Intern Year: Tintinalli- Section 4-Ch 30-Tracheal Intubation And Mechanical Ventilation

Front 1

appropriate ETT for adult male?

Back 1

8-8.5

Front 2

appropriate ETT for adult female?

Back 2

7.5-8

Front 3

Most used Mac size? For bigger pts?

Back 3

typically a 3

4 for obese

Front 4

Most used Miller blade size? For bigger?

Back 4

typically a 2

3 for bigger ppl

Front 5

ideal way to preoxygenate a patient?

Back 5

100% O2 for 3 minutes using a non-rebreather mask with 15L/min

nasal cannulas do not provide optimal preoxygenation

Front 6

Non-rebreather masks typically deliver what % of O2?

Bag mask ventilator ?

Back 6

non-rebreather: 65-75%

BVM: 90-97%

Front 7

what should be your first step after a failed attempt?

Back 7

re-position the pt

sniffing position, extension of the AO joint

Front 8

What is BURP?

Back 8

backward, upward, rightward pressure on the thyroid cartilage

Front 9

approximately how deep should an ETT be placed in men/women respectively

Back 9

men: 23

women: 21 cm

Front 10

given the following comoribidity, give the suggested pre-treatment option prior to RSI:

Elevated ICP, bronchospasm/asthma

Back 10

Lidocaine

1.5 mg/kg

Front 11

given the following comoribidity, give the suggested pre-treatment option prior to RSI:

Elevated ICP, cardiac ischemia, aortic dissection

Back 11

Fentanyl 3 micrograms/kg

Front 12

given the following comoribidity, give the suggested pre-treatment option prior to RSI:

Children <5y w bradycardia

Back 12

Atropine 0.02 mg

Front 13

Dose of etomidate for induction?

induction time?

duration of action?

Back 13

0.3 mg/kg

induction time is <1min

duration is 10-20 min

Front 14

dose of propofol for induction?

induction time?

duration of action?

Back 14

0.5-1.5 mg/kg

induction time: 20-40s

duration 8-15 min

Front 15

dose of ketamine for induction?

induction time?

duration of action?

Back 15

1-2mg/KG

induction time 1 min

duration 10-20 min

Front 16

which induction agent can lower BP?

Back 16

Propofol

note: ketamine can increase it

Front 17

what agent should be avoided for induction of elderly or for pts with potential for cardiac ischemia?

Back 17

Ketamine

bc of potential for associated tachycardia and HTN

Front 18

most commonly used depolarizing paralytic agent

Back 18

Succinylcholine

resistant to acetylcholinesterase

Front 19

commonly used nondepolarizing neuromuscular blocking agents

Back 19

Vecuronium, pancuronium, and rocuronium

work by competing with acetylcholine for cholinergic receptors and can be antagonized by anti ACh agents

Front 20

Dose of Succinylcholine for paralysis in RSI

Back 20

1.5 mg /kg

onset: 45-60 seconds

duration 5-9 min

look for hyperkalemia

Front 21

2 contraindications to the use of succinylcholine?

Back 21

known hyperkalemia

myasthenia gravis

note: cocaine and amphetamine abuse are said to be conditions that you should avoid the use of succ too

Front 22

What is the agent of choice for paralyzing in RSI in pt with hepatic or renal failure?

Back 22

Atracurium

elimination occurs by hydrolysis and Hoffman degradation, a non enzymatic process

dose 0.4-0.5mg/kg

Front 23

Dosage for Rocuronium?

Back 23

1 mg/kg

onset: 1-3 min

duration: 30-45 min

can cause tachycardia, should use succ over this if not contraindicated

Front 24

What indicates a failed attempted at nasotracheal intubation?

Back 24

presence of any vocal sounds

Front 25

Optimal initial depth for nasotracheal intubation in men and women respectively?

Back 25

men: 28cm

women: 26

Front 26

There are 5 factors that predict difficult BVM, what are they?

Back 26

Facial hair

Obesity

Edentulous patient (toothless)

advanced age

snoring

Front 27

What is the 3-3-2 rule?

Back 27

incisor distance <3 fingerbreadths,

hyoid/mentum distance <3 fingerbreadths

thyroid-to-hyoid distance <2 fingerbreadths) -

Front 28

Describe a Mallampati class I

Back 28

Faucial pillars, soft palate, and uvula can be visualized

Front 29

Describe a Mallampati class II

Back 29

Faucial pilars and soft palate can be visualized, but the uvula is masked by the base of the tongue

Front 30

Describe a Mallampati class III

Back 30

Only the base of the uvula can be visualized

Front 31

Describe a Mallampati class IV

Back 31

None of the 3 structures (pilars, soft palate, uvula) can be visualized

Front 32

What is Assist Control (A/C) ventilation

Back 32

Inspiration is either triggered spontaneously by the patient or after an elapsed time interval

the vent provides a "controlled" breath at a predetermined VT during the selected time cycle or sooner if triggered by the patients effort

Front 33

Describe synchronized intermittent mandatory ventilation (SIMV)

Back 33

a predetermined number of ventilator generated VTs can be ensured and ventilation can be synchronized to patients effort

if the pts rate is below the set rate, the mode acts like A/C

if it is above the set rate, the patients efforts are not assisted

Front 34

Vent goals for PaO2?

PaCO?

pH:

FIO2:

Inspiratory peak pressure:

Back 34

PaO2: 60-90mmHg

PaCO: 40mmHg

pH: 7.35-7.45

FIO2: 40-60%

Inspiratory peak pressure: <35 cm H20

Front 35

give the following initial vent settings following intubation

Mode:

FIO2:

Tidal Volume:

Resp Rate:

Inspiratory flow rate:

Inspiratory/expiratory ratio:

positive end expiratory pressure:

Back 35

Mode: A/C

FIO2: Begin with 100% O2

Tidal Volume: 10mL/kg

Resp Rate: 12 b/min

Inspiratory flow rate: 60 L/min

Inspiratory/expiratory ratio- 1:2

positive end expiratory pressure: Begin with 5 cm H2O