage respiratory failure -Assist poor ... effort -Temporize respiratory fatigue -Ventilate patient prior to intubation -Ventilate into ETT after intubation |
Temporarily
inspiratory |
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look at slide 22-23
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ok
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Esophageal Tracheal Combitube:
-Dual lumen tube -Seals ... proximally -Seals ... distally -Ventilation occurs between these cuffs -No facemask needed for seal -Either esophageal or tracheal seal with distal cuff inflation -Prevents regurgitation and aspiration of ... contents |
pharynx
esophagus gastric |
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look at slide 26 – 28
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ok
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Laryngeal Mask Airway (LMA):
Easier and ... to obtain airway compared to ETT In study on non-physician emergency personnel, no failure to obtain airway (vs 21% failure with ETT) No need to visualize ... Cons: -May cause respiratory obstruction -No protection against aspiration of gastric contents -Not useful for ... pressure ventilation |
faster
vocal cords high |
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Endotracheal Intubation:
... airway: -Tube in trachea with cuff inflated Allows control of oxygenation, ventilation, patency and protection of airway |
Definitive
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Endotracheal Intubation:
Indications: -Hypoxia -Hypercarbia -Impending hypoventilation -Impending compromise of airway ... -Pt inability to protect ... *Decreased level of alertness, loss of gag reflex, obstruction of pharynx |
patency
airway |
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...: gold standard in ER
Rapid and simultaneous administration of sedative and paralytic agent to facilitate intubation and decrease risk of aspiration No interposed positive pressure ventilation Procedure of choice for emergency department intubations -Faster, controlled, assumes stomach ... |
Rapid Sequence Intubation (RSI)
not empty |
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RSI Medications: Induction Agents (Sedatives):
E... 0.3mg/kg (20mg adult dose) M... 0.3mg/kg (20 mg adult dose) K... 1-2 mg/kg (100mg adult dose) -Frequently used in children -Bronchodilation T... 3mg/kg (250mg adult dose) -Beneficial with CNS pathology -Hypotension (Propofol 2mg/kg) |
Etomidate
Midazolam Ketamine Thiopental |
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RSI Medications: Neuromuscular blockers (Paralytics):
... 1.5-2mg/kg (100mg adult dose) –fast, short duration, most freq. used. -Depolarizing *Fasciculations occur followed by paralysis *Can cause rise in ICP *Release of K+ from cells problematic in hyperkalemic states Rocuronium 1mg/kg (70mg adult dose) Vecuronium 0.15mg/kg (10mg adult dose) -Nondepolarizing *Makes membrane resistant to ACh Use in conjunction with sedative/analgesic to prevent awareness |
Succinylcholine
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RSI Medications: Maintenance:
Maintenance Drugs: Keep pt sedated after intubation -... (Diprivan) *Sedation and analgesia -Lorazepam (Ativan) -Midazolam (Versed) |
Propofol
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Rapid Sequence Intubation (RSI): Procedure
IV established, cardiopulmonary monitoring Preoxygenate with 100% FiO2 -Several minutes prior to procedure -Allows for period of apnea without decline in arterial O2 -Avoid positive pressure ventilation Pretreatment ... administration Hold ... pressure -Prevents reflux of gastric contents into airway Neuromuscular blockade administration ... patient |
Sedative
cricoid Intubate |
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... Maneuver (cricoid pressure)
Prevents gastric contents from refluxing into ... Use any time patient has lost protective reflexes as you initiate airway procedure Thumb and long finger positioned on ... (not ...) cartilage Apply posterior pressure to occlude esophagus against anterior surface of ... vertebral body |
Sellick
airway cricoid thyroid C6 |
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Rapid Sequence Intubation (RSI): Contraindications:
Inability to perform mask ventilation or ... -Airway trauma, facial trauma -High likelihood of intubation failure due to difficult airway |
intubation
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... Intubation :
Most reliable method of endotracheal intubation Endotracheal tube (ETT) introduced through mouth past cords and into trachea |
Orotracheal
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Orotracheal Intubation : Laryngoscope blades :
... -Curved blade -Rests in vallecula above epiglottis -Indirectly lifts epiglottis -Better visualization of cords -Less likely to induce trauma or trigger ... |
Macintosh
reflex |
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Orotracheal Intubation: Laryngoscope Blades:
... -Straight blade -Inserted into trachea behind epiglottis -Directly lifts epiglottis -Easier to insert |
Miller
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Orotracheal Intubation: Procedure:
Visualize ... and remove debris, secretions, blood Insert tube -May use ... if needed Visualize tube entry beyond cords -2cm above ... is ideal placement: *23cm from mouth in male *21cm from mouth in female -Inflate cuff |
larynx
stylet carina |
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look at slide 49
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ok
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Orotracheal Intubation: Procedure:
Check tube placement: -Auscultate over ... -Auscultate both ... fields -Observe both chest ... with ventilation -CO2 detector onto outflow of ETT -Pulse oximeter should rise ... tube (Repeat check and securing anytime patient is moved) |
stomach
lung rise Secure |
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Orotracheal Intubation:
Most common failure due to -inadequate ... or -poor patient ... |
preparation
positioning |
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Nasotracheal Intubation:
Indications -Patient must have intact respiratory drive -Patient cannot remain ... *CHF/COPD/asthma -Unable to do neuromuscular blockade -Difficult to align ... axis *Arthritis, masseter spasm, TMJ dislocation, recent oral surgery, facial trauma, body habitus |
supine
oropharyngeal |
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Nasotracheal Intubation: Procedure:
-Spray topical ... anesthetic -Check cuff for leaks -Appropriate size ETT -2% lidocaine or KY jelly lubricant -Pt in sniffing position with assistant to hold head still -Enter more patent nare (or R nare so barrel faces septum and avoids Kesselbach’s plexus) -Advance tube ... |
vasoconstrictor
horizontally |
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Nasotracheal Intubation: Procedure:
-One hand on tube; one hand on ... -Advance at initiation of ... -Advance slowly while rotating tube medially until maximum airflow heard through tube -Pt speech indicates ... attempt -Check placement of tube with same procedure as for orotracheal airway |
larynx
inspiration failed |
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look at slide 56
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ok
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Indications for Cricothyroidotomy:
Patient unable to be ... by oral/nasal route Severe maxillofacial trauma; basal skull or cervical spine injury: need to avoid neck manipulation Edema of throat tissues : ... Unable to visualize cords: oropharyngeal hemorrhage; foreign body in upper airway Trismus/masseter spasm after succinylcholine |
intubated
angioedema |
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Contraindications to Cricothyroidotomy:
Patients <... years old: must have tracheostomy Laryngeal ... Tracheal transection with retraction of trachea into mediastinum Obscuration of anatomical ...: trauma, gross hemorrhage |
5
fracture landmarks |
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Emergent Cricothyrotomy:
Airway access obtained through ... membrane Needs to be replaced by a traditional ... (surgical procedure) -will eventually erode ... cartilage |
cricothyroid
tracheostomy cricoid |
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Cricothyrotomy:
Technique: - Locate the ... membrane -Make ... incision through the skin -Make ... incision through the membrane -Insert tracheostomy tube (or ET tube) -... the tube |
cricothyroid
vertical horizontal Secure |
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look at slide 60
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ok
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Tracheostomy:
Definitive airway through thyroid cartilages Used for ... term airway Performed in OR by surgeon ... procedure |
long
Nonemergent |
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Tracheostomy Tube:
Care involves: -Warmed, ... O2 -Suction -Keep inner tube clean, or replace as needed |
humidified
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Summary of Key Points:
An adequate airway consists of a stable patent airway as well as protection of airway from secretions and adequate respiratory drive. ... patients have considerable differences which are important clinically. Proper evaluation of an airway can assess for stability and possible difficulties which may arise. Oropharyngeal and nasopharyngeal airways may stabilize airway from obstruction in ... patient. |
Pediatric
somnolent |
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Summary of Key Points cont.:
Bag-valve mask airway may assist ... and temporize until stable airway is attained Patients with hypersomnolence, loss of protective reflexes, obstructed airway, or loss of respiratory drive require .... ... is a means of safely establishing a secure airway in emergent situations. Endotracheal intubation may be obtained orally, nasally, or through the cricoid membrane, but ... is indicated for long term airway management. |
ventilations
endotracheal intubation Rapid sequence intubation tracheostomy |
